Would you take money for a life?

Now the Department of Health is thinking the unthinkable: paying relatives to become donors. But is this a step too far? Health Correspondent Barry Nelson reports.

THE idea that relatives should be paid to become kidney donors is greeted with utter disbelief by John Paul. The 25-year-old foundry worker from Peterlee donated one of his kidneys to help his younger brother, Jamie, two years ago.

It is something he is proud of and has never regretted for a moment. But to John's amazement, the Department of Health has raised the issue of paying relatives to donate kidneys in a low-profile consultation document.

The waiting list for organ transplants is lengthening and the number of operations carried out every year seems to be in long-term decline.

But John is unimpressed. "I think it's a pretty sad state of affairs if you have got to offer somebody money to save a relative's life," says John, who was 22 when he donated a "spare" kidney to his 21-year-old brother.

"You could really hold out for the money, couldn't you? I think it is pretty sad."

The revelation that the Department of Health is carrying out a wide-ranging review of transplant policies in the UK has led to speculation that radical solutions to the problems of increasing the number of donated organs may be under consideration. One of the questions being looked at is "whether the prohibition of commercial dealings in organs from living and/or deceased people should remain."

It is understood that this could mean offering to pay relatives to become kidney donors. Even the highly controversial issue of importing donor organs from abroad appears to be part of the review. As a Department of Health spokeswoman puts it: "Nothing has been ruled in or out."

But donors, patients who are waiting for transplants and the staff who run the North-East's transplant service appear to be united in their rejection of payments.

John Paul is adamant: "You do it for the love of your family, really. As far as buying organs from Third World countries is concerned, I don't think it's right. It is exploiting people who need the money to survive. It is also going to be a nightmare to screen people to make sure you get a healthy organ."

John has thrived since he donated his kidney, making a full recovery within a few months. Now he is enjoying physical sports like rugby and kick-boxing and living life to the full.

"I feel great. I've been selected to play for the county. I'm doing even more martial arts than I used to. It's what I enjoy," he adds. His brother Jamie is "fit as a fiddle" and at college.

But what about the people waiting patiently for a transplant?

Kevin Murray, from Darlington, has been on the waiting list for a kidney transplant for nearly a year. Four times a week he visits the renal unit at Darlington Memorial Hospital to undergo dialysis which keeps him alive.

But Kevin is just as uneasy about paid organ donors as John Paul. "I don't see how a relative would want to be paid. If you are a relative you do it for love, don't you? If I was going to give an organ to one of my family I wouldn't want any money for it."

Kevin, 44, feels strongly that more should be done to publicise the organ donor register and encourage people to speak more openly about their wishes after death. And the idea of importing organs from poorer countries holds no appeal for him.

The nurse who approached John Paul about organ donation more than two years ago is Mandy McGowan, who since 1999, has been the full-time transplant facilitator at James Cook University Hospital in Middlesbrough. The main aim of her job is to persuade families to consider organ donation.

Because organs donated from a close family member have the best chance of a close tissue match to the recipient, so called "living-related" donation is regarded as the best possible solution for patients on the waiting list.

Mandy is equally adamant about payment. She says: "I've spoken to our consultants and we all feel the same. We don't think it would be a good idea to go down the road of paying potential donors."

She is keen that living-related donors are fully compensated for loss of earnings while they recover, but in many cases that already happens, thanks to sympathetic employers. "Unfortunately, some will only pay statutory sick pay and that can mean a considerable loss of earnings," she says. If this happens there is cash within the NHS which is available to help people out.

"Most of our potential donors do it because of affection for a family member but we even have husbands and wives and even long-term friends who are willing to donate, provided they are a good tissue match," says Mandy.

While she accepts that something needs to be done nationally to increase the number of transplants, she is optimistic at the progress made locally.

A combination of advanced "keyhole" surgery offered by transplant surgeons at the Freeman Hospital in Newcastle and greater awareness of living-related donations has boosted the number of transplants from relatives cared for by the Teesside unit.

"We used to do about one living-related transplant a year. So far this year we have done eight. Hopefully, by the end of the year we will be above the national average of 15 per cent of all transplants," she adds.

Keyhole surgery reduces the time taken to recover from donation from around 12 weeks to as little as a month. It also leaves a much smaller scar.

Mandy would like to see a more active promotion of living-related donations. "We shouldn't be frightened about mentioning this to families. Often they say it never entered their minds," she adds.

Sandra Latimer, a transplant co-ordinator at the Freeman Hospital, is also against payment for donation, even though there are 160 people on the hospital's kidney transplant waiting list and only 78 transplants have been done so far this financial year, compared to 95 during the same period last year.

"If you start to pay, then would you be encouraging the right people to come forward?" she says. Nightmare scenarios of people being kidnapped for their organs might not be too far-fetched if the rewards were high enough, she adds.

One of her biggest concerns is that payment could have an impact on families who allow the organs of dead relatives to be used to help others. "This could impinge on multi-organ donation which is our biggest pool of organs."

Sandra is even uneasy about the "presumed consent" option which is being pushed by the British Medical Association. This mirrors the situation in much of Europe where it is assumed that organ donation is permissible unless someone has registered their opposition. Transplant co-ordinators have repeatedly voted against this solution to the organ shortage at their annual conference.

According to UK Transplant, the NHS-funded agency which co-ordinates transplant services, the long-term outlook for patients on the waiting list is worrying. "Organ transplants have been in decline for ten years but waiting lists have been increasing," says Maxine Walter, spokeswoman for UK Transplant.

Ironically, part of the reason for the lengthening queue is the success of transplantation as a solution to serious health problems. Other reasons are well-known - better hospital care and fewer serious road accidents.

Currently there are around 5,500 people on the list for all forms of organ transplant. Normally, the service expects to do around 2,700 transplants annually. Ominously that figure is down this year. Unless things change, the estimated 1,000 patients who die on the waiting list will increase.

For John Paul, the best reward is to see his brother Jamie enjoying life. "Since the transplant he is a totally different person. He can do what he wants," he says. "No amount of money could equal that."

To be a donor you need to join the register, either by calling 0845 6060 400 or by enrolling on-line at www.nhs.uk/organdonor and you should also make your family and friends aware of your wishes.