Line Cutting the Organ Transplant Waiting List

Ethics, Personal Writing

This is a reaction paper for my Ethics, Law and Diversity in Strategic Communications class at the Mayborn School of Journalism. This paper discusses a the ethics of Todd Krampitz and his family’s advertising campaign for an organ donation.

Summary of the ad and the scenario

Discovering that a loved one has an extensive cancer that is spreading like a parasite throughout their body would be an tragic revelation for anyone, but how far would people go for the chance to evade the killer of an estimated 577,000 Americans in 2012?

After being diagnosed with advanced cancer that would render it impossible to survive the average 515 days on the transplant wait list, a man and his family took action into their own hands. Drawing from community connections and his church, Todd Krampitz set out to solicit a directed organ donation, where the family of the deceased would request that their loved one’s organ go directly to Todd. His simple message, “I Need a Liver – Please Help Save My Life!” kicked off a national campaign that spanned two billboards along a high-traffic Houston highway, TV ads, media stories and interviews. Within two weeks of the start of his campaign, Todd received a donation from another family. Unfortunately, Todd’s new liver only granted him a short amount of time and he succumbed to his illness eight months after the transplant. It is unknown whether his death was related to his extensive cancer, transplant-related complications or another cause.

His decision to bypass the organ transplant wait list overseen by the United Network for Organ Sharing (UNOS) angered many of the people who were passed over when he received his donated liver. Directed transplants are legal, albeit rare, but Todd and his family’s actions sparked the controversy that he cut in line ahead of people with a greater need. Many of those shirked people and their families believe that Todd’s tactics in advertising for a transplant instead of waiting on the transplant list are questionably ethical.

Todd Krampitz was a successful Houston business owner of a digital photography company and has been described as an upstanding citizen. He married his high school sweetheart of 13 years in March of 2004. A mere two months later, their newlywed bliss was drastically interrupted when Todd was diagnosed with hepatocellular carcinoma (HCC), a rare form of liver cancer in the United States where there is not a hepatitis endemic. According to reports from his family and friends, Todd endured …

According to U.S. Department of Health and Human Services’ Organ Procurement and Transplantation Network, 1,877 of the 16,796 U.S. candidates waiting for a liver donation are Texans as of September 21, 2012.


Reason for chosen strategy

Because Todd’s cancer was terminal, he was given a low MEDL Score (Model for End Stage Liver Disease) and placed toward the bottom of the transplant waiting list. According to a 2009 interview with CBS News, Todd credits his sister with the idea of using billboard advertisements to find him a liver. Todd and his wife explained their reasoning for buying billboard ads in that same interview, “Well, basically, the doctors said we were at the bottom of the list, and we don’t have time to be waiting around.” According to the couple, Todd’s doctors said that his cancer was so advanced that his chances of survival were grim without a transplant.

Perhaps Todd and his family were so frustrated by his grim prognosis, the transplant allocation system and wait list process, and they were so driven to preserve his chances at life that they reasoned they were justified to cut ahead of a long line of hopeful liver recipients were justified. Perhaps they believed that a person with a compelling story and enough connections and/or money is justified in seeking whatever routes available to secure a vital transplant, even if it meant overriding a system that attempts to fairly disperse donated organs to those with the greatest need. From their personal standpoint, Todd’s family and friends probably found this system unfair in deciding a person’s need, prompting them to take control of advocating his need. Rather than letting Todd waste away on the waiting list behind thousands of faceless people, his family and friends decided to capitalize on the sympathy and support surrounding Todd to help save the man they all loved and cared for. Todd and his family and friends probably also believed that his need for a transplant was as great as any other candidate and disagreed with the unfair decision (in their eyes) to assign a lower priority to him.

Supporters have defended the Krampitz’s actions by pointing out that the donor might not have given away their liver had he or she not seen the ads or media coverage. This is a good possibility, if the former owner of Todd’s new liver had not been a registered organ donor; however, we will never know for certain.


Verging on unethical boundaries

By disregarding the transplant wait list, Todd and his support system also disregarded the government’s attempt at a just system for organ distribution in favor of a course of action that benefited him best. By skipping ahead of thousands of equally desperate and needy patients who had been waiting on the transplant list ahead of him, Todd and his family could have cost a person, or many others, their lives. As he only lived an additional eight months after his transplant, critics say that the organ was wasted on Todd and could have better served another candidate.

Using advertising to solicit a directed organ donation borders on ethical lines because it lends the advantage to people who have the greatest reach of resources, in terms of money and connections. Brokering independent organ donation deals would make the already small supply of transplantable organs even scarcer, especially for those who are less fortunate and possess fewer capabilities to do as Todd Krampitz did. It could also lead to discrimination against a recipient’s race or religious beliefs. Advertising for a directed donation also opens the door for a demand that some may fulfill by means of illegal organ trafficking and harvesting.

Using advertising and publicity to identify a donor for oneself may greatly benefit and improve one’s life in the long run, but what about the people who don’t have deep pockets, a resourceful support system, savvy or a story as tragic? Who will advocate for their rights to receive a potentially life-saving organ donation? Many critics of the Krampitz family’s actions say that future of organ donations could be turned into a widespread popularity contest, one that will always favor some over others.


Impacts on society

Soliciting and brokering organ donations through print, media and online advertising threatens to undermine the current system in place, one that preserves a form of fairness in the distribution of organs. Some have argued that not regulating the distribution of organs would further exacerbate the low organ supply, placing the decision at the mercy of a popularity contest. People belonging to a particular religious or ethnic group could be greatly benefited or discriminated against, depending on how resourceful their group is.

Advertising for an organ follows along the lines of ethical egoism, which holds that people should do what is in their best interest and their actions are morally justified if it promotes their long-term self interest. While it is understandable that Todd and his supporters wanted to do everything in their power to help save his life, the question remains: what about society as a whole? Independently brokering an organ donation mean turning one’s back on the rest of the community and taking on a “get yours” mentality. If this trend becomes widespread, altruism would be buried as people become fiercely competitive in hopes of securing an organ donation.

The gift of life, an organ donation, would quickly turn into a trafficking endemic as more people lobby for the scarce supply of transplantable organs. It could fuel the illegal harvest and trade of human organs, placing society at greater risk of trafficking, abduction and sloppy motel bathroom surgeries.


Recommendations for future guidelines towards similar ads

As UNOS and many others have suggested, the government needs to find a way to improve the individual patient’s needs and experience through the entire transplant process while developing policies that are fair to the entire community of people needing organ donations. If society should progress toward independent organ solicitation, perhaps the government needs to regulate how organs can be allocated so that the process is fair and doesn’t discriminate another patient.

A close watch should be kept on the activities of organ-matching services that have sprouted up on the Internet. To protect the public against malicious, fraudulent or predatory activities, the government should ensure that there is a system of accountability against these online services. There also needs to be a thorough evaluation of the benefits versus harm of allowing individuals to campaign for vital organs, especially if the individual’s illness would not be alleviated by a transplant.


Sources list