Ambivalence on Quintuple Kidney Transplant

The news from Johns Hopkins in Baltimore about an historic 5-kidney “marathon” transplant among 4 pairs of relatives and 2 unrelated people troubles me on several different levels. 5 people will (hopefully) have a better life now, and that’s wonderful, a miracle. And, that 5th, unrelated recipient is one of the luckiest people on earth!

However, I wonder about the motives of the transplant team and the stringency of the usual transplant ethical scrutiny, especially in light of the publicity.

It seems that there were 4 patients who needed transplants, and they had 4 relatives willing to donate, but none of them matched their own relatives. There was a woman who signed up to donate one of her kidneys to anyone who needed it. And there was a 10th person, the 5th with a need for a kidney.

Someone noticed that if all of the donors were shuffled there was a match for 5 of the patients on the waiting list.

Because of tissue or blood type incompatibility, none of the relatives could donate to her specific family member. But as they traced the possible connections, officials discovered that each turned out to be a fit for someone else in the group, and the five-way match emerged.

I worry that the “marathon” was an elaborate publicity stunt on the part of the Hopkins transplant team,

Surgeon Robert Montgomery, who directs the Comprehensive Transplant Center at Hopkins, has advocated a broader system of such pairings to increase the nation’s supply of organs and save more lives of desperately ill children and adults. Although more than 72,500 people are waiting for a kidney transplant in the United States, only 11,653 such operations were performed this year through August, with only about 4,400 involving living donors.

Before I go on, I want to say that I admire all the donors. I hope that I would do what they have done, if need be. In fact, I have felt disapproval for family members who will not donate to their own relatives, while understanding their fears. I lean toward the school of thought that it is not society’s job to protect an adult from himself. It is vital, however, that we all discuss the ethics in advance, in order to protect the vulnerable around us from harm caused by others. I also wonder about the duty of healthy young donors to themselves and their children and whoever will care for them if they become ill due to becoming donors. What of the young mother or father who volunteers to become a donor to a stranger?

There have long been questions about the ethics of an adult submitting to the dangers of donating a kidney to a relative who is in need, but there are legitimate questions about the “consent” that is given in these cases. How much does guilt, family and societal pressure play into the decision, and how can we objectively measure consent to a harmful procedure that will not benefit the donor? No one knows the future, and what happens if the donor has kidney failure in the future? Does the donor have the right to endanger his or her health in this way? What happens if the kidney is rejected and the donation ends up being futile?

These questions are multiplied in the case of an unrelated, altruistic donor. In this case, the woman who added the wild card (kidney) that made the 5/10-way transplant possible said that she is doing this in reaction to the loss of a husband and daughter. She is only 48 years old, herself. What of her future health? Will she someday regret an action from grief, rather than simple concern for her fellow human being.

Finally, however, I wonder about the timing. Performing the operations virtually simultaneously seems to be some sort of stunt. Or where the surgeons afraid that some of the donors would back out after their relatives recieved a kidney from someone else?

I can’t believe that there are “economies in scale” in kidney transplants or that it was more efficient and safe for the donors and recipients to arrange such a complicated scheme:

The undertaking required 12 surgeons and more than two dozen other doctors and nurses working for 10 hours in half a dozen operating rooms. Twice that many Hopkins staff members, including medical specialists, technicians, social workers, psychologists and pharmacists, took part in the planning and in post-operative care, officials said.

In 2003, the hospital performed what it believed was the world’s first triple-swap transplant. Montgomery was in the lead then, too, calling that success “a monumental-type experience.” Three years later, it became even more so.