Is it time to offer compensation for live kidney donations?

posted at 9:26 am on May 29, 2009 by Ed Morrissey

The editors of the Wall Street Journal invited me to review two new books on the topic of kidney donations, and my review appears in today’s edition.  The first book, When Altruism Isn’t Enough by Dr. Sally Satel, gives readers a step-by-step academic analysis of the costs and risks associated with current methods of handling end-stage renal disease (ESRD), the profound shortage of transplantable kidneys, and the benefits of incentivizing live donors in order to reduce the overall costs in ESRD maintenance, ie, dialysis.  Those costs are extraordinary, and borne directly by Medicare:

Compensation would dramatically increase the number of kidneys available, the writers argue, saving lives not just because more transplant operations would be possible but also because live-donor organs perform better than those from cadavers. Another advantage of paying for kidney donations would be a radical reduction in costs to Medicare and thus to American taxpayers. Estimates of the annual costs for dialysis treatment and care for end-state renal disease approach $20 billion.

How would a compensation system work? Dr. Satel considers both government and free-market options, but she and her contributors clearly favor the former. The federal government has the means and the incentive to drive down costs through compensation, either with cash or in-kind allotments such as college tuition or tax deductions.

Readers of Captain’s Quarters will recall that my wife has had three kidney transplants.  The first of these came from a cadaver donor, which lasted nine years, about the average at the time of that transplant.  Live donor kidneys usually last for 25 years or more.  We found a friend willing to donate a live kidney in 2004, which should have sufficed, but unfortunately a viral infection in 2006 killed the kidney.  Another friend from the same organization then volunteered to donate another in 2007, and she has been healthy ever since.

Unfortunately, unrelated live donors are rare, and dialysis is a poor substitute.  The wait time now for a cadaver donor stretches as long as seven years, which is a death sentence to many on dialysis.  Half of the 250,000 ESRD dialysis patients aren’t even on the transplant list, for a variety of reasons, and the 7,000 cadaver kidneys available each year probably doesn’t keep up with the additions to the list.  Eventually, stem-cell therapies might end the need for transplants, but that’s a very long way off, and people die in the meantime — at least 1,000 patients on the list each year.  Dialysis for most people is a prolonged death, not a strategy for managing long-term survival.

Satel’s proposal for compensation prompts two major questions: does kidney donation prove harmful to donors in the short or long term, and would compensation exploit the poor and desperate?  The studies Satel and her essayists (which includes the director of the transplant center the First Mate uses) shows that live kidney donors have as good or better long-term health as the general population.  Of course, they are chosen for their good health, so that should be taken into consideration, but clearly the data show that they don’t show any long-term trends towards a degradation in health.  The “do no harm” ethic, critical for this question, seems very well established already — and our two friends have shown no ill effects at all.

Exploitation is another question.  That happens in other countries that employ a compensation system; Satel uses India as an example, where the poor do not get enough information on the surgery, get compensated poorly, and do not get good follow-up care.  Having seen the current live-donor system from the inside on three occasions — I was almost finished with the tests to donate the kidney the first time when the cadaver kidney trumped me in 1995, and by 2004 my Type II diabetes removed me from consideration — I can say that we already have protections for live donors in terms of disclosure and care.

Given that the government absorbs all the cost in the current ESRD maintenance system, a government-run compensation system probably makes the most sense, which would also hopefully structure payments across a long term to keep the acutely desperate from trading a kidney for momentary relief.  A government system would also get built in a “blind” method, where donors and recipients never meet or know each other’s identities, to avoid the appearance of the rich buying organs from the poor.  A free-market system might provide better compensation levels for the donors, but it also would be harder to ensure that the ethical considerations remain paramount, and government is already for better or worse a major stakeholder in the transaction.

The second book, Larry’s Kidney by Daniel Asa Rose, shows what happens when money talks.  I’ll refer you to my WSJ column to get the entire sense of the book, but I’ll boil it down to this: It’s a gripping read, but you’ll feel morally compromised before you get to the halfway mark.  Rose is a talented writer in a bad cause in this book, although it gives a very interesting view of modern China.

Update: Sally Satel responds on AEI’s Enterprise Blog, with some sympathy for Rose as well.


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Yes.

And compensation to families who allow donations from members recently deceased.

Mr. Joe on May 29, 2009 at 9:35 AM

Wow, you’re going to get a fight again…

Eh, sure, people should be able to buy live Kidneys that the donor WILLINGLY gave up. The transaction must be between the donor and the receiving party… If not, this could become really savage (China comes to mind…)

Upstater85 on May 29, 2009 at 9:36 AM

Slippery slope here.

