To the Editor:

Recently I spoke with Dr. James Eason, Memphis’ own leading organ transplant surgeon. He has voiced approval of and signed a letter issued this summer by about 20 members of the American Society of Transplant Surgeons encouraging a pilot project to test the effects of remuneration for organ transplants. The 30-year-old Federal Organ Transplant Act would need to be amended to bring this about.

We hear much about life saving organ transplants from altruistic donors, but not enough about the many who die because of the organ shortages (about 10,000 per year in the US, or about 20 per day). The gap between supply and need of all organs is steadily growing and cries for solution are becoming louder.

The idea of having directly enticing or coercive payment for organs has been considered repugnant and is actually illegal (since 1984) because of the possibility of black market tourism trafficking. For illogical reasons payment for organs has been looked upon as ghoulish although we may accept many other disturbing entities such as autopsy, surgery and abortion. In all other aspects of healthcare, we espouse the policy of remuneration for service. We also sell our blood, bone marrow, sperm and eggs.

On this subject ethical and legal thought is complex and strenuous, depending on such variables as whether there is live donation such as with kidneys and part of the liver or brain-dead donation such as with heart. Ethicists are concerned about having thousands die because of the idea that it is wrong to remunerate donors.

Many thoughtful activists believe that a strictly regulated, brokered marketplace, transparent and with controlled pricing would assure an adequate supply of organs. As Justice Brandeis said, “Sunlight is the best disinfectant.” Compensation would occur by removing eh disincentives that hinder living donation. Remuneration would be created by tax credits, tuition vouchers and payment for travel expenses and time of missing work.

To prevent black market exploitation of desperate patients, the laws against non-brokered direct payment and transplant tourism would be strengthened.

A living donor registry would be carefully maintained and donors and their immediate families placed at the head of the waiting list in case the donors themselves would need a donation in the future.

The increase in donated live kidneys would save Medicare a huge amount of money because funding dialysis is much more expensive than supporting transplantation and is much better for the patient.

Webster Riggs Jr., MD