AFF's Doublethink

As early as this week, 100,000 Americans will be waiting for donor organs they may never receive. On Monday, the United Network for Organ Sharing reported that the number of Americans on the waiting list was 99,986 and counting. More than 70% of these patients need a kidney, and most will languish on dialysis or die before they get one.

Every year, 3,000 Americans die for lack of a needed kidney. While kidney disease is a fact of life, the inability to get a transplant is a death sentence from Washington: U.S. law forbids Americans suffering from kidney disease and their healthcare providers to offer any “valuable consideration” for organs.

Of course, people of means don’t let the law get in the way. Those with status, connections or money jump the queue. They network to find living donors, or pay for organs on the black market. It can cost a patient as much as $200,000 to procure a kidney on the black market from countries like India or the Philippines, and the World Health Organization reported in 2004 that as much as 98% of the price paid goes to middlemen.

Even if every American signed an organ donor card, there simply wouldn’t be enough people who died under conditions that produced viable kidneys for transplantation. People are usually born with two kidneys and can donate one with little risk to themselves, but the procedure takes months to arrange and requires donors to take weeks off work.

Legalizing the sale of kidneys by live donors will not end poverty, nor will it end kidney disease, but it will significantly improve the lives of poor people who need kidneys, and poor people willing to sell one. It could create unforeseen possibilities for abuses, but these would be better than condemning innocent people to easily avoidable deaths.

The most common argument against legalizing the sale of kidneys is that the poor will be exploited. Every day, poor people make difficult decisions about how improve their conditions. It’s easy for ivory tower intellectuals and bureaucrats to say it’s unethical to sell a part of your body, but the cruel reality of a law that says there’s no price high enough for an organ is that patients cannot buy life-saving treatment, no matter how much they’re willing to pay.

Poor people who need kidneys don’t have the resources to find donors. They can’t afford to advertise, nor do they have social networks of people who can readily take three to six weeks off work. Least of all do they have the capital necessary to purchase organs on the black market.

Why should the government tell people that they can risk their lives by enlisting in the military or working in coal mines and battery factories, but not receive compensation for helping patients in need? That it is acceptable for them to risk their health disposing of other people’s garbage but not to save a life by selling a kidney?

If the U.S. allowed the sale of kidneys, it could end the shortage, and simultaneously give many Americans more immediate economic assistance than they would ever otherwise receive from government programs. Even if the government were to require donors to receive their payments in the form of healthcare savings accounts or educational scholarship funds instead of cash, imagine what a tremendous benefit it would be.

If selling kidneys were legal, they would both cost less and sell for more. When the only way to purchase a kidney is on the black market, criminal brokers are free to exploit desperate recipients and desperate sellers who have no legal recourse it they are cheated. Under such a system, the supply of kidneys for transplant is kept artificially low, the price artificially high, and brokers profit at a rate 10 times that of those selling kidneys.

If they could broker their own deals, with appropriate medical and legal oversight, patients who would otherwise die on the list could get organs that would save their lives, and people who deserve to be compensated for their service could be paid.

Any day now, 100,000 Americans will be waiting for organs. Each day we do nothing, another eight or more die waiting for a kidney. What are we waiting for?

-Sigrid Fry-Revere is president of the Center for Ethical Solutions and a contributing writer at Doublethink Online.

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