There are more than 100,000 people who need a new kidney in the U.S., but only 21,000 kidneys were available for transplant last year. One reason for the shortage of kidneys for transplant may be that it’s illegal for people to be paid for giving up one of their two healthy kidneys so that someone else can have it. Instead of payment, we rely on altruistic donations by living donors or, more often, by deceased people who agreed to donate their organs upon death.
This is not how we meet most other needs in our society. For the most part, rather than depend on altruistic donations for our groceries or car repairs, we pay people for what we need or want. If payment for these items were illegal, there would likely be a shortage of them as well. So, it would seem that paying for kidneys for transplant would alleviate the shortage and improve lives all around. Suppliers of organs would benefit from payment and recipients from a healthier life.
The problem with this market solution is that where vital needs are at issue, it seems unjust that some people should live and others die simply because some have more money than others. This is why we have a safety net meant to ensure (at least in principle) that everyone has enough nutritious food, functional clothing, and safe shelter to avoid death by starvation or exposure.
The old spiritual “All My Sorrows Soon Be Over,” contains the line, “If livin’ were a thing that money could buy, the rich would live and the poor would surely die.” We want to avoid such a situation. But a private market in kidneys could lead to exactly that. Rich people would be able to buy needed organs that poor people wouldn’t be able to afford.
But such a private market in kidneys isn’t what those advocating payment for kidneys have in mind. They advocate that the same centers of kidney acquisition and allocation be allowed to pay for kidneys and allocate their use in transplantation according to strictly medical criteria. Poor people will experience no disadvantage relative to rich people, and would gain along with richer people if such a program induces more kidney donations.
One objection concerns the justice of asset inequalities among people giving up a kidney for transplant. It’s more than likely that the people most motivated by monetary payment will be relatively poor. The payment by transplant centers could be raised from $5,000 to $50,000 to attract more middle class people, but then it becomes so much money relative to the income of the poor as to almost coerce them to sell a kidney.
Of course, any market element is going to have different impacts on the rich and poor. Few rich people work in underground coal mines or pick strawberries for a living, and more of the poor than the rich sell their blood and blood products to official blood banks, which is currently legal. So why not allow the sale of a kidney?
The issue again is the sacredness of human life. Blood products are essential to life, but they are renewable in healthy people. Kidneys are equally essential to life, but not renewable. Although giving up a kidney for transplant (with or without monetary payment) is relatively safe (if it wasn’t it would be illegal with or without payment), if something goes wrong there’s no recourse but to be the recipient of someone else’s donation, and those may still be in short supply.
On the other hand, we do allow some compensation to kidney donors at present. Some people donate a kidney to a stranger in a system that ensures that a compatible organ will be available to the donor’s loved one. Here the disparate impact is not on the poor but on those with a loved one who needs a kidney donation, and the element of coercion can be extreme.
It’s easy to imagine monetary payment that is less direct and therefore possibly legal. Prostitution (direct payment for sex) is illegal, but a woman having a sugar daddy isn’t, even if regular monetary payment (for an apartment and groceries) is designed to ensure regular sex. Such indirect payment could possibly be legal where a kidney is concerned. Cousin A needs a kidney which cousin B can supply because he’s a match. Their common grandmother promises to alter her will to give B an extra $10,000 if he will give up a kidney to help A. Is this illegal?
The most significant possible drawback of normalizing payment for kidneys is that it may reduce the supply of organs by altruistic donors. Why give something away if others are getting paid for it? But to date, legal payment for blood products seems not to have reduced altruistic donations.
Please feel free to reply by e-mail to this post: wenz.peter@uis.edu.
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