Desperate to ensure that a healthy kidney was found for the father of her child, a woman advertised for a suitable donor to come forward indicating that she was prepared to offer financial compensation to offset the costs incurred by the donor. The case, which has stimulated a public debate on organ donations, has propelled two issues to the fore.
The first poses the question on what framework for encouraging organ donation exists in Malta. The short answer, it appears, is very little. The fact that this woman felt constrained to go public with her plea seems to reinforce this impression.
There is a small voluntary organisation, the Transplant Support Group, which clearly does excellent work within the inevitable limits of its resources. It organises meetings for transplantees of organs and tissues both locally and abroad, brings to the attention of the authorities any shortcomings and ethical issues concerning organ transplantation and raises awareness to encourage more people in Malta to come forward as organ donors.
There is also a Live Donor Transplant Advisory Committee under the Ministry of Health that makes an evaluation of individual cases of organ donation and then recommends the best action to take.
It is evident that more probably needs to be done if the dearth of organs for transplants (an issue not unique to Malta), which the particular case of this woman has exposed, is to be improved.
Most countries in Europe and the developed world have proactive systems in place, such as organ donor registers, within their health service, which positively encourage organ donation on the death of an individual.
Most of these systems are based on the assumption that everyone in the country would be willing to donate organs unless they explicitly opted out before their death. This “presumed consent”, as it is called, is used in many European countries. In Spain, for example, it has been adopted with relatives being allowed the last word to refuse organ donation after death. In Austria, on the other hand, the views of relatives after death are not considered.
It would seem sensible, and overdue, for an organ donor register to be set up here, based on some sort of “presumed consent” principle, given the aching gap in organs available for transplant.
The second issue that arises, therefore, is the question of legislation regulating organ transplants in Malta.
If it were decided to go down the path of some sort of “presumed consent” scheme being introduced, legislation to cover this would be required. In any case, there is no legislation in place to cover the question of the “purchase” of organs, a subject debated in view of the €5,000 offer made by the woman seeking a kidney for her son’s father. She insisted this was meant to cover the donor’s costs and not as payment .
It would clearly be morally repugnant to accept any system that saw the sale and purchase of human organs for transplantation conducted as though in a public market-place. The issue is too ethically sensitive and fraught for that. Yet, as the German Bishops’ Conference concluded, payment should “not exclude compensation for expenses incurred”. The matter definitely has to be addressed.
Malta must improve and regulate the whole area of organ donation by adopting a more proactive approach and legislating for the moral issues that arise. This matter demands closer attention by the authorities.