This Friday, a Dutch TV station will air a reality TV program in which a terminally ill woman picks one of three people to get her kidney.
The 37 year old would-be donor, "Lisa," will choose the lucky recipient based the contestants' personal story and conversations with their family and friends. And although only Lisa will pick the recipient, viewers can voice their preference, a la American Idol.
"It's a crazy idea," said Joop Atsma, a member of the ruling Christian Democratic Party, which is trying to prevent the show from being broadcast on BNN. The Christian Union has also condemned it.
It's crazy alright. And, yes, sick and shocking. But despite my discomfort, I'm for it. Sensationalism is a powerful way to call attention to the desperate shortage of kidneys and to the tens of thousands of needless deaths each year that occur all over the world because not enough altruistic donors step forward.
Indeed, the very idea behind the De Grote Donorshow (The Big Donor Show) is to shine a spotlight on the plight of patients who need a kidney. The show is intended as a tribute to the founder of the network -- Bart de Graaff --who died in 2002 at age 35 because he could not survive the years-long wait for a new kidney.
"We think that is disastrous," said the BNN chairman Laurens Drillach to the BBC, "so we are acting in a shocking way to bring attention to the problem."
Talk about reality. In the U.S., 71,000 people need a renal transplant. They will spend, on average, five years on dialysis while waiting for an organ from a deceased donor. At least half will die or become too sick to undergo a transplant before their name is called. By 2010, the wait will be at least ten years, exceeding the average length of time that adults on dialysis survive.
Crushing as it would be not to be selected to get Lisa's kidney, the patients are no worse off. The odds of getting a kidney -- 33% -- are higher for the three participants on the show than for those on the conventional waiting list. The two who do not win simply go back on the list, hook themselves up to their dialysis machines... and wait. It's a cruel calculus any way you look at it.
The Big Donor Show is likely to lead to more awareness about shortages of kidney transplants. Hopefully more people will sign their organ donor cards so that their kidneys, and other vital organs, could save others upon their death. But part of the education will need to emphasize that deceased donation, while enormously important, will not be enough. Very few of the Americans who die, perhaps 13,000 a year (or less than 1 percent of all deaths), possess organs healthy enough for transplanting -- so even if every family consented, the need for thousands of kidneys would go unmet.
More people need to consider relinquishing a kidney while they are alive.
Thus, the BNN and "Lisa" might consider a sequel, called the Big Donor Surgery and Recuperation. There have already been many televised medical shows on organ surgery donation, so no new reality ground will be broken here. But what the public will appreciate is the relative safety of donation, the new techniques which leave minor scars and allow the donor to leave the hospital after only 2 or 3 days.
By de-mystifying the living donation process itself, more friends of relatives of renal patients might well be willing to donate. In the U.S. last year, only about one in ten individuals waiting on the kidney transplant list received an organ from a friend or relative. Reasons for not donating are complicated, of course, and must be respected, but surely some potential donors fail to give because they are anxious about the procedure.
The Dutch kidney show is getting a lot of attention internationally. And while many understandably recoil from its stunt-like quality, the painful reality of needless death hits home in any language. Indeed, it is desperate patients who refuse to wait and die who feed the shady global black market in organs.
I sympathize completely. When I needed a kidney last year, I endured a roller-coaster ride of hope and devastation as friends who promised to donate eventually fell through. I considered becoming a so-called transplant tourist. It made me too nervous, but I did go online to a donor/recipient matching site where I wrote about myself in an "ad" for viewing by prospective donors and hoped someone would pick me. Thank goodness, a wonderful friend came along, but I know how many others are not as lucky as I was.
So here is another idea for consideration: compensating living kidney donors. The alternative is to create a larger supply of organs -- and the most likely way to achieve it is through a safe, regulated system in which donors can receive compensation for their organs. This idea has long been taboo, but as thousands continue to die every year because of existing organ shortages the idea is being taken more seriously -- and it should be.
A growing number of physicians, legal scholars and ethicists are urging pilot studies of a regulated system with strong donor protections. This would require Congress to amend the 1984 National Organ Transplant Act so people who give organs could receive "valuable consideration." Such consideration could take many forms, perhaps something as simple as offering them lifelong Medicare coverage. This could also serve as a compelling incentive to other prospective donors. Or Congress could grant waivers so that states can implement their own creative incentive ideas, perhaps using tax credits or tuition vouchers.
The U.S. and other European countries need to move beyond the idea that organs must be relinquished as gifts. The altruistic motive is deeply noble and loving. But relying upon it as the sole legitimate reason for giving an organ is causing too many unnecessary deaths.
So, despite my deep unease about such a startling, in-your-face production like the Dutch Big Donor Show, I applaud its producers if it can galvanize interest in the organ shortage and raise pressure for governments to take bold steps.
Sally Satel is a resident scholar at the American Enterprise Institute.