How Much Is That Kidney in the Window? Bruce Gottlieb
Eight years ago, an article appeared in an obscure Israeli medical journal, Medicine and Law, arguing that American citizens should be permitted to sell their kidneys. This would require changing federal law, which since 1984 has made selling any organ, even one’s own, a felony punishable by up to five years in jail. The author of the article was a Michigan pathologist named Jack Kevorkian.
Kevorkian’s argument was that the current system of accepting kidneys only from dead patients and Good Samaritan donors provides too few kidneys. While this was even true then, the situation is worse today. As of April 30, there were 44,989 people on the waiting list for a kidney transplant. About 2,300 of them will die this year while waiting. If kidney sales were permitted, Kevorkian argued, these lives would almost certainly be saved.
He may be right. In recent years, economists and economically minded lawyers at the University of Chicago and Yale Law School have made similar arguments. The idea was endorsed two years ago in the pages of The Lancet by a Group of prominent transplant surgeons from Harvard Medical School and hospitals in Canada and England. Of course, legalizing kidney sales remains a fringe view, both within the medical profession and outside it. But that needs to change.
There are several familiar arguments against legalizing kidney sales, beginning with the idea that giving up a kidney is too dangerous for the donor. But, popular though this argument is, the statistics don’t bear it out – at least relative to other risks people are legally permitted to assume. In terms of effect on life expectancy, donating one of your two kidneys is more or less equivalent to driving an additional 16 miles to work each day. No one objects to the fact that ordinary jobs – like construction or driving a delivery van – carry roughly similar risks.
Another common objection is that government ought to encourage altruism, not profit seeking. But from the perspective that matters – the recipient’s – this distinction is irrelevant, so long as the donated kidney works. It’s not as if the point of kidney transplants were to improve the donor’s karma. Moreover, kidneys from cadavers function for eight years, on average, whereas those from live donors last 17 years. (The reason is that kidneys can be “harvested” from live donors in circumstances less hectic than death and that donors and recipients can be better matched.)
This brings us to the most powerful objection to the sale of kidneys – that, in practice, it would result in the poor selling parts of their bodies to the rich. But in today’s health care economy that probably wouldn’t be the case. For several decades, Congress has mandated that Medicare pay the medical bills of any patient – of any age – who requires dialysis. Transplant surgery and post surgical drug treatment are expensive, yes, but they’re nothing compared to dialysis, which costs about $40,000 per year. That’s a savings of $40,000 per year for 17 years or so during which a transplanted kidney will function. In other words, insurers and the federal government would probably be happy to buy a kidney for anyone who needs one. They’d even be willing to pay donors considerable sums - $50,000, $100,000, or more. (Indeed, according to one estimate, if kidneys could be found for all the patients now on dialysis, Medicare would break even after just two years.)
At these prices, there would be no shortage of sellers. The government could enforce price floors to keep competitive sellers from bidding down the going rate for kidneys. And given the amount of money involved, it seems downright contradictory to argue that the poor should be prevented from taking the deal on the grounds that poverty is unfair. The solution to poverty is anyone’s guess, but restricting poor people’s economic opportunities definitely isn't’t the answer. Nor is it enough to say that there are better and more humane ways of leveling the distribution of wealth than allowing kidney sales. To argue against kidney selling, one must provide a better practical way of helping the disadvantaged. It does a poor person who wishes to sell his kidney no favors to tell him instead to lobby Congress for an increase in the minimum wage or a more egalitarian tax code. Besides, the kidney waiting list contains a disproportionate share of minorities. Thirty-five percent of the people on the waiting list are black; twelve percent are Hispanic. If the point of the current law is to temper the effects of income inequality, asking racial minorities to shoulder an unequal share of the burden is surely a step in the wrong direction.
Sure, critics will say that allowing kidney sales is the beginning of a slippery slope towards selling other, more essential organs. This, of course, would be a moral disaster, since it would mean legalizing serious maiming (selling eyes) or even murder (selling hearts or lungs). But the very outrageousness of this will keep it from happening. A slippery-slope argument is convincing only when it shows that the slipping would be either inevitable (for example, that legalizing abortion when a condom breaks means people would be less careful about birth control, thereby increasing abortions) or unconscious (outlawing child porn would lead to outlawing Lolita, since bureaucrats can’t tell the difference). But it’s easy for legislators to draft a law that clearly allows kidney selling but forbids other forms of organ selling. (Kidneys are fairly unique in that, while everybody has two, somebody with just one can lead an almost entirely normal life.) And it seems implausible that a member of Congress would mistake public approval of kidney sales for approval of economic transactions that leave sellers dead or partially blind.
Nicholas L. Tilney, a Harvard Medical School professor and transplant surgeon, wrote a paper in 1989 against kidney selling. He says this is still the view of “100 out of 100 transplant surgeons.” But in 1998 – as the kidney shortage became more acute – he coauthored, along with other surgeons, lawyers, and philosophers, the provocative Lancet paper that argued for legalizing kidney sales. “We debated this question for about two years before writing that piece,” says Tilney. “All of us trans-planters, and I’m sure the public, have this tremendous gut reaction against it. That was sort of our initial reaction. And then, when we all got around and really thought about this and talked about it, our thinking began to change.”
