First organ transplant brokered via Internet underway

DENVER -- A Colorado man underwent surgery for a new kidney Wednesday in what was believed to be the first transplant brokered through a commercial Web site -- a transaction that has raised a host of ethical and legal questions.

Presbyterian/St. Luke's Medical Center spokeswoman Stephanie Lewis said the operation on both the donor and recipient was going well.

Bob Hickey, who lives in a mountain town near Vail, has needed a transplant since 1999 because of a kidney disease. He met donor Rob Smitty of Chattanooga, Tenn., through MatchingDonors.com, a for-profit Web site created in January to match donors and patients for a fee.

"Sitting on a waiting list and hoping for a new kidney for so long, your attention is attracted to anything that might help you," the 58-year-old Hickey said a few hours before the operation.

The transplant had been scheduled for Monday, but doctors called it off at the last moment to look into whether either Hickey or Smitty stood to profit from the arrangement. Both men said no money changed hands for the organ, which would violate federal law.

Ethicists said they still have serious concerns about MatchingDonors.com and the rise in the number of donations from the living.

There are no laws against soliciting an organ donation, but by using the Internet, Hickey bypassed the United Network for Organ Sharing, the not-for-profit 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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Laura Meckler contributed to this story from Washington, D.C.

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On the Net:

United Network for Organ Sharing: http://www.unos.org

MatchingDonors: http://www.matchingdonors.com

THE SURGERY

A man underwent kidney transplant surgery in Colorado on Wednesday after finding a donor through the Internet.

A FIRST

It is believed to be the first transplant brokered through a commercial Web site.

CONCERNS

Medical officials say such transactions raise ethical concerns. The biggest: Not everyone can afford to pay the Web sites' fees or donor expenses.

PROGNOSIS

The hospital said the donor and recipient were doing well after the surgery.