Today's Opinions, Tomorrow's Reality
An e-Transplant Prophecy
By David G. Young
WASHINGTON, DC, September 7, 1999 --
When a Florida man placed his human Kidneys for sale on the Internet auction site Ebay, everybody dismissed it as a joke. At first, nobody knew who made the anonymous offer, and before the man could be found, Ebay pulled the item off its site for violation of American laws prohibiting the sale of human organs. News outlets around the world enjoyed running an intriguing story that reinforced the stereotypical quirkiness of the Internet. A day later, the whole joke was forgotten.
Except it was no joke. The Florida man who offered his kidneys was poor, desperate, and more than happy to part with a redundant organ for the $5.7 million1 high bid posted before Ebay pulled the plug on the online auction. He is exactly the kind of person who needs protection, bioethicists might say, from the temptation to sell human body parts. The desire to keep people from this temptation is what led the United States Congress to pass the 1984 National Organ Transplant Act, making it a felony to buy or sell human organs. This law led to the establishment of a national system to place recipients on waiting lists and match them to prospective donors.
This program has been an utter failure. The system obtains organs almost exclusively from living relatives of recipients as well as from unrelated cadavers, and thus it has not been able to provide organs at a rate even remotely approaching demand. This has produced a national crisis -- a severe shortage of organs available for transplant. At the end of last year, the number of Americans waiting for a transplant had risen to 64,423 -- up 10 percent from the year before.2
Despite this crisis, the medical establishment is clinging to its opposition to the sale of human organs -- even if it means thousands on waiting lists will die. The paranoia regarding organ sales is simply astounding. Earlier this year, several transplant centers actually turned down a woman's request to donate a kidney to a stranger because of ethical concerns. The University of Minnesota finally agreed to perform the operation -- but only after subjecting the donor to an arduous series of psychological tests designed to make her prove that she was doing it for the "right" reasons.3
This and other outrageously conservative acts by the medical establishment at a time of a severe shortage are precisely the reason that the system is ripe for overthrow. The act of a desperate Florida man on Ebay might be just the catalyst that starts the revolution.
Most people don't realize that the existence of the global Internet and a type of privacy software called public key cryptography make it possible for an anonymous stranger to broker the sale of organs without anyone being the wiser. The technology exists today for someone with modest resources and basic computer skills to set up an offshore organ brokerage web site free of interference by U.S. law. Such a service, if combined with a simple registration system of buyers' and sellers' organ blood and tissue types, could in a matter of months overthrow the data access monopoly of the repressive American organ control system.
Of course, hospitals must first be found that are willing to perform transplants between unrelated donors. But while this still may be difficult in the United States, it is not in many other countries, such as the Philippines, where even the open sale of organs is not prohibited by law.4
Whether the establishment realizes it or not, the organ donation system in the United States is on the brink of collapse. Many experts acknowledge that despite the widespread opposition to allowing the sale of human body parts, allowing such sales would end the organ shortage virtually overnight. Such a change is bound to happen. The only question is whether it will come about suddenly via the unrelenting force of communications technology, or through the gradual reform of the existing system. Already, the state of Pennsylvania is planning to offer a $300 payment to people who donate organs upon death as a "funeral stipend."5 Such moves blur the lines between donating and selling organs, and help pave the way toward the inevitable deregulation of commerce involving the human body.