With the new healthcare coming the pike, and a gov. that has little regard for life, I see only trouble..

With the Gov. in control of our banks (and whatever else Obama decides) here’s your future…
“You’re 6 months behind on your mortgage payment Mr Johnson… perhaps a kidney would settle the matter”..

katy on May 29, 2009 at 9:36 AM

I understand the whole let’s not make it a market.

While people die without transplants.

Sorry, everything is marketed somewhat. It can be done right and make a huge difference.

Mr. Joe on May 29, 2009 at 9:37 AM

Okay, give a kidney, take a $5,000 deduction on your taxes. Win Win?

Mr. Joe on May 29, 2009 at 9:38 AM

A little OT, but I just want to honor you, Ed, for the persistent love & compassion that you’ve shown to the First Mate all these years. I’ve heard too many stories of guys who dump their wives (or vice versa) in the hour of their greatest need. God bless you.

jgapinoy on May 29, 2009 at 9:39 AM

I attended a seminar by the Institute for Humane Studies where James Stacey Taylor gave a very interesting argument for a live organ market. Wish it would have been videotaped and posted online.

Patrick on May 29, 2009 at 9:39 AM

NO! Absolutely not! Even the payment to blood donors is offensive to someone who considers the body to be part of the whole person.

People die. The when and the how is subject to many things, but it should not be subject to the availability of purchased living tissue – unless lab grown.

OldEnglish on May 29, 2009 at 9:44 AM

Here is the problem as I see it…

Rich man gives kidney. He doesn’t need the $.

Poor man gives kidney. He needs the $.

Saving lives is great but this system, with the right fine print, could be one helluva horror story. Then again, with the right fine print, it could be one helluva love story too. One thing is for certain, once the politicos get their hands on it it will be one helluva mess.

Limerick on May 29, 2009 at 9:44 AM

jgapinoy on May 29, 2009 at 9:39 AM

Seconded (or meybe thirded or fourthed by the time my comment gets posted). You seem like an awesome guy, and the First Mate is lucky to have you (although, I’m sure you’d say it’s the other way around… and you might both be right).

:-)

Abby Adams on May 29, 2009 at 9:45 AM

Here is the problem as I see it…

Rich man gives kidney. He doesn’t need the $.

Poor man gives kidney. He needs the $.

… once the politicos get their hands on it it will be one helluva mess.

Limerick on May 29, 2009 at 9:44 AM

My first thoughts as well.

How long before the lefties turned this into another class warfare issue that we would suck at pushing back against?

cntrlfrk on May 29, 2009 at 9:47 AM

I would like to donate Wanda Sykes kidneys.

Geochelone on May 29, 2009 at 9:47 AM

Those donors that donate both kidneys get the Obama National Health Care Plan for free.

lasertex on May 29, 2009 at 9:49 AM

… once the politicos get their hands on it it will be one helluva mess.

Limerick on May 29, 2009 at 9:44 AM

My first thoughts as well.

How long before the lefties turned this into another class warfare issue that we would suck at pushing back against?

cntrlfrk on May 29, 2009 at 9:47 AM

Yeah… unfortunately for those suffering, I think we’d be best to not push this through until there is finally some level headed politicians.

Upstater85 on May 29, 2009 at 9:49 AM

Why are there so few cadaver kidneys? Is it simply that the majority of deaths are of the old or sickly who’s kidneys would be of little use to the recipient?

I know the family of the deceased has to approve the use of their organs, are there a significant number of eligible donors who do not simply because of a lack of family consent?

Jeff_McAwesome on May 29, 2009 at 9:49 AM

Those donors that donate both kidneys get the Obama National Health Care Plan for free.

lasertex on May 29, 2009 at 9:49 AM

Which would be worth about $25 American…

Upstater85 on May 29, 2009 at 9:49 AM

I think Dr. Walter E. Williams makes an excellent case for allowing people to sell their organs.

aero on May 29, 2009 at 9:55 AM

I donated a kidney to my aunt in October. So far she, her new kidney, and I are all doing well :)

I don’t think there should be monetary compensation for donating, but all costs should be covered, not just the medical costs. Cost of travel and time off work are not covered by Medicare (although some states do compensate for missed work).

A much bigger issue is medical insurance. Insurance companies should not be allowed to deny claims/insurance for living donors. I personally don’t think insurance companies should be allowed to deny claims/insurance for preexisting conditions anyway, but this is a real concern for living donors. I am pretty much limited to working for a company large enough to have a group insurance plan, where preexisting condition exemptions are not permitted. This is the choice I made for my Aunt, but not one I would have likely made for a stranger.

vermillionsky on May 29, 2009 at 9:55 AM

HERE’S A GREAT VIDEO ON THE SUBJECT FROM REASON.TV
http://www.youtube.com/watch?v=QHwDeCBlqqY&feature=channel_page

Glenn Jericho on May 29, 2009 at 9:57 AM

Your organs, you want to sell them, fine.

