The need for a body organ market

Would you pay for a kidney if your had failed or were failing? Would you care where that kidney came from? Would you feel a sense of responsibility to live your life according to the dictates of your doctor if you had a kidney transplant? Is it taboo in your community to receive a transplant or to give up a body organ? Are our cultural traditions so hidebound that there would have to be special rites performed on your corpse if it is to be buried minus a kidney or cornea? Would you trust your government to run the body organ system or would you trust a non-governmental organisation? Would you care, therefore, that Kenya had a body organ 'market'?

These are the questions a Kenyan doctor working and living in the United States raised when he suggested that it is time Kenya had a law to regulate the body organ system. In the recent past, we have witnessed harrowing tales of Kenyans dying for want of a functioning kidney dialysis machine. Just the other day, equipment at the cardiac unit of the Kenyatta National Hospital went up n flames and it became apparent that a major component in the cardiac treatment system had been taken out of commission. The slack will be taken up by expensive private hospitals, such as the Aga Khan University Hospital and the Nairobi Hospital. However, these stories simply illustrate the fact that 'lifestyle' diseases are striking more and more Kenyans and at earlier ages than before. Very soon, treating the symptoms of these diseases will not be sufficient; we will need to start considering the question of how, and when, persons can donate body organs and what incentives should be in place for the same to take place with as little conflict as possible.

In the United States and the United Kingdom the system is managed by non-governmental organisations. Given the recent fulminations by the Republicans in the US, many are now familiar with the spiralling costs of healthcare there and the fact that if the US government does nothing to address these issues, the cost of maintaining what they call entitlement programmes (Social Security, Medicare and Medicaid) will bankrupt the state. In the UK, the system is managed by an NGO and the state picks up the cost of the procedures, with patients chipping in according to their capacity. In the US, the patient, until recently when the Obama healthcare reforms were signed into law, paid for everything. Now, their insurance companies will pick up a portion of the cost, or perhaps all of it. However, in both countries, the backlog of patients on transplant lists runs into the tens of thousands, with many dying before they can receive the organ of need. In Iran, on the other hand, there is a thriving organ market, where the patient gets to pay for the organ he needs and the donor is compensated for his act of selflessness. As a result, the deficit for organs in Iran is much lower than in the democratic, civilised West.

In Kenya, these are issues that would need to be ironed out when the law on organ donations comes up for debate in the National Assembly. Stakeholders in the industry including the Medical Practitioners and Dentists Board, the Kenya Medical Association, the Law Society, the KNHCR, the Nursing Board, patients' rights advocates, businessmen, economists, and members of the public must weigh in and give their opinions. The leadership of politicians and other opinion-makers must be seen; they are the ones best-placed to advice their people and stakeholders on not only the necessity of such a system, but of the need to give up some of our dearly-held and cherished cultural shibboleths for the sake of the common good. Of course, if the country goes for a system similar to Iran's, we will need to put in place mechanisms to ensure that the poor and the helpless are not exploited by the wealthy and powerful. Too often, the rich take advantage of the less fortunate to satisfy their own ends. After all, a majority of those who will suffer lifestyle diseases are likely to be wealthy.

An example of the risks of any system is best illustrated by the case of Steve Jobs, the CEO of Apple Inc. Mr. Jobs has recently taken time off from his job to undergo treatment for an undisclosed ailment. He had previously received a kidney transplant. What makes his case special is that because in the US, different states have different rules for organ donation, it becomes very expensive for an individual to get onto multiple lists across state lines. Mr. Jobs, because of his wealth, was able to get himself on multiple lists and somehow to be on top of at least one of them where he eventually found a donor and the transplant conducted. Had been an ordinary American, he would have taken his chances with the California system and hope that his case was considered favourably. But because of his wealth, he managed to use it to his advantage at the expense of someone else, who may have been more deserving. If indeed, as speculation mounts, he was not eligible as a candidate for a transplant, Mr. Jobs may very well have been dead today. And because of his ineligibility, the kidney he may be losing now may have been reserved for someone else more deserving.

Therefore, Kenya must consider very carefully the social, economic, cultural and political aspects of such a law. We must take into consideration that because of the great ignorance of Kenyans regarding this matter, that there is need for widespread education to counter the effects of ignorance-fuelled cultural opposition to organ donation. Our politicians must demonstrate a maturity in their discourse that they have so far failed to do in regards to other weighty matters and ensure that the people understand the necessity for such a law and the need to protect Kenyans from abuse by one powerful group. Only when all these duck are in a row should Kenyans be invited to make their decision regarding the law. If not, we may be in for difficult times in caring for the sick in need of 'new' body organs.