A case of kidney compensation, potential monetary rewards for organ donations

While paying the tab during my most recent visit to Francar’s, I happened to notice a small stack of business cards that proclaimed, “Clarence Walker Needs a Kidney.”  I picked one up as I left and read more.  Says Mr. Walker, “I am a married father of 3 beautiful young ladies.  Also, I have 2 grandkids that I would like to see grow up, graduate, and get married someday.  I pray that someone will step forward and help me.”  He desperately holds on to hope that he will get the kidney he needs.   But the cards are stacked against him.
Though we might like to believe that the charity in our society is sufficient to save Mr. Walker’s life, the sobering reality is that he is one of thousands of Americans on the growing waiting list for kidneys who don’t stand a chance without a miracle.
According to recent data available online from the U.S. Department of Health and Human Services, the rate of kidney failure has roughly quadrupled over the past three decades, and the shortage of donated organs has become more pronounced as the need for kidneys has exploded.
In 2010, more than 34,000 people joined the waiting list (which exceeds 100,000), and fewer than 17,000 received a kidney.  Because of the shortage, an average of 17 Americans die each day while waiting for an organ – and several more become too sick to receive a transplant, even if it were available.  All the while, quality of life for those who remain on the list is seriously impaired. Clarence Walker himself has waited on the list for 3 years and must live with the burden of dialysis 3 times each week.
But wait.  How can this be?  Millions of Americans have two good kidneys, and only one is necessary for the body to adequately filter blood.  In our “civil” society, how can we sit back and watch as people die for no good reason at all?  Why, you ask, aren’t enough people giving out of the goodness of their hearts?  The answer is obvious:  People aren’t willing to bear the costs of donation without compensation.  And, since 1984, compensation for organ donation has been against the law in the U.S.
While you and I might feel compelled to do a good deed and donate a kidney to a stranger, it would almost certainly be irrational for us to do so in the absence of compensation.  We simply can’t afford to take weeks to a month away from our studies or work, much less bear the burden of the health risks associated with surgery and a future with only one kidney.
It is clear that altruism alone is not enough.  Something must be done.  In my opinion, we should move to legalize compensation.  If we harness aspects of the market mechanism, certainly the kidney shortage will be history.  We should learn from Iran (yes, Iran!) – the only nation in the world where kidneys can be bought and sold legally; there, waiting lists are a problem of the past.
Immediately, though, rows of well-meaning but misguided critics line up in outrage to voice their concerns and shout “ethics violation” at the top of their lungs.
Many claim that legalization will result in the “commodification” of human life or that it will undermine the altruism present in our current system.  Maybe those claims have some truth to them, but isn’t it a far worse crime to let people die when we could easily save them?
Still other opponents will make the common claim that legalizing would exploit the poorest members of our society – that those who need the money most would be “forced” to sell a kidney.
My response to this objection is two-pronged.  First, by criminalizing compensation in the U.S. as we currently do, we are already fueling the exploitation of people …just not in America.  The age-old economic truth is that black markets will emerge where the government attempts to stamp out trade.
It really shouldn’t come as a surprise that more and more people are traveling to developing countries to receive organ transplants from the poor through what has been termed “medical tourism.”
If anything deserves to be called exploitation this is it.  Secondly, I would suggest that those who advocate restricting the abilities of the poor to sell their kidneys are actually insulting them by inherently claiming that financial need would prevent them from balancing the costs and benefits to make a rational decision on their own (assuming informed consent).
Yes.  There are many unanswered questions, and I readily admit that I don’t know exactly what an America with legalized compensation for kidneys would look like.
Of course I realize that many people don’t view completely free markets as a feasible solution.  To be more realistic, maybe our society can find compromise and develop a creative solution.
One potential idea is to have a government-run system in which donors are compensated with tax credits, tuition vouchers for children, or contributions to retirement accounts (not immediately accessible cash) and transplants are provided to all people equally on the basis of need.
If it could be shown that the costs associated with this form of government intervention would be less than or equal to the amount that taxpayers already contribute for Medicare to cover the dialysis costs of those remaining on the waiting list, even I might view this as an improvement.
The unequivocal bottom line is that donor compensation of some sort is necessary to fix the problem that we face. If we begin to consider that donors are really not much different than the policemen and firemen whom we praise for taking on risks for the benefit of our communities, then we might start viewing compensation as beneficial.
Maybe just maybe, instead of blaming God for the suffering and pain that persist in the world, we can take some responsibility for the injustice before us and use the brains that God gave us to find a workable solution.  The lives of countless Americans like Clarence Walker depend on it.

Comments on this opinion can be sent to david.a.lockwood@live.mercer.edu