The fine print will take hold when Ogabe and the ‘rats inflict National Health Care upon this poor nation. Your placement on the recipient list will be according to criteria set up by the left (minority, union member, party affiliation), not by how badly you need an donated organ.

Bishop on May 29, 2009 at 9:57 AM

The moral dimension might be answered if the compensation were to be in the form of medical care. This would be very expensive in the end, but it would recognize that the doner was placing his future life and health at risk.

The cost would be mitigated if a sufficiently wealthy recipient were expected to contribute to the cost of the donor’s care. The threshhold should be set as a multiple of the poverty level.

njcommuter on May 29, 2009 at 9:58 AM

Your organs, you want to sell them, fine.

The fine print will take hold when Ogabe and the ‘rats inflict National Health Care upon this poor nation. Your placement on the recipient list will be according to criteria set up by the left (minority, union member, party affiliation), not by how badly you need an donated organ.

Bishop on May 29, 2009 at 9:57 AM

Good point. It’s not the actually theory of selling organs that worries me. It’s what our very powerful government would do if we allowed this…

Upstater85 on May 29, 2009 at 10:00 AM

Here is the problem:

Billy Rooster here in beautiful downtown Medical City.

You too can have an new roof! Look at this beauty right here, gen-u-ine spanish tile. It can be yours for a cornea and two feet of your lower intestine.

Do you like this Prius over here? Just a kidney and two feet of leg vein and you can help yourself and the environment too!

We are located just two blocks south of Big Brother blvd. We have medical counselors just waiting to approve your case today.

See ya there!

Limerick on May 29, 2009 at 10:02 AM

first step: compensation to live doners for ‘optional’ things like livers…

next step: compensation to live doners for ‘elective’ things like corneas

next step: aristocracy determines that your organs are more valuable to someone else

seems that this stuff always starts out as fiction. Excellent read btw.

gatorboy on May 29, 2009 at 10:05 AM

Ed,

I saw an episode of Scrubs recently with two people who needed kidney transplants. Their spouses weren’t matches, but they were for the opposite couple. So the donor spouses planned to trade kidneys. Is that legal, i.e. can you barter organs?

commodore on May 29, 2009 at 10:05 AM

I originally disagreed, until I read the comment that they could get a tax break, that I would go for. I donate blood and don’t expect compensation, but because the new world order Obama gubmint is wanting for force my altruism with more taxes, I would appreciate some compensation for not being a tattooed, gay sex, philandering, drug user.

An aside: the spell correction for “gubmint” gave “gunpoint” as a suggestion, how scary. We’re DOOMED.

kirkill on May 29, 2009 at 10:05 AM

The Onion: Anonymous Hero Donates Hospital 200 Human Kidneys

Glenn Jericho on May 29, 2009 at 9:59 AM

LOL!

katy on May 29, 2009 at 10:07 AM

I also want to ask, if you can sell your kidneys why can’t you rent your girlyparts?

Limerick on May 29, 2009 at 10:09 AM

I also want to ask, if you can sell your kidneys why can’t you rent your girlyparts?

Limerick on May 29, 2009 at 10:09 AM

Renting any parts should come before selling kidneys (via the gov’t).

Upstater85 on May 29, 2009 at 10:13 AM

An aside: the spell correction for “gubmint” gave “gunpoint” as a suggestion, how scary. We’re DOOMED.

kirkill on May 29, 2009 at 10:05 AM

Step away, it’s become self-aware!

Tax breaks would be used as just another case for discrimination activists to say that’s not fair to those who don’t pay taxes.

OldEnglish on May 29, 2009 at 10:14 AM

Ed,

I saw an episode of Scrubs recently with two people who needed kidney transplants. Their spouses weren’t matches, but they were for the opposite couple. So the donor spouses planned to trade kidneys. Is that legal, i.e. can you barter organs?

commodore on May 29, 2009 at 10:05 AM

Yes. In fact, Johns Hopkins recently performed the first 6-way kidney paired donation, and schools like Carnegie Mellon are working on software systems for matching paired donors to recipients

vermillionsky on May 29, 2009 at 10:14 AM

To get the correct answer to this question, you must ask yourself a deeper, more important questions…

How is this going to help Michelle’s kids?

How is the government going to benefit from this transaction?

Will ACORN be signing up people as donors?

