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For Kidney Donations, Should the Market Decide?

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For Kidney Donations, Should the Market Decide?


For Kidney Donations, Should the Market Decide?

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
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Kidney transplants have now become relatively routine, but there is a huge shortage of kidneys available for transplantation, and the wait for a kidney can stretch for years. People die waiting for one, more than 4,000 in the United States alone last year. A recent editorial in The Economist magazine suggested that instead of making it illegal for people to sell their kidneys, governments should permit it, even license and encourage it. Daniel Franklin is the executive editor of The Economist. He joins us from his office in London. Mr. Franklin, thanks very much for being with us.

Mr. DANIEL FRANKLIN (The Economist): My pleasure.

SIMON: What are some of the other drawbacks, including the one's we've mentioned, that you see in the way the kidney market, and I guess that's the word we have to use, now operates?

Mr. FRANKLIN: Well, the main drawback is that people are dying waiting. People are desperate to get hold of healthy kidneys, and in order to do so they're resorting to the black market and the result of that is you have a terrible situation really for both the donors and for the recipients of kidneys, operations done in poor conditions, very high infection rates, people who get infected with HIV, for example, and no real aftercare for the donors of kidneys either.

SIMON: So legalization, in your mind, would bring it out of the back alleys and into the hospitals?

Mr. FRANKLIN: Yes. I think you have to recognize that you want to think very, very carefully before legalizing this sort of trade, intuitively, if it seems a very strange thing to do. But then you have to compare it with the current situation, and actually the logic of it dictates that it would lead to an improvement on all sides, really.

SIMON: Led me pause at some of the concerns, and I know you've run them through your mind as well. First, there are people who would be concerned that legalizing a market like this would just make it possible for all the wealthy people to buy kidneys.

Mr. FRANKLIN: Yes, of course at the moment what is happening is that it's primarily the wealthy people who are resorting to the black market and the very poor and desperate on either side of this equation, if you like, who are involved. The one country where this has been tried, quite successfully, is Iran - not a place that we normally look to for examples of public policy, but in this area it's eliminated the waiting lists. And in that case it has not been only the rich who have been able to benefit. It's poor Iranians as well who've managed to obtain kidneys from other poor Iranians. So in theory anyway, a market should benefit people of all incomes.

SIMON: And what about the concern that having an open kidney market would essentially legalize last resort, desperate money-making schemes on behalf of destitute people?

Mr. FRANKLIN: There is a risk, of course, that some people's donations might not be entirely voluntary, that there might be a degree of coercion. And that's why any market of this sort would have to be extremely carefully regulated to ensure that, for example, there wasn't abuse of people who were in peculiarly vulnerable positions, prisoners for example. So there would need to be a robust system of regulation to ensure that there was genuine free will on both sides.

SIMON: Let's say a healthy young man or woman in their 20s might say, well, look, I'll sell a kidney rather donate it, because I could use the money, I have to pay for graduate school. Or to be maybe more realistic, I have to pay for some of my vices or I can't find a job or it beats working. And then they get to be in their 40s and really need that kidney they've lost.

Mr. FRANKLIN: Curiously enough, the chances of dying from having only one kidney compared with having two healthy kidneys, they rise only very insignificantly. Your chance, if you donate a kidney, of living a healthy life are extremely good. Other forms of surgery, voluntary surgery, that people undergo that are perfectly legal, such as surrogate motherhood, for example, liposuction, are just as risky or in the case of surrogate motherhood, many times more risky. So kidney operations, kidney donation, if done properly, are really not hugely risky. And one of the things that a regulated market could ensure, for example, is health coverage for those who've sold their kidneys and potentially also guarantees that if there is a problem with the one remaining kidney, then they are first in line for a new kidney.

SIMON: Daniel Franklin, executive editor of The Economist. Thanks very much for being with us.

Mr. FRANKLIN: Thank you.

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