Bob Hickey posted the story of his quest for a kidney online where he met a young man who agreed to give him one. The actual transplant, however, nearly didn't happen Wednesday after word came that Hickey had paid some of his donor's travel expenses.
Doctors were concerned the payments could be construed as paying Rob Smitty for the organ. Federal law prohibits the selling of human body parts.
A Utah expert on organ donation believes the story shows two big problems with living donations such as Samaritan kidneys.
"To me, this case identifies the growing demand" by people who are in need of organs (60,000 Americans wait for kidneys), said Tracy Schmidt, executive director of Intermountain Donor Services, which coordinates organ donations for Utah and the surrounding area.
It also shows, he said, there are "people willing to donate in an altruistic way. What's not being met is some way to resolve these issues. We need someone at a national level to put this together and coordinate" for living donations.
Matching Donors, the site where Hickey posted his story, demonstrates that there's "no national system right now" to bring donors and recipients together from different areas, said Schmidt. Individual transplant centers coordinate anonymous kidney donations but not for the entire area. Intermountain Donor Services is one of only three in the nation that coordinate for an area.
That may change. The United Network for Organ Sharing, which oversees transplants involving cadaver donations, is considering whether to include living-donor transplants.
Schmidt thinks that's likely sometime in the future. But that doesn't solve the problem of bringing Donor A on the West Coast together with Recipient B in the South for a life-saving transplant now.
The Web-page owners, he said, may simply have recognized a need and decided to help fill it. As for the cost, "the goal may very well be altruistic, and they came up with the $300 (charge) to break even."
Or not, he said, adding that's another reason coordination, monitoring and regulation are important.
The second issue is reimbursement of expenses incurred by the donor. In this case, Hickey reportedly reimbursed Smitty for his travel and some incidental expenses, to the tune of several thousand dollars.
Paying for direct recipient expenses is not considered unethical, Schmidt said. But it's tricky and raises some questions. What is a reimbursable expense? How much is reasonable and where do you cross the line into buying the organ? And beyond that, does it mean someone who can't afford to reimburse a donor for expenses will not be able to find a donor?
"This issue of reimbursing travel expenses has been out there quite a few years in living donation," Schmidt said. "Some federal bills are trying to add that as an item that can be reimbursed through federal dollars. That makes sense."
It would also provide guidelines and oversight so it wasn't abused, he said.
The anonymous donor program works great if the recipient and the donor both live in Salt Lake City, he said. But it's harder if the donor has to come up from St. George or down from southern Idaho, pay for travel and housing and more. And not everyone has local friends or family who can put them up. Some people can't afford to donate, with those added expenses.