Is It Ethical For Patients With Kidney Disease To Purchase Kidneys

One controversial, and almost universally illegal, approach to tackling the shortage of kidneys for transplantation is for a patient with kidney disease to buy a kidney from a living donor who is usually in a developing country. But is the buying and selling of organs ethical? A provocative debate in PLoS Medicine considers both sides of the issue.

Tarif Bakdash, a pediatric neurologist and Assistant Professor of Bioethicis at Damascus University, Syria, argues that “poor people should have the right to exercise their autonomy by selling their organs.”

The argument that we should protect the poor from being exploited by banning them from selling their organs is a myth, says Dr Bakdash. “The poor are always exploited from the day they are born,” he says, “and in all avenues of life. The only thing of value left for some of them is their bodies.” Dr Bakdash believes that the sale of organs should be legalized and regulated.

But Nancy Scheper-Hughes, Professor of Medical Anthropology at the University of California, Berkeley, and Director of Organs Watch, argues that “dividing the world into organ buyers and sellers is a medical, social, and moral tragedy.”

Research done by Professor Schepher Hughes and colleagues found that among hundreds of kidney sellers in Moldova, Romania, Turkey, the Philippines, and Brazil, many suffer post-operatively from chronic pain, social isolation, stigma, and severe psychological problems. “While many individuals have benefited from the ability to get the organs they need through illegal circuits,” she says, “the violence associated with kidney selling gives reason to pause.”

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Citation: Bakdash T, Scheper-Hughes N (2006) Is it ethical for patients with renal disease to purchase kidneys from the world’s poor? PLoS Med 3(10): e349.

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Kidney Disease Patients Often Excluded From Heart Studies

Despite a high risk for cardiovascular death, patients with chronic kidney disease (CKD) are frequently excluded from cardiovascular trials, researchers at Yale School of Medicine report in the Journal of the American Medical Association (JAMA).

The researchers also found that published trials provide no information on renal function in participants or the effect of interventions on participants with renal disease. This results in poor information on how to treat cardiovascular disease in CKD patients.

“Inclusion and reporting of kidney disease patients in cardiovascular trials must improve,” said senior investigator Chirag Parikh, M.D., assistant professor in the Section of Nephrology at the Yale School of Medicine. “Alternatively, we need to design separate trials for cardiovascular treatment exclusively in CKD patients.”

Parikh and Steven Coca, renal fellow at Yale, reviewed 153 clinical trials for treatment of cardiovascular disease from 11 major medical and subspecialty journals published from 1985 through 2005. Patients with kidney disease were excluded from 56 percent of the trials and were also more likely to be excluded from multi-center trials. Only five percent of original articles reported the proportion of enrolled patients with renal disease and only 10 percent reported mean baseline renal function.

Cardiovascular death remains the leading cause of death in patients with CKD and over nine million people in the U.S. have CKD.

Parikh and Coca, who are also affiliated with the Clinical Epidemiology Research Center at the VA Connecticut Healthcare System, said there are many biological reasons cardiovascular disease in patients with CKD may be different from that in general population and interfere with effectiveness of existing therapies and prognosis. Patients with CKD have abnormally high levels of protein in their urine, elevated homocysteine levels, and a higher burden of hypertension, anemia and inflammatory factors.

“We strongly urge researchers to universally adopt standards for reporting of renal disease in cardiovascular studies,” said Parikh. “Funding agencies should make these studies a priority to gather information in this increasingly important subgroup of patients.”

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Citation: JAMA, Vol. 296, No. 11 (September 20, 2006)

Chronic Kidney Disease Award

The American Association of Kidney Patients (AAKP) is pleased to announce the recipients of its annual Chronic Kidney Disease (CKD) Awards – the AAKP Spirit of Service Award and AAKP Visionary Award.

These awards, which were presented during AAKP’s 32nd Annual Convention in Las Vegas, are designed to honor a patient and physician who have performed extraordinary service on behalf of those with CKD.

The AAKP Spirit of Service Award was established to honor a kidney patient who raises awareness of CKD in his or her community.

This year’s recipient, Jenna Lynne Smith of Iowa City, Iowa, is an inspiring example to fellow patients. An end-stage renal disease (ESRD) patient, she has used peritoneal dialysis, received a living-related kidney transplant, and currently uses hemodialysis to treat her kidneys.

She volunteers for numerous organizations, such as Kidneeds, an organization started by her family to support research to find a cure for membranoproliferative glomerulonephritis type II, known as MPGNII. She makes jewelry, which can be found in jewelry stores throughout Iowa, as well as greeting cards to raise money for kidney research. She is also a regular participant in Habitat for Humanity.

In addition, she received an award by the 2005 Iowa Medical Society Alliance to recognize her community service endeavors, as well as the Peterson Scholarship through the University of Iowa Foundation for her scholastic achievements.

The AAKP Visionary Award was created to pay tribute to a physician for his or her outstanding performance in CKD education.

This year’s recipient, Jay Wish, MD, of Cleveland, has made a positive impact on kidney patients throughout the country.

He was selected for his exemplary efforts in patient education. Dr. Wish is a member of the AAKP Medical Advisory Board and regularly contributes to AAKP’s patient publications, including Kidney Beginnings: The Magazine. He has also participated in important, renal organizations, such as Be Active, the American Society of Nephrology, the International Society of Nephrology, the Renal Physicians Association, and the National Kidney Foundation. In addition, he has worked with ESRD Networks throughout the country for more than 20 years.

Each of these individuals spends countless hours ensuring that kidney patients, especially those with CKD, understand their disease and live life to the fullest. Both recipients have helped increase awareness of CKD among patients, family members and the general public.

It is estimated that CKD – a condition affecting the kidneys that may progress to kidney failure – affects more than 12 million Americans. The most common causes of CKD are diabetes and hypertension (high blood pressure). AAKP would like to thank Ortho Biotech Products, L.P., for its generous sponsorship of the CKD awards presentation.