Sarah Borg, who posted an advert asking for a kidney for the father of her son, is determined to keep fighting to promote organ donation even if it might not benefit her former partner directly.

“I will insist with the 21 donors who offered to give their kidney to Chris (Bartolo) to go ahead and donate, even if it does not go to him,” Ms Borg said.

She disagrees with the “disappointing” ruling of the transplant ethics committee that has decided not to allow the potential kidney donors to give their organ specifically to Mr Bartolo.

The donors came forward after Ms Borg posted an advert asking for a kidney for Mr Bartolo, 30, the father of her son Zac, 10. She offered €5,000 to the donor to cover medical and other expenses incurred.

The Live Organ Transplant Advisory Committee held an urgent meeting last week to decide whether to allow the donors for Mr Bartolo to be processed.

It decided this would go against the principle of “distributive justice” adopted when anonymous people, who are complete strangers to the patient, offered to be donors. The committee said the donors could, however, contact the hospital to start the process to donate their kidney, which would go to whoever needed it most. The committee did not want to condone advertising for organ donation.

Ms Borg said there could be a system through which the 70 people on the waiting list for a kidney were offered support to voice their story through regular campaigns.

“Personally, I don’t agree with the decision... I argue, who are you to tell these people who to give their organ to? This is making me more determined to keep helping. If they don’t want to help Chris, then he’s in God’s hands. But maybe my destiny is to help others,” she said.

Romina Deguara, a 33-year-old mother of twins, was among the 21 donors. She believes the committee’s decision was “stupid” and she hoped it would change its mind.

“I understand there are people on the waiting list, but this is my organ and I should be able to give it to who I want... I was touched by the story of Chris and wanted to help him... I should be able to choose and this is not about the money. I will not take one cent,” she said.

Ms Deguara agreed the situation exposed a need to reach out to the public through regular campaigns for donations.

Renal patient David Vella, who has been waiting for a kidney for three years, agreed with this point: “This might be a pointer to the support group to focus more on attracting living donors.”

He agreed with the committee that a person who had been on the waiting list for a year should not have access to a kidney before others because he had placed an advert.

“On the other hand, without his (Mr Bartolo’s) input these people would not have come forward,” he said.

He understood that a person should be free to give their kidney to whoever they wanted but cautioned against the abuse this might lead to, such as money demanded behind the scenes.

Asked to comment on the decision, Transplant Support Group president Alfred Debattista only said that he hoped the donors would remain available.

See poll question on this website.

ETHICS COMMITTEE DECISION IN FULL

The following is the full text of the ethics committee decision -

An urgent meeting of the Live Organ Transplant Advisory Committee (LOTAC) was held on Wednesday 14th March 2012 at the request of the Chief Executive Officer, Mater Dei Hospital, Mr. Joseph Caruana. The meeting was requested as a result of a recent advertisement for a kidney to be donated against payment. The Committee considered this request, basing its conclusions on its current terms of reference, which are reproduced below.

Members present:

Prof. Carmel Mallia, Chairman, Dr. Brigitte Gafa, Lawyer, Rev. Prof Emmanuel Agius, Ethicist, (substituting Rev. Fr. Paul Pace SJ, who was abroad), Mr. Kevin Cassar , Clinician, Prof. Joseph Cacciottolo, clinician, Mr Paul Sceberras, Clinical Psychologist, Mr Paul Calleja, Nursing Officer Dialysis Unit and Transplant Co-ordinator, acting as Secretary for this Meeting.

Dr. Louis Buhagiar, Dr. Emmanuel Farruiga, Dr. Mario Pio Vella and Dr. Joseph Farrugia, Consultant Nephrologists were invited to attend the meeting.

There are the following types of living donation for kidney transplantation:

A. Directed-donation, where an organ is donated to an identified recipient. This may occur in the following circumstances:

i. genetically-related donation, where the potential donor is a blood relative of the potential recipient (e.g parent, sibling)

ii. family-related, but not genetically related donation (e.g. spouse, in-law)

iii. emotionally-related donation in cases of a long-established emotional relationship (such as friend, partner, neighbour, co-worker)

iv. paired donation, where a relative, friend or partner is fit and able to donate an organ but is incompatible with the potential recipient and they are matched with another donor and recipient in a similar situation, so that both patients in need of a transplant receive a compatible organ;

v. pooled donation – a form of paired organ donation whereby the pair are matched with other donors and recipients from a pool of pairs in similar situations, and more than two donors and two recipients are involved in the swap, so that more than two people in need of a transplant receive a compatible organ.