PappaMac on May 29, 2009 at 10:16 AM

Yes. In fact, Johns Hopkins recently performed the first 6-way kidney paired donation, and schools like Carnegie Mellon are working on software systems for matching paired donors to recipients

vermillionsky on May 29, 2009 at 10:14 AM

Well bartering organs is no different than selling them, it’s just using a different medium of exchange. So I don’t see why it shouldn’t be legal.

commodore on May 29, 2009 at 10:18 AM

This is a great article. Yes they should. My best friends husband died on April 26th this year. In six months she lost her daughter, her father and now her hubby. They donated all of his parts so others can have life. The Helicopter flight from Santa Maria, Ca. to Santa Barbara was 41,000.00. He was on life support for two days. His bills are unreal and her family was left with nothing. One would think that if a person helps give life and helps the doctors make money, then yes they should compensate the family. Now my friend has to file bankruptcy. She got a letter letting her know that a woman, got his lungs, another got one kidney while another young girl got his other kidney. That is not all the parts that can save lives. Would help a lot of people if they would do this. There has to be a better way than Nationalizing health care.

sheebe on May 29, 2009 at 10:18 AM

I’m sympathetic to the argument, and have family members who have given and received transplants. I argue no to financial incentives, but wouldn’t fight it passionately.

My concerns are that I don’t trust the govt. to do it well (even a handful of exploited donors is unacceptable IMO), it removes the altruism from the process, and the potential liability. Live donors are often healthy, but you’re going to get that one-in-a-thousand case where the surgeon accidentally nicks something else while taking the kidney. Taking that risk for a loved one, or out of compassion, is different in my mind that taking it for $.

cs89 on May 29, 2009 at 10:20 AM

Abso-freakin’-lutely! This is a freedom issue. It is no one’s business if I sell a kidney and no one’s business if someone buys my kidney in a voluntary, mutually beneficial exchange between two people. Organ donations overall would increase exponentially if it were put on the free market. Government interference, especially government interference in the finance of healthcare only ruins the system, as it does with all systems in which it gets involved.

King of the Britons on May 29, 2009 at 10:23 AM

How is this going to help Michelle’s kids?

Might not. That’s why Barry probably won’t endorse this.

How is the government going to benefit from this transaction?

If they don’t, believe me, they won’t be behind it.

Will ACORN be signing up people as donors?

PappaMac on May 29, 2009 at 10:16 AM

The only “donors” ACORN will be signing up are the ones deep down in the ground…

Upstater85 on May 29, 2009 at 10:24 AM

They pay blood and sperm donors (and a kidney removal is more painful than the former and more permanent than the latter), then just compensation is in order.

If paying someone 20 (or even 100) grand saves someone else’s life, it sounds like a bargain.

profitsbeard on May 29, 2009 at 10:26 AM

Abso-freakin’-lutely! This is a freedom issue. It is no one’s business if I sell a kidney and no one’s business if someone buys my kidney in a voluntary, mutually beneficial exchange between two people. Organ donations overall would increase exponentially if it were put on the free market. Government interference, especially government interference in the finance of healthcare only ruins the system, as it does with all systems in which it gets involved.

King of the Britons on May 29, 2009 at 10:23 AM

I agree with you in principle, but I’m concerned that this is something that could (at least under the current administration) create a larger government.

If this is allowed, it should be between the two individuals with minimal if any government interference.

Upstater85 on May 29, 2009 at 10:27 AM

I would like to donate Wanda Sykes kidneys.

Geochelone on May 29, 2009 at 9:47 AM

+1

jgapinoy on May 29, 2009 at 10:31 AM

I think Dr. Walter E. Williams makes an excellent case for allowing people to sell their organs.

aero on May 29, 2009 at 9:55 AM

If he’s for it, I’m for it.
Williams & Mark Steyn are why I’m happy when Rush goes on vacation.

jgapinoy on May 29, 2009 at 10:33 AM

I agree with you in principle, but I’m concerned that this is something that could (at least under the current administration) create a larger government.

If this is allowed, it should be between the two individuals with minimal if any government interference.

Upstater85 on May 29, 2009 at 10:27 AM

You are correct. For this to be done, it would require the government to get out of the healthcare business altogether and I realize that that is not happening anytime soon (quite the opposite it about to occur). For those who object because of the exploitation issue – that is the same argument used by liberals to empower the nanny-state in every area of our lives. It is not an argument based on the principle of freedom.

King of the Britons on May 29, 2009 at 10:34 AM

Ed, I’m glad your wife is well.

