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Controversial Kidney Transplant Operation Carried Out

Colorado Man Gets Kidney From Tennessee Donor

UPDATED: 6:12 pm MDT October 20, 2004

Setting aside ethical concerns, surgeons completed a kidney transplant Wednesday in what is believed to be the first operation where the donor and recipient met through a commercial Web site.

Bob Hickey met his kidney donor over the Internet.

Presbyterian/St. Luke's Hospital spokeswoman Stephanie Lewis said both the donor and recipient were in good condition following the surgery. She said the transplanted kidney started functioning "almost immediately," which was a good sign.

Before the operation, Bob Hickey, 58, met with Dr. Igal Kam, the surgeon whose objections initially postponed the transplant. The meeting was described as a time for "healing the scars of the last several days."

Kam suddenly cancelled Monday's transplant operation after learning that Hickey had met his donor, Robert Smitty, 32, of Chattanooga, Tenn., through a Web site called MatchingDonors.com. Smitty agreed to give Hickey one of his kidneys before the two men ever met. The hospital later said the operation was only "postponed."

Hickey, of Edwards, Colo., has needed a transplant since 1999 because of a kidney disease. He said he was tired of waiting on the national donation list.

The hospital's Clinical Ethics Committee met on Tuesday to evaluate concerns about the transplant, including whether either Hickey or Smitty stood to profit from the arrangement. The panel later advised the hospital to make a compassionate exception, once both men had signed statements indicating that neither would benefit financially.

"We're pleased we were able to resolve this quickly with a compassionate exception. But it's also important to note that organ donations continue to be the topic of a broader national debate and more answers are needed," Mimi Roberson, chief executive of P/SL in Denver, said in a statement.

Roberson insisted, however, that the granting of an exception in this case was not to be construed as an endorsement by the hospital of MatchingDonors.com and said officials would give greater scrutiny to such arrangements in the future.

By finding his own donor, Hickey bypassed the waiting list maintained by the United Network for Organ Sharing, the nonprofit group that works under government contract to allocate all organs donated from the dead. It doles out organs, in part, according to which patients need them the most.

The network does not oversee the increasing number of live donors, such as Smitty. Last year, there were 6,920 living donors compared with 6,457 dead ones.

University of Pennsylvania bioethicist Arthur Caplan said the first ethical issue raised by Internet donations is financial: Not everyone can afford to pay MatchingDonors.com's fees or donor expenses.

"Those who are better off are going to have access to people as potential donors that the poor or the shy won't have," he said.

Caplan also said the Web site did not highlight potential hazards for donors. "Their job is to make these matches happen," he said. "They're not in the business of trying to discourage anyone or warn them."

MatchingDonors.com, based in Canton, Mass., charges varying fees to post profiles of people looking for live organ donors. The company says all its profits go to maintain the site, and they have no problem waiving their fees.

"If people can't afford it, we get them on it anyway," said Dr. Jeremiah Lowney, the medical director for MatchingDonors.com and a specialist in internal medicine.

Hickey paid the site $295 per month for three months. He is also expected to pick up about $5,000 in transportation costs and other expenses incurred by Smitty. Within three months of posting his profile on the Web site, he received 500 offers for donations.

UNOS came out against MatchingDonors.com in June, saying it "exploits vulnerable populations and subverts the equitable allocation of organs for transplantation." UNOS spokesman Joel Newman said the network is concerned when anyone puts his or her need for an organ above others.

"An organ that becomes available with certain medical characteristics should be offered equally to the people that could benefit from it," he said.

Typically, transplant patients find living donors on their own. Most living donors, though, are family, friends and others who have a personal connection to the patient.

Strangers have occasionally met over the Internet, but the MatchingDonors.com Web site is the first to systematically try to match donors and patients online.

Federal law prohibits the sale of organs, but it does allow payment for living donors' expenses, such as time lost from work or airfare to the hospital.

The Colorado hospital went ahead with the operation after granting what it called a "compassionate exception."

But Mimi Roberson, the hospital's chief executive, insisted that the granting of an exception is not to be construed as an endorsement of MatchingDonors.com and said officials will give greater scrutiny to such arrangements in the future.

"They're allowing me to do something just good for this man," Smitty, a part-time photographer and food distributor, said before the operation. "Maybe they went and found out I don't have a million dollars in the bank somewhere. I feel grateful, privileged to be wearing the shoes I am."


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