B. Altruistic non-directed donation. A form of living donation whereby a kidney is donated by a healthy person who does not have a relationship with the recipient and who is not informed who the recipient will be.

The case under discussion does not fall under any of these categories, since it concerns one specific potential donation of a kidney by an individual to a specific recipient, without there being any form of relationship, genetic, family or emotional, relationship between the donor and the recipient.

TERMS OF REFERENCE

LOTAC was set up in 2003 by the Department of Health to process all applications for live organ transplantation. The current members have been serving on the Committee since its inception.

The Committee interviews both donor and recipient with a view to ascertain that the following ethical principles are respected:

the donor is willing to donate the organ (principle of autonomy)the donor is well informed by his specialist and consents (principle of free and informed consent)the donor is not being subjected to coercion or duress (principle of non-coercion);the donation is free and is not subject to a financial or material consideration (principles of dignity, integrity and non-commercialisation)the risk to the donor's health is acceptable (principle of non-maleficence)the recipient will benefit from the procedure (principle of beneficience)

Donors and recipients are referred to the Committee by consultant nephrologists (kidney specialists): the specialist responsible for the donor is always different from the one responsible for the recipient. The nephrologist will have ascertained and declared that the donor fully understands the nature and consequence of the donation. This certification is accompanied by declarations, one signed by the donor and the other by the recipient, authorizing LOTAC to:

have unlimited access to confidential information regarding the financial state of affairs including transactions of the parities;subject both parties to any examination and/or interview to be conducted by any person deemed appropriated by the Committee to determine the appropriateness of the parties or either of them for the donation.

A form has to be signed by the donor attesting that no payment, coercion, duress or inducement has been or is being offered or made: this form is signed in the presence of the clinician. A similar form has to be signed by the recipient, attesting that no payment of money or of money's worth has been made or will be made to him/her or to any other person and that no such money or money's worth has been made or will be made by him/her or by any other person to the prospective donor.

The appropriateness of the donor remains confidential by the Committee throughout and shall not be divulged to third persons.

Discussions and Conclusions

In the case of donation between blood relatives and family members who are not blood relatives, an organ is donated to an identified recipient. In other non-related donations a pre-existent close emotional link has to be present between donor and recipient for such a donation to be acceptable. In the case of anonymous donation the committee adopts the principle of distributive justice, where scarce resources (such as organs available for transplantation) are distributed to each person according to the medical need of the potential recipient, irrespective of the socio-economic group that the recipient belongs.

The committee feels that condoning advertising for the donation of organs for transplantation will mean that those who have the most compelling stories and the means to advertise their plight tend to be the ones to get the organs, rather than those who are most in need. Justice as fairness prohibits such unethical practice.- Ethics Committee

As implied by its terms of reference, the Committee views transplantation as a selfless gift without expectation of remuneration. A strong emphasis on altruism reinforces the philosophy of voluntary and unpaid donation, and solidarity between the donor and the recipient.

The Committee is convinced that the responses following the recently made appeal for kidney donation were genuine and well motivated. However, the Committee is bound to assess this whole scenario against the prevailing ethical and legal requirements and its current terms of reference. To date organ donation has to be voluntary and unpaid. This means that that the donor should not be compensated in any form.

The Committee is aware of amendments to this law, which are under way, which may allow some form of compensation to be given: the amount and the modality of such compensation will have to be in line with guidelines issued by the Superintendent of Public Health. Until this law comes into force the Committee is bound to follow the exiting ethical and legal practice which disallows any compensation.

The Committee also recognises the fact that the appeal has raised a considerable amount of public awareness to the shortage of available organs, and lauds the potential donors who came forward. In the case of potential kidney donations that do not fall within the category of directed-donation mentioned above, the Committee finds no objection for the screening process to go ahead (once all other ethical requirements as set up above have been satisfied) and the donated organ/s going into a pool from which any compatible prospective recipient may benefit .according to his/her needs, and this on the basis or the principle of distributive justice.

Considering the present legal situation, the Committee is against any form of financial inducement and also against advertising, either with or without any financial inducement, for living organ donation to a directed recipient, as opposed to undirected donation to the transplantation system, for use by any patient who is in greatest need for it.

The committee feels that condoning advertising for the donation of organs for transplantation will mean that those who have the most compelling stories and the means to advertise their plight tend to be the ones to get the organs, rather than those who are most in need. Justice as fairness prohibits such unethical practice.

In the light of the above considerations, it is the opinion of the Committee that this planned transplant should not go ahead.

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