When Janet Newens was a teenager, she lived above a doctors' surgery. A bright and energetic child, her parents were quick to notice when she went off her food and did not seem to be interested in drinking much. After two check-ups at hospital, doctors were little the wiser as to what was wrong. It was the 1980s.
No one knew that Newens, from Warrington in Cheshire, was slowly being poisoned by the toxins increasing daily in her body. Her kidneys were failing in their job of cleaning the body of its waste. When one of the doctors from the surgery downstairs saw her condition she was rushed to hospital.
'There was an ambulance with a police escort,' Newens said. 'They said that if the condition had not been recognised I could have been dead in a few hours.'
Newens had kidney failure. Although there is limited treatment for the disease, the one way to find a complete cure is to have a kidney transplant. After two years of dialysis (the mechanical cleaning of the blood in hospital, which takes hours at a time), her brother was found to have the correct tissue match and donated one of his two healthy kidneys. Newens was able to rediscover a life of normality.
'It was wonderful, not to go through hours every week in hospital,' she said. Five years later, as is often the case, Newens's body rejected the kidney after she suffered a chest infection. She has been on the waiting list for another kidney ever since.
Newens's case reveals a growing problem. There are 7,000 people in Britain waiting for kidney transplants. The number of transplants every year is about 1,400. People wait for years, decades, in pain, in the faint hope that one day they will receive the call from the hospital that will return their life to normal.
'When I realised I would have to go back to dialysis, it hit me like a ton of bricks,' Newens said. 'I am in hospital four hours a day, three days a week. I can't work or live a normal life. My arms are full of scars from all the injections. I just keep waiting for good news.'
Now leading members of the medical world are beginning to think what was once unthinkable: should people be paid for donating live organs?
Sir Peter Bell, vice-president of the Royal College of Surgeons, professor of surgery at the University of Leicester and one of the most eminent transplant surgeons in the country, is leading the debate. Speaking to The Observer , Sir Peter said that, although he could see no way forward in paying people abroad to donate kidneys, the payment of relatives in Britain, under governmental control and the NHS, should be considered.
Sir Graeme Catto, president of the General Medical Council and an expert in kidney transplantation, has also said that, however distasteful it may seem, it is time for the Government to consult on the issue.
'[Payment for organs] is illegal in this country and the vast majority of people find it distasteful, but nevertheless it is one way of obtaining more organs and it needs to be discussed,' Catto said in an interview last week.
The issue raises high emotions. Last week Jarnail Singh, a family doctor who was willing to help a dying man buy a kidney for transplant in India, was suspended for six months for serious professional misconduct.
In August, another doctor, Bhagat Singh Makkar, 62, was struck off the medical register for acting as the middle man in the purchase of kidneys for transplantation in India and Britain.
Few medical experts countenance the legalisation of such a trade. Bell makes the point that, as it is relatives in this country who most often have the right tissue match to donate a kidney, then a 'compensatory payment' is reasonable.
The Government is considering changing the 1989 Human Organs Transplant Act, which bans payment for donors. In a consultation document sent out in the summer to medical experts and patient groups, the Department of Health asked: 'Should the prohibition of commercial dealings in organs from living and/or deceased people remain? If not, why?'
If there were ever any doubt about the number of people in the world desperate for a new kidney, log on to the Yahoo! internet search engine and type 'kidney donor needed'. The pleas for an organ donor come in all forms, from a young girl in Singapore to a 30-year-old American businessman. Along with the pitiful messages, there are emails from men and women who are keen to earn extra money by offering a healthy kidney. It is a seller's market. It may be dangerous, dishonest and disreputable, but it is undeniably happening.
Some British surgeons want to go further than simply having a debate. Professor Nadey Hakim, director of transplant surgery at St Mary's Hospital in west London, believes the Government should set up a regulatory system so a fixed fee could be paid to patients prepared to donate a kidney, which would go to those most in need.
'The comparison I would make is to the days of back-street abortions, when a poor girl would go to some shabby house, have the procedure performed in a dirty room, and end up dying of an infection. We legalised abortions, and it saved many women's lives,' said Hakim.
'Now what are we seeing? Patients are going to Israel, Turkey, Iraq, India and the Philippines, paying $10,000, or much more in some cases, and coming back with infections. They put their lives in danger and that of the donors, but they do it because they are desperate.'
He believes Catto has been brave to speak publicly on the issue, and disputes that selling a kidney means premature death for the donor. 'If we did this in a regulated way, the donor would be healthy to start with, and their life expectancy would be no lower than someone with two kidneys,' he said. '[The donor] would be checked for diabetes or high blood pressure, and followed up for years afterwards.'
The moral conundrums over paying for part of someone's body rage on, but the levels of demand are not in dispute. As of this week, there are 7,040 people in the UK waiting for a transplant, and 6,249 of them are in the queue for a kidney. So far this year, 147 kidney transplants have taken place - 892 taken from dead donors and 255 from living relatives. A brother, sister, child or parent can donate a kidney - provided they are the right blood type, and they are themselves healthy.
During the last 30 years, organ transplants have become more common, but as the demand for organs increases, so there is a need to find more donors. In Britain, which outlawed the sale of body parts in 1989, organs can be 'harvested' from bodies as soon as the person is certified dead. But the patient, or relatives, have to give their consent for this.
Doctors have suggested a system where organs can be automatically removed unless a patient specifically does not want this, under a system of 'presumed consent', which exists in Spain but has been resisted here. As the number of serious road accidents falls, so does the number of potential donors. It is an unpalatable fact that the improvement in road safety has made the chances of a seriously ill kidney or heart patient receiving a transplant less likely.
The British Medical Association and others have come down firmly against the idea of a regulated organ trade, although the issue is often discussed in its committees. For a profession whose Hippocratic Oath says 'First, do no harm', many doctors believe a permitted selling of organs would cross a line from which there would be no turning back, and would lead to the wholesale selling of embryos and other organs.
But it is worth remembering that the organ trade is fed by the desperation of patients, someone like Allison Pack, who has been waiting nine years for a kidney to be available after the first kidney transplant she received in 1987 resulted in renal failure. Her page on the Yahoo! site says it all. 'My family and friends join me daily in praying for a kidney. Please I beg of you to find it in your heart to help me by donating a kidney ... PLEASE!'