Given that the government absorbs all the cost in the current ESRD maintenance system, a government-run compensation system probably makes the most sense, which would also hopefully structure payments across a long term to keep the acutely desperate from trading a kidney for momentary relief. A government system would also get built in a “blind” method, where donors and recipients never meet or know each other’s identities, to avoid the appearance of the rich buying organs from the poor. A free-market system might provide better compensation levels for the donors, but it also would be harder to ensure that the ethical considerations remain paramount, and government is already for better or worse a major stakeholder in the transaction.

I trust the government far less than you here. Don’t give the government any more authority than it has over our bodies. There are always unintended consequences. The government is less reliable than private industry. When has the government not lapsed into “oops” mode on anything? Regulation is good/bad enough. But to authorize the government with exclusive rights to medically determine who gets what, and what gets done is socialized medicine and another stroke enabling eugenics.

maverick muse on May 29, 2009 at 10:37 AM

For those who object because of the exploitation issue – that is the same argument used by liberals to empower the nanny-state in every area of our lives. It is not an argument based on the principle of freedom.

King of the Britons on May 29, 2009 at 10:34 AM

Yes, and even though exploitation is troubling on moral and ethical levels, this doesn’t mean it won’t happen without the legality of selling kidneys. There will still be those that “voluntarily” give up their organs to criminal elements. If anything, more legal demand should cut back on illegal exploitation.

Upstater85 on May 29, 2009 at 10:37 AM

legal demand = legal supply

Sorry

Upstater85 on May 29, 2009 at 10:37 AM

Here’s the “heartless” solution that I’m sure the new world order gubmint will agree with – “The reason so many people need kidneys is because of poor eating and exercise habits. If we can all just have mandatory diet and exercise times before the workers go into the factories, we’ll be able to reduce the demand.”

You think Orwell was kidding?

kirkill on May 29, 2009 at 10:37 AM

Live donors are often healthy, but you’re going to get that one-in-a-thousand case where the surgeon accidentally nicks something else while taking the kidney. Taking that risk for a loved one, or out of compassion, is different in my mind that taking it for $.

cs89 on May 29, 2009 at 10:20 AM

Post-op, the once healthy donor may recuperate but yet fall ill down the road.

I can understand the the rationale to not take organs without financial recompense. It’s already happening. It’s directing the money specifically into the donors’ hands that matters. They are being exploited already. And that is NOT reason enough to placate conscience with the pay-off, washing hands of what subsequently comes of the donor.

Flowers for Algernon comes to mind; all those good intentions. No follow through when the worse became obvious.

maverick muse on May 29, 2009 at 10:42 AM

kirkill on May 29, 2009 at 10:37 AM

As Nancy. Regulate and inventory every detail.

maverick muse on May 29, 2009 at 10:44 AM

What a mess. No. And I think the urge to transplant is rife with enough potential for abuse already without adding fees for organs to the pot.

I think that if we allow this we will get into a situation where if you want to sell that it will be based on a waiting list and that soon the sale will be subject to a plethora of regulations similar to the EEOC. And the government will begin to pay to make it “fair”.

We either have to come up with better therapies for renal disease, bit the bullet and pay for dialysis, or learn to accept that you can’t live forever. I think adult stem cells may lead to breakthroughs here. Selling body parts is a prescription for disaster and abuse.

Oh and compensating for the use of dead relatives=more dead relatives.

clnurnberg on May 29, 2009 at 10:56 AM

Give an inch. Go the length. Once the government has the authority to barter our living organs, given socialized medicine and poverty, we’ll be forced to negotiate treatment with organ donations in payment. We won’t even be allowed to live into old age, but instead be forced to recycle (sacrifice) our bodies before they deteriorate.

At least if things remained AS IS, we can age even if in poverty we decline and die, we do it naturally.

As a young adult, I signed on my driver’s license that my organs could be donated upon my death. But no longer, as over the years, different concerns have changed my mind, particularly hospitals where employees jump the gun. The other reasoning has to do with the metaphysical. I don’t want my essence inside some stranger. If it were a relative or friend that I were donating to by choice, that would be a different matter that I would absolutely consider. But arbitrarily, I no longer want myself as part of another. The native Americans are not alone in their reflection that the person who saves a life is then responsible for everything that life does and becomes. It’s a personal choice issue.

maverick muse on May 29, 2009 at 10:57 AM

I’m surprised organ selling has not been a part of the ‘for profit” system of health care in America all along. You don’t have altruistic Doctors or Hospitals, why then expect altruistic donors to add to the Doctors/hospitals profits?

