Who Wants to buy My Kidneys? Thoughts on Legalized Organ Sales

Our evolution has blessed us with two kidneys, when a single functioning one is all that is needed for survival.  It is truly wonderful that medical technology has made it possible to take advantage of this over abundance and prolong the lives of people who would otherwise die.  In 2008, 16,517 Americans were saved with the kidney of some recently deceased person or some generation living person who and many more have been saved since.

This however, is hardly enough.  Medical advances are keeping people alive longer and advances in safety are cutting down car accidents and other causes of accidental death, which previously made it possible for the supply of kidneys to keep up with demand.  Patients needing a kidney transplant now can expect to wait several weeks, months or years before a suitable donor is found.  As of 2010 there were 93,000 patients on the waiting list in the United States.  The waiting grows at around 3000 to 4000 patients each year, while the supply has stagnated at a grossly inadequate 50,000.  As a result, over 4,000 Americans die on each year waiting for a donor to be found.

Part of this is due to the fact, that Americans who donate to their friends and family are expected to do so out of the goodness of their heart, as financial compensation is prohibited (though I suspect, many still receive off the book compensation after the fact).  Perhaps it is time to explore the possibility of allowing one person to profit from such a transaction. Many Americans find such an idea repulsive as do many human rights organizations, but I believe it merits some exploration, and what better place to do this, that a venue dedicated to free thinking.

Currently, the only country that allows for legal sale of one’s kidneys is Iran, hardly a bastion of freedom, but still worth examining.  In Iran, there two organizations the Charity Association for the Support of Kidney Patients (CASKP) and the Charity Foundation for Special Diseases (CFSD), that regulate the kidney market alongside the government.  The organizations match donors to recipients, both of whom must, be of the same nationality.  Donors are required to provide the consent of their nearest relative.  In return they are given the equivalent of 1,200 from the government, in addition to some negotiated compensation from the recipient, in the means of money and in some cases employment.  Additionally, donors receive a year’s worth of free health care.  There is always a greater number of willing donors than those in need, and the country has essentially eliminated it’s waiting list.

On the downside, the system has been accused of being coercive as the vast majority of donors are extremely poor by Iranian and international standards, making them quite desperate as well as easily manipulated.  As a response, I would argue that, the fact there are such large numbers of willing donors, that this means of earning money should not be taken away. Others have pointed out that there is a lack of data to affirm that donors are better off in anyway, after the procedure. This however, may largely be due to  a social stigma surrounding the donations in the country, and as a result many who have participated, do not wish to talk about it, regardless of how much they may or may not have benefited from the financial gain.  Additionally, Organs Watch, a group that is vocally opposed to such programs has pointed out that it has undermined the deceased donor program, in the country which it believes is preferable.  This point appears to be correct, but needs to be weighed against the other factors previously mentioned.

It seems to me that concerns about dishonesty, murder, organ theft, kidnapping, and unwanted bodily tampering are at the root of most concern about the ability of one to sell his or her body parts. No one likes to hear stories of organ theft, negligence of the sick or government, people not being compensated for their organs and the executions of people to harvest their organs (China has been accused of this). It would seem then, that the goal would be to step our enforcement of laws against murder, fraud and kidnapping and fight for human rights around the world, rather than prevent consenting adults from saving lives and enriching themselves by selling their parts.

Simply put it should, be a goal of all of us to create a world where consenting adults can use their bodies as they please without the fear of being harmed by other parties involved.  Perhaps this could only work in a country within the borders of a country with a strong rule of law, but I would like to think that being able to sell ones organs, in a setting where one’s bodily autonomy, personal consent and full disclosure are respected may be of great benefit to people in third world settings.  After all, if a third world citizen, can voluntarily sell a kidney or a bit of their liver for a couple thousand dollars to a first-world citizen, it could be of a great benefit to both if done in a way that the autonomy of both is respected.

Either way it does seem that as our medical technology improves this is going to a matter our society must address. I’ll also point out that a legitimate market for organs in which the rights of all involved is protected, will drive down their cost, making it more difficult for ugly black market conditions to appear.  I tend to be pro-choice to the extent that I favor consenting adults doing whatever they please with their own bodies, especially if they can help others and make money in the process.  I encourage our readers to think about this issue and voice their opinions.

Sources:

1.  “National Data Reports”. The Organ Procurement and Transplant Network (OPTN). dynamic. Retrieved 2009-05-07. (the link is to a query interface; Choose Category = Transplant, Organ = Kidney, and select the ‘Transplant by donor type’ report link)

2.  Kidney Transplant Waiting List. uptodate.com:  http://www.uptodate.com/contents/the-kidney-transplant-waiting-list

3.  Organ Donation and Transplant Statistics. The National Kidney Foundation:  http://www.kidney.org/news/newsroom/factsheets/Organ-Donation-and-Transplantation-Stats.cfm

4.  Hippen, Benjamin E. “Organ Sales and Moral Travails: Lessons from the Living Kidney Vendor Program in Iran”. Cato Institute: Policy Analysis.
5.  Griffin, Anne (March 2007). “Iranian Organ Donation: Kidneys on Demand”. British Medical Journal 334 (7592): 502–505.

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