Article Proposes Open Market for Human Kidneys
MICHELE NORRIS, Host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.
ROBERT SIEGEL, Host:
And I'm Robert Siegel.
There is a widely reported black market in human kidneys for transplant operations, and there are far more people in need of transplants than there are kidneys available. Well, there's an article published today in the journal Kidney International that thinks the unthinkable. It argues for legalization and regulation of the sale of human kidneys.
Amy Friedman, Associate Professor of Transplant Surgery at Yale Medical School, is one of the authors of the article.
Dr. Friedman, what would be gained by legalizing the sale of kidneys?
AMY FRIEDMAN: There are a number of things that are potentially gained. First, larger number of transplants. But most importantly, this black market of kidney transplants and paid donors exists around the world, and those donations are currently taking place in an unregulated manner with little follow-up for the donors, and no reported outcomes that are widely available. So those donors are unprotected, and that's the grave concern that we have.
SIEGEL: But you acknowledge that you're proposing something that many people feel instinctively is wrong, in part because it could lead to large populations of poor people opting for life with one kidney so that populations of rich people can have two.
FRIEDMAN: Certainly this is a very great concern. Yet, the need is so great, and the rising volume of the black market so profound, that the major American and international transplant societies are currently engaging in a debate about this issue.
SIEGEL: You address the question in your article, how much should a kidney cost? How should you calculate the cost of a kidney?
FRIEDMAN: Yes. And the price around, the reported price around the world varies from as little as maybe $800 to $1,000 in India to some reports of maybe as much as $100,000 dollars. We base our initial price for discussion at $40,000 based on an article by Nobel Laureate Gary Becker and his colleagues, who went through a very careful and thoughtful analysis of the costs and reimbursements involved.
SIEGEL: But Gary Becker's model, as you describe it in the article, is based on earning assumptions of a person and also the risk of the possibility of loss of life or loss of quality of life.
Wouldn't it follow that a donor who is a farmer in the third world, who would have a shorter life expectancy and lower income, should get a lot less for his kidney?
FRIEDMAN: Yes. And that's the issue of, what will the market bear? That's one of the principal reasons for considering a regulated system, so that in fact we might protect the less knowledgeable, lower class farmer and make it fair and equitable for them.
SIEGEL: Now, doing transplants, obviously, you are familiar with this problem, and so you've gotten past the hurdle that some of us are having difficulty with, the idea that selling our organs is something we should rationally consider. It's not that irrational to you.
FRIEDMAN: It's not that irrational, but I will tell you clearly that my mind is not clearly made up. I would point out, however, that as a woman of, and I will not reveal exactly what my age is, but I've borne three successful pregnancies and I would be able to legally rent out my uterus now as a surrogate mother. And in doing so I could earn income and I could have multiple medical risks, including the risk of death. And that would all be legal in this country.
The principal difference of course is that you can't regenerate a kidney and you only have two. But this is a very gray area in medicine, and it has not been fully addressed yet legally. And I think that's really what the point of our essay is, to take this out of the closet, open up a full discussion, know what's happening to these donors and consider this frankly on the table.
SIEGEL: Well, Dr. Friedman, thank you very much for talking with us.
FRIEDMAN: Thank you.
SIEGEL: Dr. Amy Friedman, who is Associate Professor of Transplant Surgery at Yale Medical School. She and her co-authors, also her father, Dr. Eli Friedman, have written an article in the journal Kidney International about the possible legalization and regulation of the sale of kidneys for transplant.
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