Organ donation: 'He's giving my life back'

Derek Marshall is giving one of his own kidneys to save the life of his friend, Bill Brough. But, says Jeremy Laurance, there is still a desperate shortage of organs, and now some doctors are beginning to think the unthinkable: payments for donors

It may be the nearest a man can come to giving birth – delivering a part of his body to sustain another life. In a couple of weeks time, Derek Marshall will donate one of his kidneys to his lifelong friend Bill Brough. Both know that without a new kidney, Bill, aged 54, will die before his time. Both have also been told by doctors that Marshall, aged 56, will not shorten his own life by giving up one of the precious organs. Indeed, by a statistical quirk, Marshall's life chances will actually improve once he has undergone surgery. Yet the operation both of them are about to have remains astonishingly rare in Britain.

Although they are not the first friends to enter into this most unusual contract, Marshall and Brough may be harbingers of a change that could transform transplant surgery in Britain. There is a desperate shortage of organs for transplant, especially kidneys, and each year thousands of people die in Britain for want of one.

In the first 10 months of this year to the end of October just nine people had received a kidney from a friend. A further 297 had received kidneys from living relatives or spouses, and 1,026 from dead donors. That left 4,956 still waiting. Many of them will die before they get a transplant.

More friend-to-friend transplants could therefore save lives. Relying on a spouse to be a donor depends on their being a good match. Opening up the pool of potential donors to friends increases the chances. And this raises an even more radical idea – donation by strangers. Some doctors think financial inducements should be offered to encourage people to donate their kidneys.

Women who rent out their wombs to others in surrogacy arrangements are permitted by law to charge expenses (but not a fee). The idea of similarly compensating kidney donors for their time, suggested by some specialists, is being considered by a Government committee set up to review the transplant system.

For Marshall and Brough, money did not enter into it. Indeed, under the rules, careful checks are made to ensure that Marshall has not been put under any pressure to make his donation. The two men have known each other since primary school in Middlesbrough where they both still live. They were inseparable as children and their relationship survived into adulthood. Marshall was best man at Brough's wedding and is godfather to his two daughters.

Brough runs a shipping business and had just returned from a trip to Mexico in 2001 when he developed Legionnaire's disease. He was in intensive care for three weeks and when he recovered he was told his kidneys were permanently damaged. When Marshalllearnt of his friend's predicament he wrote a long and "very touching" letter to the hospital, offering one of his own kidneys to his friend, according to consultant Stephen Kardasz.

A battery of tests were begun to check that Marshall was medically fit, under no coercion and that his kidney was compatible with Brough. This is less critical than was thought in the past – matching blood groups is usually sufficient. Each man was allocated a separate consultant and then the case was referred to a third consultant before being sent to the Unrelated Live Transplant Regulatory Authority (Ultra) which vets all such applications.

Although he is apprehensive about the surgery, Marshall says his decision was unavoidable. He talked it over with his wife, a nurse, and two grown-up sons before volunteering. "Kidneys are in short supply. Bill's condition would deteriorate over the years, but I can fix things with one of mine," he said. Brough is tearful when asked about Marshall's gesture. "It is simple, really. Derek is giving me my life back."

The main task at each stage of the assessment is to ensure that no pressure is being applied and that the relationship between the friends is genuine. For that Ultra needs to see evidence that it is long-lasting and not a relationship of convenience that has been forged with payment.

Emotional pressure can be a factor too. Dr Kardasz said: "We do get that from families sometimes. I heard of one guy who was put forward as a donor by his family. He was sweating buckets – it was quite obvious his heart was not in it. So the doctors told a white lie – that he was not a good match and the transplant was not going to work."

Once it is established that the donor is acting of his or her own free will, their health must be assessed. "We only take them if they are in tip-top condition – they need to have both kidneys functioning well and they need to be medically fit," Dr Kardasz said.

One bizarre result of this assessment is that once a person has passed it, their life expectancy is greater than that of the general population and their chances of suffering kidney failure are lower, even after one of their kidneys has been removed. But there is a risk that they will fail the assessment. "People have to understand we will be doing intrusive tests and we may turn something up – such as a hepatitis C virus – that they may not want to know about," Dr Kardasz said. Despite these hurdles, the proportion of living donors has risen in the last few years. About one in five of all kidney transplants is from a living donor, the vast majority blood relatives or spouses.

An urgent debate about how the proportion of living donors can be increased is taking place within the transplant community. Professor Sir Peter Bell, the vice-president of the Royal College of Surgeons and professor of surgery at the University of Leicester, said "compensatory payments" should be made to relatives who donate a kidney to a family member.

Professor Bell made his suggestion as a way of staving off the growing trade in kidneys from the Third World. Two British GPs have been found guilty of serious professional misconduct by the General Medical Council in the past four months for becoming involved in organ trafficking.

Professor Sir Graeme Catto, the president of the GMC and a kidney specialist, has also called for a debate on the issue, backed by transplant surgeons such as Andrew Ready, the head of the renal unit at Queen Elizabeth Hospital, Birmingham. These specialists argue that it is impossible to stop desperate people who are facing death from taking whatever chance they can. Far better, this argument goes, that the trade is regulated and made safe than that it is ignored and left to flourish as a black market that exploits the Third World and puts lives at risk. Mr Ready said: "Increasingly we have to look at newer concepts and some may argue that there may be a role here for financial incentives."

There is no support within medical circles for legalising the organ trade as it stands. But some specialists have proposed that the state should purchase organs from willing donors that would then be pooled and offered to patients in order of need. This would protect vulnerable patients and donors from the risks involved in a direct commercial transaction, and boost the supply of organs.

Earlier this year, a survey by specialists at Queen Elizabeth Hospital in Birmingham showed at least 29 NHS patients had travelled overseas for kidney transplants, against medical advice. In over half the cases, the kidney failed and one third of the patients died. For Mr Ready there is a lesson to be learnt: "It is the plight of these individuals, the desperation they are pushed into, that should highlight the need for improved donation."