If you have been a dedicated follower of this blog, a common refrain has been the complexity inherent to ESRD and organ donation issues. I am honored to share an interview with Dr. Sigrid Fry-Revere (photo above), the Chairwoman and Founder of the Center for Ethical Solutions. Dr. Fry-Revere has enjoyed an extensive career in bioethics and health policy. I recently had the opportunity to ask Sigrid about her upcoming book, The Kidney Sellers, a book that chronicles her journey as the first Westerner to witness firsthand the Iran’s organ procurement system.
Orgcomplexity: Dr. Fry-Revere, thank you for sharing news of your new book with Orgcomplexity. Many may (or may not) be aware of how the need for procurement of organs in the United States. Would you share how bad the organ shortage in US and abroad is?
Dr. Fry-Revere: In the United States there are 100,000 or more people waiting for kidneys. Worldwide 90% of those who need life-saving organs need kidneys. In the United States only 15% of those waiting get a transplant. The rest wait and get sicker and sicker on dialysis and most die without getting a transplant. The longer on dialysis, the less likely a kidney transplant will work even if the person gets one. The average wait in the U.S. is five years.
Orgcomplexity: Why aren’t there enough cadaver kidneys? Is living donation the answer?
Dr. Fry-Revere: Only approximately 1% of people who die in the United States die under conditions where organs can be harvested. Most are too sick, too old, or die too far from the hospital for organs to be usable. Even if every organ that is even conceivably usable were harvested (Presumed Consent), we would only increase our kidney supply by less than 30,000 kidneys, and we need 100,000 or more. Note 30,000 is an optimistic figure because the more marginal the conditions under which a kidney is harvested the lower the conversion rate — the lower the chances that it will be transplantable even if harvested or that the transplant will succeed.The world’s first transplants were with living donors and in the last 30 years in the United States anywhere from a third to half of all kidney transplants were done with kidneys from living donors. For example, the 30,000 assumes an 82% conversion rate, but when the Washington D.C. Transplant Community (where I’m the ethicist for their Organ and Tissue Advisory Committee) makes efforts to maximize the number of organs harvested by harvesting from older and sicker patients, the conversion rate drops by 10% or more. So the yield of potentially usable cadaver kidneys is difficult to pin down.
Orgcomplexity: I have heard about a black market in organs. Is that true? What is the black market in kidneys?
Dr. Fry-Revere: A black market is an illegal market where anyone involved is punishable by fines or jail if they participate and/or there are is no legal infrastructure or laws to deal with disputes when contracts are made. A 2009 United Nations report estimates that 10% of all transplants are illegal black-market transplants with most of the purchasers being from western countries in North America and Europe while most sellers are from developing nations. As a result there is horrific exploitation of impoverished people by wealthy Westerners who don’t have friend or family who can donate and don’t want to brave the waiting list. As a result donors often don’t get the money they are promised, suffer crude and indignant surgical procedures, and often suffer or die for lack of adequate post-operative care.
Orgcomplexity: One might ask why you would want to go to Iran as a subject for your book.
Dr. Fry-Revere: I would rather go to the Bahamas but Iran is the only country in the world with a legalized market in kidneys. I was in Iran for nearly two months. I visited six major cities, each of which had a transplant program. I interviewed kidney buyers and sellers, doctors, the middlemen who arrange kidney sales, and an Ayatollah.
Orgcomplexity: Thank you so much for sharing news of this great work. Could you share how someone might be able to find your book?
Dr. Fry-Revere: The book website is on the CES website. www.TheKidneySellers.com. It is due to come out on February 1, 2014 in hardback. All author royalties are going to the SOS (Solving the Organ Shortage) project of the Center for Ethical Solutions. You can visit www.ethical-solutions.org/projects/sos/ for more information about The Center and this project. Thank you for this opportunity to reach the systems community.
Interested in Orgcomplexity’s take on ESRD and its systemic issues? Check out the hot links for past Orgcomplexity blogs on the subject!
Disclosure- Orgcomplexity’s founder, Michele Battle-Fisher, is on the Board of Directors of the Center for Ethical Solutions. Michele Battle-Fisher does not profit in her affiliation with CES. Michele Battle-Fisher or Orgcomplexity do not in any way profit directly from the sale of this book.