Ethics committee rules organ donation: ‘a selfless gift without expectation of remuneration’

The Live Organ Transplant Advisory Committee (LOTAC) has decided that organ donation to specific donors by patients or their relatives against payment will not be allowed.

In a press release, LOTAC chairman Carmel Mallia said an urgent meeting was held last Wednesday at the request of Mater Dei Hospital CEO Joseph Caruana. The committee was reacting to an advert on MaltaPark, offering €5,000 as compensation for the donation of a kidney.

Some 20 donors have already come forward.

"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," the LOTAC chairman said. 

"Justice as fairness prohibits such unethical practice. It is the opinion of the Committee that this planned transplant should not go ahead."

The committee explained that 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," Mallia said.

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 said.

Mallia added that the Committee was convinced that the responses following 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," Mallia insisted.

He added that the Committee was aware of amendments to the 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 has to follow the exiting ethical and legal practice which disallows any compensation," Mallia said.

"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 found no objection for the screening process to go ahead - once all other ethical requirements as set up above have been satisfied - and the donated organs going into a pool from which any compatible prospective recipient may benefit according to the needs.

"This on the basis or the principle of distributive justice," the Committee stressed.

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.