Organs for Sale?

The sensational news about kidneys for sale has put the organ shortage on the front page.

Now that the issue has your attention, here are some basic facts:

      • 80,000 people are waiting for a kidney.
      • 13 will be dead tomorrow at this time because an organ never arrived.
      • In big cities, the wait for a kidney can be up to 8 years (maybe only half can survive that long on dialysis)

As long as the shortage persists there will be black markets. This means that the only remedy is more organs. The only way to do that is to incentivize donors.

In a nutshell here is the proposal:

A Good Samaritan donates to the next stranger on the queue. The state offers compensation such as tax credits, tuition vouchers, a contribution to a tax-free retirement account, lifelong health coverage, or a very generous contribution to a charity of the donor's choice.

A non-cash reward won't appeal to those in desperate need of financial help. What they want is quick cash, not delayed in-kind rewards. A months-long waiting period would dampen impulsivity and give more than ample time for donor education and careful medical and psychological screening.

Who benefits? Everyone because the transplants would be performed according to the same formula that hospitals use now. Finally, donors would receive quality follow-up care, something the current system does not ensure.

Now, I realize that some people feel queasy about the idea of rewarding the donor. If it is not given for free, they say, it is tainted or "undignified" in some way. They think it reeks of greed on the part of the donor or coercion on the part of the desperate patient.

To them I say, yes, the notion of the "gift of life" is a beautiful ideal. And for some, including me, it became a reality. But if we continue to rely on altruism as the sole legitimate justification for giving an organ, we guarantee the perpetuation of the black market and ensure more needless deaths of those on the waiting list.

So, I offer several ways to think about the notion of rewarding well-informed, freely choosing people who would like to relinquish a kidney to save the life of a stranger:

Look at our daily lives. Financial and humanitarian motives combine all the time. The goodness of an act is not diminished because someone was paid to perform it. The great teachers who enlighten us and the doctors who heal us inspire no less gratitude because they are paid. A salaried firefighter who risks her life to save a child trapped in a burning building is no less heroic than a volunteer firefighter. Soldiers accept military pay while pursuing a patriotic desire to serve their country. The desire to do well by others while enriching oneself at the same time is as old as humankind. Indeed, the very fact that generosity and remuneration so often intertwine can be leveraged to good ends: to increase the pool of transplantable organs, for instance.

Today we routinely assign valuation to the body. Human blood plasma is collected primarily though paid donation. Personal injury lawyers seek damages for bodily harm to their clients. The Veterans Administration puts a price on physical disabilities. We pay for justice in the context of personal injury litigation in the form of legal costs, and for our very lives in the form of medical fees. There is little reason to believe--nor tangible evidence to suggest--that these practices depreciate human worth or undermine human dignity in any way.

Also keep in mind that the entire transplant system is awash in money. Surely, hospitals need to charge a fee for use of the operating rooms; surgeons need to be paid; and so on. Ironically, the only person who takes a risk and gives something of value in the course of the transplant is the one who is prevented from benefitting: the donor!

In the end, a donor compensation system operating in parallel with our established mechanism of altruistic procurement is the only way to accommodate us all. Moreover, it represents a promising middle ground between the status quo--a procurement system based on altruism--and the dark, corrupt netherworld of organ trafficking.

The current regime permits no room for individuals who would welcome an opportunity to be rewarded for rescuing their fellow human beings; and for those who wait for organs in vain, the only dignity left is that with which they must face death.

Sally Satel, M.D., is a resident scholar at AEI.

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