Kidney Swapping and Selling
The Atlantic recently published an interesting piece about possible solutions for the kidney shortage, by former Reason editor Virginia Postrel. There are more than 80,000 people on the donor waiting list in the United States, undergoing dialysis while they wait 10 years (or much longer) for a kidney transplant. About 1,335 of these potential kidney candidates live in Missouri. Dialysis, a time-consuming four-hour process that is repeated three times a week, fatigues patients — 90 percent of them are unable to work even part-time. Because dialysis treatment is guaranteed by the government (and can potentially go on for decades) it is extremely expensive from a fiscal standpoint.
Postrel’s article lists suggestions for ways both to decrease the transplant wait time and to increase the supply of kidneys, which currently stands at approximately 16,000 per year. One of her suggestions, “donor chains,” would essentially allow a patient’s friends or family, who may be willing to donate a kidney but are not a match, to trade places with other willing donors who do match. The longer these chains of donor-recipients are allowed to grow, the more kidneys can be closely matched to existing biological needs. For people with lots of relatives and friends who are willing and able to donate, this would be a boon.
There are plenty of people who cannot take part in such a chain, though, and for them another interesting solution presented is to purchase healthy kidneys. Donating a kidney is not without cost, and there are very few people who would be willing to donate one to a complete stranger. Any major surgery comes with the risk of potential complications. While a person can live a very healthy life with only one kidney, this lifestyle has additional risks: A single kidney expands to compensate for its missing counterpart, making it more vulnerable to collisions or contact sports, for example. Offering compensation for a kidney donor is a way of taking into account and making up for the risks that the donor decides to undertake. (Also, as Andrew Sullivan’s blog notes, a kidney donor is thereafter limited to one alcoholic beverage per day, which might affect some people’s quality of life.)
The Atlantic article suggests that if Medicare paid donors even $25,000 or $50,000 for a kidney, the resulting equilibrium would cost less than than the current expense incurred by the government-guaranteed dialysis treatments — not to mention the immeasurable quality-of-life benefit for patients who would otherwise waste years of their lives on dialysis.
Some question the morality of “selling” organs like kidneys. They voice legitimate concerns that unscrupulous people would take advantage of the poor, or that debtors or drug addicts would rashly sell their kidneys. Internationally, the kidney market is not benevolent, because some kidneys for sale are taken from unwilling donors in prison.
However, if such a plan were implemented in the United States, each donor would first be required to undergo both a psychological and medical evaluation to ensure that he or she could undertake the ordeal. Waiting periods or payment plans could also be instituted that would prevent people from making snap decisions about becoming a compensated donor. A legitimate American market would also discourage coercive international practices, which mostly arise from transplant tourism. If kidneys are more readily available at home, gray-market transplants abroad would no longer fill a significant economic niche.
If morality is to enter the equation of whether to allow kidney sales in the United States, however, a better question to pose might be whether it is moral to let people die or linger for decades on a waiting list when there are already plenty of healthy kidneys available from willing donors.