The issue remains controversial. The debates range across issues of morality, ethics and economics, though to some extent, they are only starting to acknowledge a phenomenon that is already taking place.
Currently donors are exploited by unscrupulous middlemen who exact their profits from the difference between the price patients are prepared to pay and the pittance the donors actually receive. A Indian black market transplant ring “paid as little as $1,000 for the kidneys and then sold them for as much as $37,500.”
Woman Sells Her Body Parts
Medical Risks : In addition, donors might not be fully aware of the risks involved, both during and post-operation. These include delays in their return to full activities (3.2 to 6.2 weeks), risks involved in complications (30%) and death (0.03%). For willing donors, more visibility regarding how much patients are prepared to pay, the risks involved and the available assistance, will reduce the level of exploitation.
Reaching Potential Donors and Patients
Even if perfect information can be made available to potential donors, who are typically poor and illiterate, reaching them via the web would be difficult because of low Internet penetration. Even a more powerful means, such as online videos, is fraught with the challenge of gaining audience attention. In YouTube, “Woman Sells Her Body Parts,” describes the illegal organ trade in India, while “Live Life Then Give Life!” features 18 friends who died because of the shortage of organs in the United Kingdom. Both had fewer than 100,000 views. Most of the remaining “kidney” or “organ donor” videos had from a few hundred to 10,000-plus views, and get lost in the vast sea of popular video sites. Such videos must be narrowcasted to a specific target audience and be mindful of the policy, behavior, or practice change sought. They should seek to create the finished narratives that matter in most advocacy contexts.
Live Life Then Give Life!
Establishing a Community of Donors, Patients and Caregivers
A better way to reach potential donors would be through influencers such as local doctors, clinic, NGOs, and religious organizations. Beyond the provision of information, the power of the network can be exploited to establish a potential community of volunteer doctors and nurses to provide pre and post-operation care.
The network could also be utilized to allow poor patients to benefit from this initiative. A kiva.org-like arrangement could be included to encourage potential benefactors to sponsor or lend money to poor patients by vesting them with a direct interest between their contribution and a successful outcome. However, one has to be mindful of the significant difference in funds sought. The average amount of each Kiva loan is only US$454.18, while the average total amount loaned per Kiva lender is only US$135.50.
Lowering the Cost of Transplant Through a Learning Network
Even if organs can be successfully sourced and matched, the cost of an organ transplant operation, at US$160,000 in the United States, remains prohibitive for most. Here again, the power of the network could be tapped in the quest to lower the cost of a transplant operation. We can build on the achievement of others and add our own contributions. Aravind Eye Care in India, for example, increased productivity from 400 eye surgeries per doctor per year to 2,600 and reduced cost of cataract procedures, including accommodation, to US$50 to US$330, while still achieving world class eye care quality. If Aravind’s lessons can be successfully adapted, the cost of transplant operations can hopefully be lowered by a similar order of magnitude without compromising on safety and patient care.
Implementation Challenges
Starting and maintaining such a site would obviously entail cost. Network for Good, for example, required an operating budget of US$4.2m for 2006. Coupled with the issues of visibility and credibility highlighted above, an alternate solution could be to park this site under the ambit of an independent but established fundraiser associated with care for organ patients like the Singapore National Kidney Foundation . In the recent financial year 2006/2007, it managed to raise US$42m while providing subsidized treatments and dialysis for nearly 5,000 patients. Establishing and maintaining a site such as "www.lifeorgan.org" could ensure that donors are not exploited, while poor patients can also benefit from the initiative. Such an approach would be consistent with the National Kidney Foundation’s patient-centric vision.
Conclusion
While the idea of organ trading or compensation remains controversial, Singapore’s decision to legalize kidney compensation will create many potential gaps where the poor donors could be exploited and the poor patients deprived. Starting off on the right foot will be crucial for the initiative’s durability and Singapore’s credibility. By exploiting the features of Web 2.0, some of these gaps can be addressed by creating a dedicated online portal. Lifeorg.org can help potential donors better understand the compensation mechanism and medical risks, both during and after operations. However, the passive provision of information alone is not likely to go very far. Lifeorg.org can also proactively help connect poor patients who could not otherwise afford the transplant with financial donors to help them benefit from the initiative. Finally, lifeorg.org can help create a learning community of practitioners to increase the quality of care for both the donors and patients and hopefully reduce the cost of transplant operations. However, Web 2.0 is not a panacea. Many of the poor donors and patients cannot be reached through Web 2.0. Even if it could, capturing their attention and especially that of potential financial donors would be challenging. The final communication gap might have to be breached by doctors and nurses who might not agree with the organ compensation initiative. Most importantly, Web 2.0 cannot provide the answer to the ethical dilemma between man’s refusal to acknowledge death and the potential need to exploit the poor to do so.
