Search for Transplant Organs Becomes a Web Free-for-All

Internet appeals, proponents say, help everyone by expanding the pool of donors.

"Anyone you can take off that list, regardless of where they fall, is helping others to move up," said Lowney of MatchingDonors.com. "We're not interfering with that system. We're augmenting that system."

But opponents also fear private matching is fostering a lucrative marketplace for selling organs. Lois Greer, 68, of Salem, Va., said she gave up on her MatchingDonors.com listing after getting nothing but offers to sell her a kidney.

"Everyone who responded wanted money. I had one call at midnight asking if I'd pay $50,000. I had one from Peru saying they needed money and needed it bad and needed it fast. I had one who said, 'I have a kidney for you. What have you got for me?' " Greer, a retired machine shop worker, said. "It's nothing but a shame."

The Web sites acknowledge they are plagued by unscrupulous offers. They all post prominent warnings that selling organs is illegal, monitor listings closely and try to weed out anyone trying to offer an organ for sale.

Beyond outright sale of organs, skeptics worry about more subtle deceit. Recipients can legally reimburse donors for medical bills and other associated costs, making it difficult to draw a clear line.

"If I fly somewhere and donate an organ I incur some costs -- my hotel, my food, my babysitter, time lost from my job. But there are ways to inflate the expense of being a donor depending on who wants to know," Arthur Caplan, a University of Pennsylvania bioethicist, said.

By getting to know their donors, recipients are also making themselves vulnerable to extortion, Caplan and others said.

"There's always the risk that the donor, two or three or four years down the road, may have a problem and call the recipient and say, 'Hey, I did a favor for you a few years ago. Now I need you to do me a favor,' " Hanto said. "That's the problem with an arranged marriage, if you will."

Donors, too, could be victimized -- by patients who lure them with false information, or pressure them when they get cold feet. "Once that ball gets rolling, it's a difficult snowball to stop for someone who has misgivings," Fox said. "It becomes very difficult to say, 'I'm sorry. I've changed my mind.' "

In the absence of regulation, the decision whether to perform surgeries involving privately arranged donations is left to individual transplant centers. Most refuse because of the controversy. But some agree after subjecting donors and recipients to careful screening. Supporters say that provides safeguards against abuses; opponents argue that centers use inconsistent criteria and are ill-equipped to play that role.

Many want UNOS to step in to provide some uniformity and guarantee of fairness, but as recently as June, the organization decided against getting involved. It opted instead to simply provide information for donors and recipients through its Web site.

"I don't think we can legislate or regulate how people get to know each other," said UNOS President Francis L. Delmonico. "Once that occurs and someone decides they want to save another person, I don't think we ought to stop that as long as they are medically suitable, are not violating the law and are fully informed."