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Since healthy humans have two kidneys, living donors can donate a kidney to someone who needs it -often to family and friends, rarely to strangers. However, there is now advertising for organs on the internet, and the net has become a way of finding an organ. Despite their different laws and systems, demand for kidney transplants outstrips supply in almost every country. Statistical research at the Oregon Health and Science University found that the average American patient would wait three weeks for a heart, three months for a liver or pancreas, and 476 days for a kidney.
In general, countries have either dissent or consent approaches. The dissent approach means that, during his or her life, a person must explicitly dissent to donation. The consent approach is the opposite: a person must consent to be a donor. It follows from this that countries with dissent approaches do not have waiting lists for organs, and those with consent approaches often suffer shortages. However, the main problem with both systems is that the majority of people do not explicitly state one way or another. Despite having the most successful transplant system in the world, Spain still has problems with organ shortage – 1 in 10 people who need a transplant die while still on the list.
A range of potential approaches have been proposed to address the worldwide problem, such as donor registries and monetary incentives for signing up to be a donor. The Centre for Ethical Solutions, a bioethics think tank in America, is now looking to Iran’s system for inspiration in overcoming the serious problem of organ shortage. The sale of kidneys in Iran was made legal in 1988. It is thought that before this, the waiting list was like that of a Western country. Now, there is no waiting list. The system is organised and regulated by the government. The government funds the transplant process and pays the donor. Donors also receive free health insurance. There is an independent third-party organisation which arranges contact between donors and recipients. In Iran, patients wait an average of zero to four months for a donor kidney, almost 14 months less than the average wait in the United States.
When it is not organ shortage in the headlines, then it is the seedy underworld of trading. Organ trading is banned in most countries due to ethical and medical concerns. Yet the internet often makes its own rules -perhaps the most well-known case is the eBay auction of ‘one functional human kidney’ in 1999, an auction which was later blocked by the site. The highest bid reached $5.7 million. The sale of human organs is punishable by up to five years in prison and a fine of $50,000 in the United States.
Despite the fact that exchanging human organs for cash is illegal in most countries, the World Health Organisation (WHO) believes that one fifth of the kidneys transplanted come from the black market. The World Health Organisation identified half a dozen countries as organ-trafficking hot spots, one of which was Egypt. As is the case in many poor countries, word has spread among Egypt’s destitute that selling a kidney is a quick way out of debt. For Frank Delmonico, a surgery professor at Harvard Medical School and advisor to the WHO, organ selling is a global problem. ‘And it’s likely to get much worse unless we confront the challenges of policing it’, he says.