Un marché pour légaliser la vente d'organes ?

==> Généthique.org :

"Deux médecins américains, Eli et Amy Friedman, viennent de demander la légalisation de la vente d'organes provenant de donneurs vivants. Ces spécialistes de la transplantation rénale pensent qu'il s'agit du seul moyen pour lutter contre la pénurie de donneurs et pour stopper le développement du marché noir international.

Des européens en attente de rein vont ainsi payer jusqu'à 150 000 Euros à des trafiquants pour obtenir un organe acheté en Europe de l'Est moins de 2500 Euros.

Eli et Amy Friedman proposent de créer une agence gouvernementale chargée de réguler ce marché officiel des organes. Ils suggèrent de verser 40 000 dollars à un donneur de rein".

"Selon un rapport du Conseil de l'Europe, 40 000 patients européens attendraient une transplantation rénale. 15 à 30% d'entre eux mourront faute d'avoir pu trouver un donneur".

© genethique.org

Chaque article présenté dans Gènéthique est une synthèse des articles de bioéthique parus dans la presse et dont les sources sont indiquées dans l'encadré noir. Les opinions exprimées ne sont pas toujours cautionnées par la rédaction.

==> All Things Considered, February 16, 2006.

"An article in the journal Kidney International proposes the legalization and regulation of the sale of human kidneys. One of the authors, Dr. Amy Friedman of Yale University Medical Center, explains to Robert Siegel the rationale behind this growing opinion."

==> "Junk medicine: organ donation", by Mark Henderson

"No need for a meat market

More than 5,500 British patients are waiting for a new kidney. However, the shortage of organs is such that only 1,700 of these can expect a transplant each year. More than a quarter of the lucky ones have a friend or relative to thank for their new organs. Of the less fortunate, more than one a day will die on the waiting list.

Though the NHS’s transplant registry has been running for more than a decade, demand for donated organs still far outstrips supply. Only one Briton in five has recorded a wish to help someone else to live in the event of an untimely death. Too many people who would not object to donation fail to make their wishes known and many bereaved relatives are thus understandably reluctant to sanction a transplant.

The result is great human misery and significant cost to the NHS — the recipient of a kidney transplant costs between half and a third as much as a dialysis patient over five years.

This week, two American doctors suggested that society address this problem by thinking the unthinkable.

In the journal Kidney International, Eli Friedman, of the State University of New York, and Amy Friedman, of Yale University, proposed that medicine break down a great taboo and consider a regulated market in organs sold by the living.

Permitting the sale of kidneys would ensure that paid donors received a fair price — the paper suggests $40,000 (£23,000). The cost could be financed by savings on dialysis. Legalisation would also clean up a murky field, in which rich 'transplant tourists' travel to developing countries for new organs.

Friedman and Friedman compare the sale of a kidney to surrogate motherhood and sperm and egg donation, for which payment is permitted in the US, though not in Britain. But while their paper is thought-provoking, it goes too far. Their analogy with reproductive medicine is a false one — a sperm donor parts with nothing that threatens his health, while the risks of egg donation and surrogacy are trivial when compared with the loss of a kidney.

The best response to the existence of a black market that exploits the poor is not necessarily to accept it. To institutionalise the sale of organs might improve the medical care of paid donors but at a cost of encouraging the vulnerable to mutilate themselves for money.

It is not a price worth paying, particularly as there is a simple and proven solution to the organ shortage that has none of the drawbacks of paid donation. This is to adopt a policy of 'presumed consent', by which everybody is regarded as a potential donor unless they have specifically indicated otherwise. Where Britons opt into the donor system, citizens of Spain, Belgium and Austria must opt out.

The experience of these countries suggests that presumed consent makes a vast difference. Those with objections to transplantation, such as Jehovah’s Witnesses, have their rights protected. The deceased’s next-of-kin can still refuse permission but the assumption in favour of donation makes this less likely in practice. In Britain, almost half the relatives of potential donors refuse to release their organs. In Spain, the rate is just 24 per cent.

Spanish waiting lists for new organs have halved since the system was changed ten years ago.

Yet when presumed consent was proposed to Parliament in 2004, with the backing of the British Medical Association, it fell under a government three-line whip. A squeamishness about organs and consent — the legacy of the Alder Hey affair — has strangled a perfectly ethical measure that would alleviate much suffering, while saving scarce funds.

The dead — and, for that matter, their families — have no call for kidneys and livers. Until this source of organs for transplants is maximised with presumed consent, the kidney of a living person will remain an unethical purchase."

Mark Henderson is the Times science correspondent
© TimesOnline.co.uk