Public Health

Why Not Buy A Kidney?

News stories have a way of firing up old debates. So maybe it was predictable that scarcely had the feds broken open the money-laundering-kidney-smuggling corruption ring in New Jersey last month, when some economists started clamoring once again to legalize the regulated sale of human organs for transplant. Their basic argument: Banning the legitimate sale of organs merely forces willing sellers and buyers into a dirty and dangerous black market.

kidney donation

Experts differ on whether dirty money leads to dirty kidneys. Wikimedia Commons hide caption

itoggle caption Wikimedia Commons

The Freakonomics guys weighed in early, with their observation in a New York Times column that "it is hard to find an economist who agrees with this policy" of banning kidney sales. (This follows a previous column last fall, where they noted that many organ donors in the U.S. don't have health insurance).

Dr. Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute, has been widely quoted, too, based on her experience of having to ask a friend for a kidney when her own failed several years ago. Satel wrote a book about it, and the woman who donated the kidney, writer Virginia Postrel, explains her own support of financial reimbursement for traded organs in this month's Atlantic.

Meanwhile, the New Yorker and Mother Jones are weighing in with their own stories about the downside of organ sales. And the Jewish Daily Forward quotes ethicist Art Caplan's central argument against legalization:

The people who sell are almost always incredibly poor. They're usually up to their eyeballs in debt....past the point of desperation. They're not making a calculated decision.

The sales money in such cases is rarely enough to cover ensuing costs from medical complications, Caplan and others have pointed out. Plus, people who are financially desperate enough to sell their organs are probably also more motivated than non-coerced volunteers to lie about their health.

The arguments on both sides are well-made. But before you decide this is the standard left/right debate, it is perhaps worth noting where the kidney doctors stand.

There is a middle ground, writes retired pediatric nephrologist, Atul Sharma. He agrees with the National Kidney Foundation, which has long supported legislation that would compensate organ donors for expenses, but not pay them additionally. Transplant chains, that create a network of donors and unrelated recipients are another answer. And the state of Florida last week took steps to make organ donation after death easier, with online registration.

The debate over how best to deal with the increasing need of healthy organs for transplantation is far from over. But, at least in the case of kidneys, there is a well-documented middle ground.



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