The Internet and Stranger-to-Stranger Organ Donation: My Opinion

 

The World Wide Web is, far and away, the largest and fastest international communication forum the world has ever known. It seems that every day new uses can be found for this intriguing medium. From its inception, however, the internet has raised ethical puzzles that have at times seemed insoluble. In the same way that the pen is mightier than the sword, the internet is now one of the most powerful avenues of idea-dissemination ever. In this vein, freedom of the press, libel, personal property rights, hatemongering, and espionage, to name a few, are important human rights issues promulgated and compounded by the power of the web. To these have been more recently added legal and moral debates of a bioethical bent impinging on concerns of the body, mind, and soul.

One example of the power and new problems of the web is internet pornography, an industry that in the U.S. generates more money than all professional sports combined. Perhaps the single most damaging force destroying homes and people in the world today, this private, easily available, consuming addition has ruined countless lives, careers, and families.

The web is also a marketplace for ethically suspect medical and health services. Dangerous prescription medications are easily available online with little medical and legal oversight. Even high cost, high-risk reproductive health care (up to and including sale of human sperm and eggs) can be arranged easily from the privacy of one’s home via the internet. 

In addition, a puzzling new phenomenon has been created by the intersection of the newly established relationships and pseudo-relationships with high tech medicine. The internet is now being used by would-be organ recipients to attract would-be organ donors in order to facilitate and expedite living, non-related organ donation.

Imagine: John X creates a web page for his daughter Mary X. In glowing terms he describes her unique life, the many lives she touches for good, and the gory facts of her impending death should she be denied the opportunity to receive a kidney   transplant. A carefully crafted site can be achingly persuasive in obtaining offers by total strangers to help Mary X continue her valuable life. This is good, right?

In some ways, it is very good. While some have called the entire “industry” of transplant surgery into question—expense, time, hassle, social justice, allocation of scarce resources—most Christians believe that God provides through doctors the knowledge necessary to help nourish life. They believe that organ transplantation—especially from dead donors—is an example of this knowledge. No one wants Mary to die, and if a generous, healthy stranger is willing to share his or her “extra” kidney, this may be a noble, redemptive act allowing Mary to continue a long, meaningful life. Every week many die because of the scarcity of liver, kidney, pancreas, and other organ donors. Given the obvious shortage of organs from dead donors, why do we not encourage live donor donations? We live in a free society, largely based on innovative, entrepreneurial principles. If John creatively, legally can help his daughter Mary live, good for them! Or is it good for them? Is it good for the donors? Is it good for society?

What are a few of the problems with advertised, living, stranger-to-stranger organ donations? Eight concerns spring to mind:

  1. It is almost impossible to give a would-be donor full information to obtain informed consent. Even if donors think they know what they are in for, complications occur. Their remaining kidney may fail, or they may become infected, permanently disabled, or even die. Even if they are informed repeatedly of such possibilities, when they happen, donors inevitably feel permanently and sadly surprised. Ironically, perhaps from guilt or preoccupation with their own loved one, recipients and families may be less than supportive of donors when this occurs.
  2. Such surgeries are unbelievably expensive—even without complications. Whose responsibility is it to pay for the increased surgeries that may result from this new practice? Twenty to thirty per cent of Americans are medically uninsured or grossly underinsured. Is justice served by spending inordinate sums of money on the few, while ignoring the many?
  3. John X was very persuasive. But what about Larry Q, who doesn’t have the money or the knowledge to post his daughter’s needs on the internet? Should Suzy Q die because the organ she might have obtained goes to Mary X? One could argue that this kidney would have stayed with its original owner and not been donated at all, but this only begs the issue of why we are not effective in reaching more people with the message of need for more organ donors.
  4. What are the motivations of the donor? One has to wonder what prompted him or her to find the website, to offer to help, and follow through. While genuine altruism probably exists among us, mixed motives are the rule in humans.
  5. What about our current system of organ procurement? Rules have been established and standardized by knowledgeable professional organizations to obtain the best possible outcomes for the largest number of persons. Should all these principles be ignored because John was technologically gifted, and was able to connect with a generous stranger?
  6. Human prejudice as it is, would this practice further disenfranchise minority citizen groups? Would it be harder to obtain organs for poor, inner-city, or minority recipients, who, even if they achieved a great web presence, would likely have fewer potential donors who would identify on a personal level to them?
  7. Are there other examples in medicine where dangerous procedures are performed on healthy volunteers that will in no way assist the volunteer? Standard research ethics forbid performance of known dangerous acts on healthy persons who stand to receive no benefit whatever from the procedure. One of the Hippocratic tradition’s primary maxims is to “First, do no harm.”
  8. Even if the volunteer believes that they are only placing themselves at risk with the dangerous surgery—what about all the other lives attached to the donor? Should we make rules that donors must all be single, friendless, and jobless, so as not to damage the lives of others if the surgeries fail? The Pony Express encouraged orphans to apply for positions with the Express. Should we do the same with stranger-to-stranger donations?

The Technological Imperative—i.e., because we can do something, we should—may take this issue out of our hands, and make it a widespread reality soon. It has already begun. But I think that we should evaluate this process very carefully, and set appropriate safeguards and restrictions in place before it is too late and our window of opportunity is lost. As abortion has proven, and in the same way that possession is three quarters of the law, once internet stranger-to-stranger organ donation becomes a given, it will not be an easy thing to undo.