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,
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 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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