Sunday Star Times

Banking on a lifeline for transplant patients
14 December 2003 
By RACHEL GRUNWELL

Parliament will soon debate whether New Zealand should set up a live organ bank and whether live donors should be paid in a bid to shorten transplant queues.

New Zealand's laws allow live donors to give their organs away, provided they have passed psychiatric and medical tests. Organs cannot be sold.

Britain and Australia have also been looking at creating live donor banks.

A New Zealand Ministry of Health spokesman said a report on the issue would be tabled in Parliament before February 24.

Health Minister Annette King would not comment until after she had responded to the select committee.

But ministry spokesman Colin Feek has said in the past the ministry did not support paying donors.

"Our view is that any form of payment for live donors' loss of earnings . . . could be seen as payment for giving an organ," Feek had commented.

The chairman of the Transplantation Society of Australia and New Zealand's renal transplant advisory committee, Graham Russ, said the issue was difficult because society only tended to accept the concept of donors gifting, not selling. If there was payment it would need to be highly regulated.

Russ said the poor were more likely to become donors "and you can get into all sorts of difficulties".

Russ said if payments were introduced it would be hard to define a boundary where people were given money for costs or as "incentive".

Liver transplant unit director Stephen Munn, who is based in Auckland, supports the idea of paying donors. He wants donors to be paid $5000 to reimburse travel fees, costs and time off work. This money should come from the government and relevant medical organisations, Munn said.

He is meeting with Feek soon, armed with a survey of transplant surgeons and kidney specialists who mostly support the payment.

Munn said New Zealand had already "sown the seeds" of implementing a live organ bank - comprising a list of names of people wanting to donate with no genetic recipient in mind.

Two people have already undergone kidney transplants from live donors who wanted to help "anyone".

"I guess they wanted to make a difference to someone in life," said Munn. "We have a lot more people interested in this now." A lot of people called after they heard rugby legend Jonah Lomu needed a kidney transplant, said Munn.

He said potential donors in the bank would undergo psychological and medical assessments to ensure suitability. They would then go on a list to donate to whoever is next in line.

But to have such a bank Munn said more people would need to be involved and "we will have to pay them".

He said in Iraq there was no waiting list for kidney transplants because there was a payment system of the equivalent of $20,000.

The payment system would help the 350 people waiting for a kidney and save money - keeping a patient on dialysis costs $60,000 a year.

Surgeons perform about 50 live kidney transplants a year and have done two live liver transplants.

Otago School of Medicine's professor of medical ethics Grant Gillett said there were no ethical issues in compensating donors for expenses and $5000 was a good sum. He did not think the figure should be any higher because it might become an incentive.

But he said the shortage of donors would be best addressed by changing the rule that allows families to override their dead loved one's wish to donate.

Anthropologist Jennifer Ngahooro, who is doing a masters in bio-ethics and health law, said about 400 people are on the organ waiting list - and 80% of them need kidneys.

New Zealand has one of the lowest donor rates in the western world, with 1.1 million people stating on their driver's licences that they will donate if they die. That is 42% of drivers.

But Ngahooro said only 39 people were donors in 2001 because many donors die before they reach hospital so their organs cannot be used, and families may veto donor's wishes.

About 15% of patients die waiting for liver transplants and 10% die waiting for lungs. A much higher percentage die waiting for kidney transplants.