Wealth and the ethics of organ donation
Despite queue-jumping concerns, Melnyk plea boosts donor numbers
It should shock no one that in the matter of access to health care, even to the organs in other people’s bodies, the wealthy and well-connected, such as Ottawa Senators owner Eugene Melnyk, are different from the rest of us.
“The rich do better,” Dr. Arthur Caplan, head of bioethics at New York University Langone Medical Center, told the Star. “I don’t know that that’s a headline, but it’s nonetheless true.”
Caplan co-wrote an article on Forbes.com last week that said publicity campaigns for donor organs, such as that successfully mounted by Melnyk for a liver, create “a double standard” under which those with name recognition have an advantage over those with fewer resources and less profile.
After a plea last week by the Senators on Melnyk’s behalf, more than 500 potential donors volunteered. Doctors with the University Health Network’s multi-organ transplant team selected one from 12 potential candidates and performed a liver transplant this week on the 55-yearold Melnyk.
More than 20 of those not selected to donate to Melnyk have said they would continue in the process to donate to others in need, said Dr. David Grant, leader of the surgical transplant team. “Many lives will be saved as a result of this appeal.” Both Melnyk and the anonymous donor were in stable condition and recovering. The donor, who wished to remain anonymous to the public and to Melnyk, told Grant that part of the motivation was a desire to help the owner bring the Stanley Cup “home to the Ottawa Senators.”
Despite Grant’s belief that others awaiting transplants will benefit from the public appeal, experts agree there’s something unsettling about the speed at which Melnyk was treated and his ability to raise options less famous people couldn’t hope to match.
The intriguing aspect, said Dr. Udo Schuklenk, Ontario Research Chair in Bioethics at Queen’s University, is less that Melnyk used all tools at his disposal to save his life — who wouldn’t? — but that there were “apparently hundreds of people willing to donate organs for him, but not for others.”
Even so, he said, there is nothing unjust because “when you take the emotions out of it, you ask yourself, given what this guy has done, is any other patient any worse off? The answer is no.”
Melnyk had been suffering endstage liver failure from an undisclosed disease.
He was put on the waiting list for a liver from a cadaver. Because of his rare blood type, the odds of that happening were slight. That meant finding a living donor.
After unsuccessfully seeking a match from family and friends, he went public through the Senators. The response was remarkable.
Schuklenk said a case can be made that those still waiting for transplants will be better off as a result.
Melnyk is off the waiting list. Prospective donors who came forward for him might still donate to others. The awareness created by high-profile stories such as his will likely bump those signing organ-donor cards.
There are about 1,500 waiting for a heart, kidney or liver in Ontario. One in three people die waiting for an organ.
For his part, Caplan said each transplant centre holds considerable authority to determine what donors and recipients they will treat.
“Maybe more regulation is needed,” he said. Few would balk at a parent donating a kidney to a child. But “if you want to donate your liver to me, that gets to be a little different. Because, ‘Why me?’
“There might be others who are needier or would do better with it. I think we could use an examination of that issue.”
An obvious concern is whether money or other considerations are changing hands, he said. Or whether a recipient might be vulnerable later to extortion.
There are also two lives at risk in such a procedure, he said, and there are questions to be asked of a donor.
“Are they doing it for the right reasons? Are they rational? Are they overcome in this case by being a fan?” If the Melnyk case proves troubling to Canadians, it should be possible to find better arrangements, Caplan said.
“You could set up a system whereby people who need donors register their name and remain relatively anonymous, if you were trying to balance the playing field. You could set it up so that the only way you could get an organ is going through the system” and playing by the same rules as everyone else. Caplan had another question. “Who’s paying for all this?” It’s nice that a donor stepped up for Melnyk, he said, but they didn’t for others with rare blood types also needing livers. “If we’re all going to pay for it, how does that sort out relative to fairness?”
It was not the only money question to arise.
As the Ottawa Citizen reported, Melnyk is a Canadian citizen but a permanent resident of Barbados. The Ontario Health Insurance Plan requires patients to make their primary residence in Ontario and spend at least 153 days in the province in any 12-month period to maintain coverage.