Kidney Mart

Several years ago, a California inmate convicted of armed robbery was dying. A viral infection damaged his heart—he desperately needed a transplant. The inmate, whose name was not released due to medical confidentiality, was placed on the organ donation waiting list, and eventually a match was found. The state of California paid somewhere in the neighborhood of one million dollars to transplant a heart to the violent felon, which was quite controversial. Yet the real tragedy concerns not money, but organ scarcity. With only a few thousand hearts available each year, demand greatly exceeds supply.

Organs are a scarce commodity. According to the United Network for Organ Sharing there are almost 100,000 people waiting for organs, and only about 15,000 donors last year. Many others don’t even make the list, since only the healthiest patients are considered for transplants. Understandably there is public backlash when prisoners, let alone violent criminals, receive one. After all, giving one patient a heart means that another patient must be denied. But should we really start distributing organs on principles of moral desert? To some, it may seem clear that murderers don’t deserve transplants. But what of the recovering alcoholic who needs a new liver, or the smoker with bad lungs? Perhaps organs should be saved for those in their twenties, married with children, who have long lives ahead and families to support. To play God and assign organs from moral judgments, rather than biological compatibility, is a difficult and dangerous game to play. We shouldn’t have to struggle in deciding who deserves a transplant. Instead, we must do whatever it takes to make more organs available for all who need them.

The best way to increase transplant availability would be to allow financial incentives for organ donation. The 1984 National Organ Transplant Act, authored by Al Gore, criminalized such compensation. As of now, donors are only encouraged to donate because it is a nice thing to do. While this is enough for some, many others would probably be willing to donate if there were more concrete benefits to the deal. Simple economics dictate an increase in supply along with an increase in price.

Kidney donation serves as an excellent model for changing financial policy. The kidney is unique because almost everybody has two, yet can survive with only one. Without specific medical tests, you would probably be unaware that you had a single kidney. This means that living donors can safely provide a kidney, bypassing the complicated legal system of post-mortem inheritance. Additionally, the demand for kidneys is the highest of any organ transplant. The standard treatment for kidney failure is also particularly grueling. Patients are typically on hemodialysis, which requires traveling to a dialysis center every other day for about four hours. There, blood is removed from the body and runs through a special filter which removes toxins before returning it to the patient. The patient’s veins must also be surgically modified to allow for repeated piercing with large needles. Dialysis is time consuming, exhausting, and generally miserable—about one fifth of patients voluntarily discontinue treatment and allow themselves to die. In contrast, a transplant vastly improves the quality of a patient’s life, allowing him to return to something close to normalcy.

Kidney disease has another quirk. A strange law places patients with end stage renal disease into Medicare, regardless of age or insurance status. Thus, the federal government basically pays for all dialysis treatments and eventual kidney transplants. Dialysis can cost about $80,000 per patient per year, and the Medicare program spends billions of dollars on this less than ideal treatment. And though a kidney transplant is an initially expensive operation, the follow-up care is quite cheap compared to dialysis, usually about $20,000 per year. Consequently, increasing the availability of kidneys could save taxpayers a large amount of money, and greatly benefit patients.

So why not allow people to sell one of their kidneys? There are patients in need and donors willing to sell. The government still sees fit to prohibit the transaction, but the reasons are murky at best.
One common objection is that selling organs is an unacceptable commodification of human life. Objectors believe we have no rights to sell our bodies, just as we cannot sell ourselves into slavery. However, other current policies are inconsistent with this. Donors are regularly paid to give plasma, the fluid component of our blood which carries blood cells. While the selling of organs typically mortifies the public, paying for plasma rarely, if ever, produces a reaction. In reality, the human body is often treated as a commodity. Bodyguards, surrogate mothers, and pro-football players are all paid for either the risk to or use of their bodies. In any case, there seems to be something dirty or improper when money is associated with organs; an organ is seen as a special gift. But why should we believe that? Currently, the staff who harvest the organ, the transplant surgeon, and the hospital all make money from each procedure. The donor, who makes the biggest sacrifice, is the only party that doesn’t profit!

Another common worry is that some will be exploited for their organs if financial sales are permitted. The poor will be unduly pressured to donate a kidney since they need the money most. This could be quite problematic because there are serious risks associated with donation—including death. Modern medicine has, however, heavily reduced this risk to a level of one in thousands. If there is no serious harm to the donor, why should we interfere? Surely there are some who could benefit greatly from the sale of their kidney. What is more demeaning—‘forcing’ the poor to sell a kidney, or disallowing them from making the choice? Others argue that minorities will be exploited for their kidneys. Ironically, this argument can also work against the detractors. Before a kidney can be given to a patient, it must be tested for biological compatibility. The immune system uses special markers on our tissue to discriminate self from non-self foreign attackers that must be eliminated Each person inherits a set of markers, and if a kidney is given to someone with a very different genetic profile, then the body will attack and destroy the kidney. These biological markers tend to be distributed along racial lines. Blacks, for example, are much more likely to have type B blood. Yet there are few type B kidneys donated, and so the chance for a black patient to find a matching kidney is lower. Allowing kidney sales could help alleviate this problem.

Because the government basically administers all care for those with renal disease and would be the primary purchaser of the organs, the sale of kidneys could be tightly regulated. It is likely that extensive counseling and education would be required to sell your kidney, just as living donors undergo now. Some will probably still worry that drug addicts or the like will start selling their kidneys to buy cocaine. If this concern becomes overriding, however, the government could provide non-financial benefits. Offering health insurance to an uninsured donor could be a potential solution. This would increase the organ supply and perhaps save taxpayer money if a patient is taken off of dialysis. Some will always find organ sales distasteful. Unfortunately, organ shortage remains a deadly problem, and thousands die each year in want of a transplant. Of course, charitable donations would be preferable in an ideal world. In reality, however, its unacceptable to let patients die when there are willing buyers and sellers of kidneys.