German transplant surgeon Christoph Broelsch embroiled in payment for live donor dispute.
On March 15, 2002, the British Medical Journal reported on the scandal in a news round-up. At this time, the Jena University Hospital has banned all transplants using organs from living donors, and the German Medical Council, the Bundesarztekammer, is currently conducting an investigation into possible misconduct by Broelsch.
The story begins on December 6, 2001, when the controversial transplant was performed by Prof. Broelsch at the Jena University Hospital. This was not usual. Broesch's his own hospital is in Essen; however, the hospital's ethical committee had turned down the operation because of doubts about the relationship between the Israeli recipient and the donor, who was said to be his Moldovian nephew. According to German transplantation law German transplantation living donation is permited only if donors and recipients are relatives or close friends. Independent hospitals in hospitals are charged with excluding commercial interests. The Jena hospital did not have such a committee at the time, leaving Broelsch free to perform the transplant without resistance.
A few months later, on February 11 2002, the magazine (newspaper?) Arzte Zeitung described the curious events around the Jena operation, including refering to an anonymous letter in which Broelsch is accused of organ trading. 'Ridiculous' said Broelsch in response to the article in the Arzte Zeitung. 'The anonymous letter is of no significance. It is well known that there are opponents to living donation and furthermore: I have personal enemies.'
In June 2002 Broelsch organized an International Symposium on Living Donor Organ Transplantation in Essen. At the conference, Broelsch said discussions should begin on offering financial remuneration for living donation of kidneys or liver segments.
The guest speaker at the symposium was Professor Gary Becker, a Chicago economist and Nobel Prize winner, who talked on Aspects on the Economics of Organ Donation. According to the June 13, 2002 issue of German weekly Die Zeit, Becker told the audience his interest in transplantation - not his usual speciality - was initially aroused by the long wait for organs under the present system and the resulting development of a black market.
"When an economist sees that sort of phenomenon, his conclusion is inevitably that price control is not working," Becker said, adding that a black market arises when artifical restrictions are imposed on it. Even a moderate payment for organs could "close the gap between demand and supply" and make the illegal market superfluous, he said.. Becker had also thought about prices: $10,000 US for a kidney, twice as much for a part of the liver. The prices had to be payed by insurance or by the state.
Broelsch, already an advocate of testing payment donation, obviously had an a open ear for Becker's theory. In the newspaper Deutsches Arzteblatt, June 21 2002, he proposed giving organ donors a premium to increase the number of donors. Broelsch said,
"With hope and altruism alone we will not be able to improve the situation. I plead for the acknowledgement of organ donors. In what form - that is for the society to decide. Maybe a tax reduction for everyone with a donor card.'
Reacting to Broelsch controversial statements the German Medical Council, the Bundesarztekammer, published a press release on June 24, 2002, stating that organ donation should not be linked with financial stimuli and that it rejects every commercialization of organ donation. It would be ethically reprehensible when healthy people are incited to donate an organ for purely financial motives, the release said.
Broelsch responded the the council's objections in a press release from Essen University in July 2002. Again he pleaded for a donor premium in the form of a tax reduction. "Why not insure the risk of a living donor by the health insurance of the recipient? Whoever contributes to organ transplantation, contributes to cost reduction in health care!" he said.
In December 2002 Die Zeit published an article about illegal organ trade in which Modolva was cited as a major souurce of living donors, the country where the 'nephew' in Jena came from. Die Zeit reported that the Israeli patient who received the transplant from the Molovan stayed in the Sheraton Hotel in Essen, while the poor Moldovan "nephew" did not. Broelsch, asked to comment on the article, maintained an organ sale was out of the question and did not take place.
Finally, on March 1 2003, Der Spiegel wrote about the payment of "several hundred thousand dollars" to an Israeli agent for an all-inclusive contract: the search for a matched donor, the journey and the operation in a German clinic. In addition, the magazine reported other controversial kidney transplants had been performed under Broelsch's direction. Der Spiegel said three other donors from Moldova, Ukraine, and Russia, all allegedly cousins of the recipients, had donated their kidneys in Essen. Broelsch commented again that he did not to know whether any payment was made.
At the time of this writing, the Jena University has initiated a ban the transplantation of organs from all living donors. And in a press release the Bundesarztekammer repeated that human organs are not to be sold and said it will begin an investigation on potential misconduct carried out 'by individuals or institutes'.
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|Author:||Van Putten, Bart Meijer|
|Date:||Apr 14, 2003|
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