The prospect of someone going under the knife to earn a down payment on a new house or to pay for college is far from pleasant. But neither is the reality of someone dying because a suitable kidney can’t be found. The free market may be the worst way to allocate kidneys. The worst, that is, except for all the other alternatives
React to this statement. " A still living human body and a newly dead body should be treated with the same degree of respect and dignity. Don't immediately choose to agree or disagree. Instead, explore in the entry your feelings and beliefs, both agreement and disagreement, until you reach a point of conviction, showing yourself coming to a place where you strongly agree or disagree. (Length: 3 paragraphs, 4-5 sentences each. Write up in your exercise book. Due Monday)
Kevorkian’s argument was that the current system of accepting kidneys only from dead patients and Good Samaritan donors provides too few kidneys. While this was even true then, the situation is worse today. As of April 30, there were 44,989 people on the waiting list for a kidney transplant. About 2,300 of them will die this year while waiting. If kidney sales were permitted, Kevorkian argued, these lives would almost certainly be saved.
He may be right. In recent years, economists and economically minded lawyers at the University of Chicago and Yale Law School have made similar arguments. The idea was endorsed two years ago in the pages of The Lancet by a Group of prominent transplant surgeons from Harvard Medical School and hospitals in Canada and England. Of course, legalizing kidney sales remains a fringe view, both within the medical profession and outside it. But that needs to change.
There are several familiar arguments against legalizing kidney sales, beginning with the idea that giving up a kidney is too dangerous for the donor. But, popular though this argument is, the statistics don’t bear it out – at least relative to other risks people are legally permitted to assume. In terms of effect on life expectancy, donating one of your two kidneys is more or less equivalent to driving an additional 16 miles to work each day. No one objects to the fact that ordinary jobs – like construction or driving a delivery van – carry roughly similar risks.
Another common objection is that government ought to encourage altruism, not profit seeking. But from the perspective that matters – the recipient’s – this distinction is irrelevant, so long as the donated kidney works. It’s not as if the point of kidney transplants were to improve the donor’s karma. Moreover, kidneys from cadavers function for eight years, on average, whereas those from live donors last 17 years. (The reason is that kidneys can be “harvested” from live donors in circumstances less hectic than death and that donors and recipients can be better matched.)
This brings us to the most powerful objection to the sale of kidneys – that, in practice, it would result in the poor selling parts of their bodies to the rich. But in today’s health care economy that probably wouldn’t be the case. For several decades, Congress has mandated that Medicare pay the medical bills of any patient – of any age – who requires dialysis. Transplant surgery and post surgical drug treatment are expensive, yes, but they’re nothing compared to dialysis, which costs about $40,000 per year. That’s a savings of $40,000 per year for 17 years or so during which a transplanted kidney will function. In other words, insurers and the federal government would probably be happy to buy a kidney for anyone who needs one. They’d even be willing to pay donors considerable sums - $50,000, $100,000, or more. (Indeed, according to one estimate, if kidneys could be found for all the patients now on dialysis, Medicare would break even after just two years.)
At these prices, there would be no shortage of sellers. The government could enforce price floors to keep competitive sellers from bidding down the going rate for kidneys. And given the amount of money involved, it seems downright contradictory to argue that the poor should be prevented from taking the deal on the grounds that poverty is unfair. The solution to poverty is anyone’s guess, but restricting poor people’s economic opportunities definitely isn't’t the answer. Nor is it enough to say that there are better and more humane ways of leveling the distribution of wealth than allowing kidney sales. To argue against kidney selling, one must provide a better practical way of helping the disadvantaged. It does a poor person who wishes to sell his kidney no favors to tell him instead to lobby Congress for an increase in the minimum wage or a more egalitarian tax code. Besides, the kidney waiting list contains a disproportionate share of minorities. Thirty-five percent of the people on the waiting list are black; twelve percent are Hispanic. If the point of the current law is to temper the effects of income inequality, asking racial minorities to shoulder an unequal share of the burden is surely a step in the wrong direction.
Sure, critics will say that allowing kidney sales is the beginning of a slippery slope towards selling other, more essential organs. This, of course, would be a moral disaster, since it would mean legalizing serious maiming (selling eyes) or even murder (selling hearts or lungs). But the very outrageousness of this will keep it from happening. A slippery-slope argument is convincing only when it shows that the slipping would be either inevitable (for example, that legalizing abortion when a condom breaks means people would be less careful about birth control, thereby increasing abortions) or unconscious (outlawing child porn would lead to outlawing Lolita, since bureaucrats can’t tell the difference). But it’s easy for legislators to draft a law that clearly allows kidney selling but forbids other forms of organ selling. (Kidneys are fairly unique in that, while everybody has two, somebody with just one can lead an almost entirely normal life.) And it seems implausible that a member of Congress would mistake public approval of kidney sales for approval of economic transactions that leave sellers dead or partially blind.
Nicholas L. Tilney, a Harvard Medical School professor and transplant surgeon, wrote a paper in 1989 against kidney selling. He says this is still the view of “100 out of 100 transplant surgeons.” But in 1998 – as the kidney shortage became more acute – he coauthored, along with other surgeons, lawyers, and philosophers, the provocative Lancet paper that argued for legalizing kidney sales. “We debated this question for about two years before writing that piece,” says Tilney. “All of us trans-planters, and I’m sure the public, have this tremendous gut reaction against it. That was sort of our initial reaction. And then, when we all got around and really thought about this and talked about it, our thinking began to change.”
The prospect of someone going under the knife to earn a down payment on a new house or to pay for college is far from pleasant. But neither is the reality of someone dying because a suitable kidney can’t be found. The free market may be the worst way to allocate kidneys. The worst, that is, except for all the other alternatives
React to this statement. " A still living human body and a newly dead body should be treated with the same degree of respect and dignity. Don't immediately choose to agree or disagree. Instead, explore in the entry your feelings and beliefs, both agreement and disagreement, until you reach a point of conviction, showing yourself coming to a place where you strongly agree or disagree. (Length: 3 paragraphs, 4-5 sentences each. Write up in your exercise book. Due Monday)