BL@KBIRD on May 29, 2009 at 10:57 AM

… They donated all of his parts so others can have life. … He was on life support for two days. His bills are unreal and her family was left with nothing. … Now my friend has to file bankruptcy. She got a letter letting her know that a woman, got his lungs, another got one kidney while another young girl got his other kidney.

This too could be answered by the “medical care for the donor” system, although it would be very severe pressure on the family of the deceased. Still, it seems better than just paying cash.

njcommuter on May 29, 2009 at 11:01 AM

Paying people to donate oragns concerns me.

As Limerick on May 29, 2009 at 9:44 AM said

Rich man gives kidney. He doesn’t need the $.

Poor man gives kidney. He needs the $.

And I would add to that:

Rich man needs a kidney, He can afford to pay for it

Poor man needs a kidney, He doesn’t have the $$ to buy one.

katiejane on May 29, 2009 at 11:03 AM

katiejane on May 29, 2009 at 11:03 AM

So government will pick up the tab and selling will be based on an anonymous and approved need list.

clnurnberg on May 29, 2009 at 11:07 AM

Rich man needs a kidney, He can afford to pay for it

Poor man needs a kidney, He doesn’t have the $$ to buy one.

katiejane on May 29, 2009 at 11:03 AM

Solution: Tax Middle Class into extinction so there are only rich governing classes and impoverished, unheard classes…

Upstater85 on May 29, 2009 at 11:09 AM

different concerns have changed my mind, particularly hospitals where employees jump the gun.
maverick muse on May 29, 2009 at 10:57 AM

It’s absolutely your choice whether to put the “donor” info on your license, and I agree with some of what you say. This quote, though, I don’t see.

I’ve been pretty close to the process in more than one hospital, and at least in my experience, employees “jumping the gun” just doesn’t seem to happen. If you have any concrete examples, I’d be happy to consider your concerns.

cs89 on May 29, 2009 at 11:12 AM

“Dialysis? What is this, the Inquisition?”

OneGyT on May 29, 2009 at 11:24 AM

If one examines the reason why the US doesn’t allow the sale of blood, the reason we shouldn’t allow the sale of organs becomes obvious.

Those who participated in the once-legal sale of blood tended to be drug users, alcoholics, and others who had no steady employment. One would have expected the industry to assure the quality of what it provided, but it did not, and as a result, thousands of recipients of sold blood contracted AIDs through their transfusions.

Recently, the LA Times ran a story on the sale of donated cadaver body parts:

The conspiracy was uncovered when a state health investigator grew suspicious that Nelson was fraudulently claiming that the parts had been screened for infectious diseases before selling them.

Perhaps my use of the word “shouldn’t” is too strong. But the industry will indeed be drawing principally upon the “dregs” for live organs, and a prime guarantor of the health of a donated live organ (the altruism of the provider) will be absent.

unclesmrgol on May 29, 2009 at 11:25 AM

I despise the words “organ shortage” as it implies there is not enough death to help and that people are praying for someone young and suitable to die.

When I look at all the rcent stories of people killing their children, I just see paid donations as an incentive to do this MORE often and more cleverly.

Also I imagine people will be pressured to sell.

What will the legal age of consent for this be?

Every surgery, even one to “harvest” an organ entails risks and pain. Young people eager for cash are not good judges of risk, even short term risk, and I’m not sure that they can look down the road and see that a kidney given today cannot be given to a child down the road or might be needed in the event of an accident or disease down the road.

clnurnberg on May 29, 2009 at 11:32 AM

With the gubbmint tracking our health records, maybe they could just sort through their files and send somebody over to your house to get it.

cntrlfrk on May 29, 2009 at 11:33 AM

This is an interesting topic. Thanks for bringing it up (albeit tied into your WSJ review). And most importantly, I’m sure we all wish continued good health for you and your wife.

My hope is that someday relatively soon, cloning technology will advance to the point that we can grow needed organs in a lab. Perhaps another word would be better for this sort of technique, as “cloning” tends to scare people.

But even if that happens (and that’s a big “if”, considering the technological and political obstacles), it’s several years off.

For now, I dont see why we shouldnt allow payments for organs. It’s your body; you should be allowed to decide what you do with it. People sell their hair to wigmakers (or donate it to cancer-related charities). People sell their blood as well. Granted, these are renewable and kidneys are not, but in my opinion the same priciple applies.

Obviously safeguards would have to be put in place to ensure that the “woke up in a bathtub full of ice” story remains an urban legend. And probably that could be mitigated somewhat by ensuring that the payout for a kidney would be large enough to be an incentive, but small enough so that it’s not worth it for a black market. (5 or 10 thousand is a lot for a person, but not necessarily enough for the black market, considering all the risks and the number of people who would have to be paid to make it work. For one thing, you’d need a surgeon to take out the kidney, and they likely wouldnt sell their services on the black market cheaply.) And frankly, in this day of DNA testing, it shouldnt be too difficult to make sure that the person who claims to have given a kidney is telling the truth.

