Kidney ClarityWhat\'s Really at Stake

Peter Catsimpiris - Contributing Editor

The monumental confusion surrounding the issue of organ sales in recent discussions that have appeared in The Brown Daily Herald can be avoided by examining the values held in common by members of both sides of this debate. We would all like for two things to happen: first, we would like individuals (especially the poor) to benefit from the sale of redundant organs (barring the “exploitation” argument I will examine later); second, we want the best possible allocation of these scarce resources. This column will argue that both values are best served by a legal marketplace for organs, and that this solution also best respects human dignity.

With the prohibition of organ sales, neither of our values is achieved. An impoverished father with no kidney problems is forbidden from selling one of his kidneys for a king’s ransom and providing his family a better standard of living, while nearly 75,000 dialysis-receiving Americans are playing a game of medical “musical chairs” with roughly 13,000 “seats”! In a recent article in the Herald, “Opting for Organ Sales,” Hope Henderson ’08.5 nobly suggests legalizing organ sales, but with a government monopoly on organ purchases, which she recommends, although there will likely remain a shortage (remember Economics 101), and individuals wishing to sell will not be able to get top dollar. Both of our aforementioned values are thus partially unfulfilled.

But what if we allow market forces to determine organ allocation? Are the impoverished going to tear kidneys out of their torsos in desperation while the rich stockpile vital organs in their house-sized freezers and the destitute go without? Let us consider. First, by legalization, we obviously maximize individuals’ economic benefit from organ sales, securing our first value. But what about our other concerns? Remember that surgeons are licensed and the Red Cross, et al, exist as a function of charity, especially the charity of the wealthy. Surgeons who chop up patients likely to suffer kidney failure would lose their licenses and risk civil and criminal malpractice suits, making the “indignity” argument unlikely. Further, charitable organizations would be the largest go-betweens, distributing organs to those who cannot afford them. In fact, the rich “exploiters” are likely to “give back” in the form of monetary and even organ donations to these organizations. Furthermore, the very rich who are desperate for an organ will pay an exorbitant price, making further research and donations possible, to the benefit of all.

But will there be enough for everyone? Yes: there are $50,000 kidneys and there are $500,000 kidneys – a new immigrant might be willing to sell his for the former price, and a middle-class single male for the latter. With 300,000,000 potential donors just in America, there are roughly 4,000 kidneys for each dialysis patient, an enormous surplus even taking into consideration donor-recipient compatibility issues.

Finally, the most convincing reason for the free exchange of organs is the same principle confused prohibitionists champion: human dignity. In the generation of Roe v. Wade, the contradictory paternalism of many prohibitionists is absolutely mind-boggling – is Congress to enshrine “a woman’s right to choose” with one hand and violate individual sovereignty over one’s body with the other? While I am staunchly pro-life, I wonder: where is the feminist lobby chanting, “get the government out of our bodies!”, when it comes to the issue of organ sales? Rather than making an unconsidered attempt at promoting what is at best a fuzzy conception of “human dignity,” ought not we to respect the definite right of each individual to do with his body what he sees fit, while simultaneously ensuring the best possible allocation of our most precious resources?

The foregoing arguments aside, what about our inexorable queasiness concerning such a marketplace? Is the thought of stocking six-packs of human kidneys next to Tombstone pizzas in the freezers at Wal-Mart limiting our ability to countenance the sale of human body parts? Let us think about this. Would we demure so strongly in the case of human hair, fingernail clippings, or even appendixes (yes, that is a properly-spelled plural) or tonsils? Probably not. So what is it about a kidney that makes us squirm?

One possibility is that despite its redundancy, the kidney is a vital organ, and an auxiliary is essentially an insurance policy against potential health problems down the road. It would seem, however, that the values implicit behind such a position should be equally strong in mandating that individuals continually strive for pristine bills of health in every way possible. But for some reason those hoping to prohibit organ sales do not seem willing to support legislation, for instance, outlawing outright the consumption of trans fats in the hopes of preventing individuals from risking their long-term health. And ought not we to champion the right of a struggling single parent to unload an unnecessary organ for money to make his or her life easier above that of a couch potato to kill himself with a poor diet?

Ultimately, we must decide whether our naive hesitation to allow the establishment of a market for human body parts, no matter how natural it is, or how universal, ought to take precedence over the financial needs of consenting adults and also the eradication of the current shortage of vital organs for those who need them to live. Shall we immolate the poor and the sick on the altar of our own squeamishness?