>I REFER to the calls for the liberalisation of kidney transplants, which have engendered a healthy, albeit often emotive, debate.
There are legitimate concerns about the possible exploitation of the poor by the wealthy and how this might lead to the slippery slope of the commoditisation of human organs.
However, this bears further study.
It is important to see beyond the fear of possible abuse and realise that the prime imperative is and should always be the saving of lives.
Is there really an immutable ethical or moral imperative demanding a ban on consensual transplants between unrelated persons?
Our rules banning transplants without a family link appear somewhat artificial and arbitrary, and may need to be re-examined for relevance in light of the immediate need to expand the pool of donors.
Statistics suggest that the family-linked donor pool is shrinking even as the recipients in need multiply and the problem is growing.
But it may well be that nearly all the perceived fears of abuse may be alleviated by proper regulation, stringent safeguards and judicious enforcement.
The impression that this will lead to deregulation is misplaced, when the answer could actually be greater regulation.
We generally agree that an unfettered market model should be avoided and could, instead, look at a regulatory model that requires the entire process to be managed.
For example, organ recipients can be carefully selected and prioritised based not on their ability to pay but on clear
and objective medical considerations such as the length of time on dialysis, age, medical needs and chances of recovery.
Equally, the matching of donors can be based on medical compatibility, health factors, ability to receive pre- and
post-operative care and the informed consent of the donor and his family. No patient should lose his place in the queue because of his inability to pay.
For example, there could be a tax levied on each transplant, which could help fund transplants for patients who fail the means test. Medical insurance cover can also apply. Even the Government need not subsidise these transplants.
This way, available kidneys can go to the medically deserving on merit and not just to the rich.
The process can be managed by a medical committee led by doctors from the private and public sectors to ensure that it is as fair and transparent as possible.
The main issue here is not ethics or money, but the degree of acceptable medical risk. Expecting donors to be completely altruistic seems akin to expecting our surgeons to work for free.
If the medical risks of a donor living without a kidney are acceptable, then how different are voluntary transplants between unrelated persons from the practice of surrogate motherhood for a fee, which is accepted elsewhere?
Our laws now withhold available kidneys from those who will die without them. We must not shy away from taking a hard, pragmatic look at how we can make our laws fairer and more humane.