There are slippery slope issues and potential for horror stories, but I think this is the right way to go.

orange on May 29, 2009 at 11:42 AM

So government will pick up the tab and selling will be based on an anonymous and approved need list.

clnurnberg on May 29, 2009 at 11:07 AM

So if I have a kidney that is in short supply due to some special qualities is the government going to negotiate with me? Are they ging to develop a price list offering a base price for a common kidney and a premium for one with just a few years on it? If I’m entitled to “sell” my organs why shouldn’t I get top dollar for them?

katiejane on May 29, 2009 at 11:43 AM

Sorry, everything is marketed somewhat. It can be done right and make a huge difference.

Mr. Joe on May 29, 2009 at 9:37 AM

Excellent point. As this is a right-leaning blog, I would think that most folks here would be for a free market with limited governmental intrusion.

orange on May 29, 2009 at 11:45 AM

If the donor (or donor’s estate) can’t be compensated for the organ, then why is the surgeon doing the transplant being compensated? By the logic that one cannot put a price on life, it is inconsistent to pay the mechanic and not pay for the parts.

Vashta.Nerada on May 29, 2009 at 11:52 AM

But the industry will indeed be drawing principally upon the “dregs” for live organs, and a prime guarantor of the health of a donated live organ (the altruism of the provider) will be absent.

unclesmrgol on May 29, 2009 at 11:25 AM

I’m no expert, but I’d think the prime guarantor of the health of a donated live organ would involve health tests. Someone could appear to be healthy (ie not be a member of the “dregs”), yet still not truly be healthy. I presume you wouldnt call Ed Morrissey a member of the “dregs”, but health tests determined that he was not an eligible donor.

That said, you make a valid point. I just dont think altruism is the prime guarantor of organ health.

orange on May 29, 2009 at 11:55 AM

The government can take your land (with compensation they deem appropriate). How big a leap is it to see them claiming your body parts, after death at first, then…
What used to be nonsense is now the law of the land. After all, it’s for the “greater good” (in unison: “Greater Good”).

SKYFOX on May 29, 2009 at 12:03 PM

Maybe the Presidents Office of Substitute Decision Maker can help you decide whether you need that kidney or not.

cntrlfrk on May 29, 2009 at 12:04 PM

I see on this page opinions from at least two people who have had loved ones who have needed kidneys. They both support the idea.

I think that’s telling. People who have had to go through this terrible situation are willing to face the worries of slippery slopes to make sure that others dont have to suffer the way they did.

If your spouse or child was lying in a hospital about to die, would you refuse a life-saving kidney if you found out that the donor had been paid?

orange on May 29, 2009 at 12:08 PM

His bills are unreal and her family was left with nothing. One would think that if a person helps give life and helps the doctors make money, then yes they should compensate the family. Now my friend has to file bankruptcy. She got a letter letting her know that a woman, got his lungs, another got one kidney while another young girl got his other kidney. That is not all the parts that can save lives. Would help a lot of people if they would do this. There has to be a better way than Nationalizing health care.

sheebe on May 29, 2009 at 10:18 AM

God bless your friend and her family.

If God does exist, I suspect He’ll reward her mightily someday for what seems so unfair now.

Professor Blather on May 29, 2009 at 12:30 PM

I only worry about Obama’s interference in this. If it is left to a free market for those who wish to participate (and only legal adults deemed able to make decisions for THEMSELVES) we could take most of the people off the waiting list. For $100k, I would be first in line to donate.

We can still have the government list for the folks who can’t afford a kidney or who want to wait for an altruistic donor kidney.

If more kidneys are widely available, more people would be willing to donate or sell them. How many people are reluctant to donate incase a loved one needs the kidney later.

Laura in Maryland on May 29, 2009 at 1:13 PM

Maybe we need an organ czar (Bill Clinton eagerly volunteers).

Laura in Maryland on May 29, 2009 at 1:13 PM

By the way, if you think this isn’t already happening behind the scenes, you are kidding yourself.

Vashta.Nerada on May 29, 2009 at 1:18 PM

I have polycystic kidney disease (genetic), and I’m going on the list this month. I hate reading stories like this. I don’t like learning about the coming attractions. Dialysis is a horror story. My family would certainly be willing to legally pay for an organ.

fleiter on May 29, 2009 at 2:24 PM

Kidney donations whether intervivos or from recently deceased persons should be compensated. Especially in the latter case because of political considerations in the Obama and (upcoming) Sotomayor era. Rich democratic whites, blacks and Hispanics will get first (and perhaps the ONLY) preference. Any other white (especially males) need not apply. Asians too, even though they tend to vote Democratic, will also get low priority because no Asian can influence an election in any of the 57–er 50 states.

