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Memorandum addresses living donor solicitation

To: OPTN/UNOS Board of Directors

From: Robert A. Metzger, M.D., President

Re: Internet Solicitation

Date: January 12, 2005

The recent publicity generated by the live donor transplant arranged through a commercial website has called to question the appropriateness of public solicitation for live donor organs for transplantation. The United Network for Organ Sharing (UNOS), which operates the National Organ Procurement and Transplantation Network (OPTN), has formed an ad hoc committee to further study the issues involved in public solicitation for donated organs. That committee will make recommendations to the OPTN/UNOS Board of Directors. It is important to re-examine what types of living donor/candidate relationships are acceptable in our changing society. In asking that committee to consider issues relating to live donor transplantation, the OPTN/UNOS Executive Committee recommends the committee to take the following considerations with respect to Internet solicitations into account.

In today's world, innovative ways of initiating friendships are continuously expanding and the internet is playing a major role in this process. Appropriate transplants have occurred between live donor/recipient pairs who have met online. Free, online chat rooms and forums exist where such donor/recipient relationships have developed. Operation of a commercial website for the purposes of matching potential live donors with potential organ recipients raises the issue of whether potential donors or recipients are being exploited financially, although commercial websites can be effective in bringing the parties together to initiate friendships. Nevertheless, neither the live donor nor the candidate/recipient for organ transplantation should be exploited in the donation and transplantation process.

One might ask if use of the internet for initiating potential donor/recipient relationships is acceptable, since not all potential candidates may have access to the internet. But then again, all potential candidates may not have access to churches, synagogues, other places of worship or of employment, where donor/recipient relationships traditionally viewed as acceptable, might occur. Those organizations which develop organ transplant policies and provide transplant services need to continuously evaluate new developments in communication methods available to those they serve. However, absent a meaningful relationship, prospective living donors are encouraged to allow their organs to be allocated according to the principles of equitable organ allocation developed by the Organ Procurement and Transplantation Network.

Transplant centers vary in their approach to live donation, and each center has developed acceptance criteria that are reflective of its philosophy for providing live donor transplantation. These criteria may range from accepting only known relatives or those with close emotional ties, to approving transplants from non-directed donors or those with only distant relationships.

Ultimately, the transplant center, utilizing ethical principles that underscore established standards of care for the donor and recipient, must develop the criteria for the medical and psychosocial acceptance for live donor transplantation at that center.