I had a friend, recently deceased, whose Chinese wife refused to donate his kidney-when they took him off life support- because his political views on this subject were well know. I have instructed my Japanese wife, if the opportunity arose, not to donate my kidneys-not because a rich liberal, black or Hispanic will get it but because ONLY a rich liberal, black or hispanic will get it. (PS, as you can imagine, the lion’s share of these donations will, ironically go to rich white liberals.)

Thus I would favor some sort of remuneration to the living donor or to the donor’s estate-and perhaps to some specific recipient- to avoid the Sotomayorization of kidney transfers.

MaiDee on May 29, 2009 at 3:02 PM

Tragically, I think we can cross off a free market system which is not just an invitation to exploitation and abuse, but a guarantee. It takes almost no imagination to conjure up the ensuing glut of advertisements and questionable solicitation, along with industrial strength, profit based (cost cutting!), harvests and a whole new class of ambulance chasers. If I can sell a kidney, why not an eye or skin, or the occasional vein or vessel?

“A government system would also get built in a “blind” method, where donors and recipients never meet or know each other’s identities, to avoid the appearance of the rich buying organs from the poor.”

The only blind people here will be donors, recipients and almost anyone who might otherwise be in a position to question the political bureaucrats who will be screening and tracking both sides of the equation as well as prioritizing, and very likely means and age testing, the list of who gets what, when, where and how — the least of which may be deciding who gets cadaver kidneys and who gets live donor kidneys.

It’s entirely possible that those maintaining on dialysis could end up waiting 7 years regardless, or that anyone whose first transplant failed would end up at the back of the line on a secondary list. Would intra-family donations be subject to regulation as transactions? Almost any transaction can now be subjected to the federal dictates of interstate commerce, of course, and the step between incentives and compulsion is very small.

When it comes to exploitation, whom do you envision all these potential live donors to be? Do you really think those who are financially comfortable will be lining up in any numbers to sell their organs? I’m sorry to be blunt, but do you believe your friends would have put their kidneys up for sale to recipients they didn’t know? What about parents who might want to offer up the kidneys of minor children — for the good of the family?

That’s just a 2 minute start on the questions that occurred to me once I got over recoiling from the prospect of commercializing the sale of body parts. In this reduction to cost/benefit analyses, has the enormous cost of running dollars through the federal government really been factored in? Have you included every conceivable kind of litigation which might arise? Because it will. When we abandon altruistic donation, we will reach a host of unanticipated moral, legal and political questions sooner rather than later.

Ultimately, the sheer mass of both enabling and preventive regulation, and of subsequent government rule-making, management and oversight, will reach nightmarishly byzantine and inevitably political heights. Even from a financial perspective alone, I believe we would be far wiser to pour such resources into promising research. Alas, where government is concerned, we must confront the searingly difficult questions of financial triage, which includes measuring the relative value of kidney transplants against other forms of intervention. Where lives hang in the balance, there are no painless answers.

JM Hanes on May 29, 2009 at 4:47 PM

I donated my left kidney to my cousin on Oct 3rd, 1996. The only compensation I received was the cost to travel to Minneapolis (he bought tickets for my girlfriend and i), and 6 weeks of disability ($325 a week) from the state of California. I had to fight the state for benefits at first, because they claimed a transplant was an “elective procedure”.
My cousin’s insurance (Blue Cross) paid for all of our medical bills. I know that the Univ. of Minneapolis Medical Center billed BC huge $$’s for my half of the transplant, and huge $$’s for my cousin’s half. How long would it be until insurance companies like BC stop paying for the “donor” half of a LIVE transplant operation if we made it legal to sell an organ? Recipients unable to pay the donor side costs will be shifted right back over to the taxpayer (as they are now for the uninsured for basic health care , but many, many times over)
As for cadaver kidney donation, I don’t think recipient insurance carriers should have to bear the donor side of the transplant costs. I also don’t think that cadaver donations should be compensated either because an unknown number of unfortunate people will become cadavers because they are a perfect blood match.

JustJP on May 29, 2009 at 5:29 PM

stem-cell therapies might end the need for transplants, but that’s a very long way off, and people die in the meantime

Well if the gov would put money into research that had a future(IE Adult over Embryonic) . . . .

- The Cat

MirCat on May 29, 2009 at 8:53 PM