Kidney for Sale
Despite campaıgns to promote organ donation, thousands of Minnesotans are awaiting kidney transplants. What would it take to convince you to part wıth one of your internal organs? How about $95,000?
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What’s more, Americans unwilling to wait for a transplant are often buyers in such markets. Last year, in an interview published in the University of Pennsylvania’s Bioethics Journal, Francis Delmonico, the director of renal transplantation at Massachusetts General Hospital and a professor of surgery at Harvard Medical School, told the story of a New York woman who traveled to South Africa, where she received a kidney transplant that involved a seller from Brazil and a broker in Israel. Experts refer to such practices as “transplant tourism.”
“These markets that sell kidneys are indistinguishable from the markets that exist to sell children and women,” Delmonico said in the interview. “As a society, collectively, internationally, as a people, and as a human race, it is not for us to have members of our society have to sell themselves, in any fashion…. As a transplant surgeon, I find it abhorrent.”
But Matas notes that we’ve already attached price tags to other body parts and fluids. Men sell sperm. Women sell eggs. Surrogate mothers carry babies for other couples. College students sell blood and plasma. And courts regularly award damages for lost limbs. Matas dismisses the concern that putting a price on organs would attract primarily poor people as donors. “What’s wrong with that?” he asks. “It doesn’t feel right, I understand. But poor people can make independent decisions about what to do with their own lives…. If a person makes an autonomous decision after a lot of thought that this is in their best interest and they get something of value to them in exchange, then I’m not sure we should prevent it.”
So how much is a kidney worth? Matas has calculated the value at $95,000, based on the amount that Medicare would save in deferred dialysis costs for a patient. And that number doesn’t factor in improvements to quality of life, Matas says: Other scientists have estimated a kidney’s value at $250,000 or more.
Matas supports a regulated system in which only the government could buy and allocate kidneys. Individuals wouldn’t be able to go out and buy kidneys on their own, so wealth wouldn’t determine who lived and who died. And donors would have to go thorough extensive medical and psychological screenings. Such a system, Matas thinks, would be the best way to squelch what is being done poorly elsewhere: “People say ‘This is terrible—what is happening in other countries—so we shouldn’t do it here.’ The reality is that we should do it here because it is being done badly in other countries.”
For a long time, Matas was a lone voice. Surveys done in the early 1990s showed that just 25 percent of doctors and nurses thought a regulated kidney market was a good idea. (Surprisingly, 70 percent of the general public supported the proposal.) Today, he says, a majority of medical professionals endorse the idea of setting up some kind of trial experiment. Still, the idea makes many people squirm. “I give talks and people stand up and start arguing with me,” Matas says. “I’m the person they line up to throw tomatoes at.”
Meanwhile, altruistic donors in the United States give and give: They not only risk their lives, they also shoulder tremendous costs. The recipient’s health insurance pays for the donor’s surgery and hospital stay (and many transplant centers, including the U’s, offer grants to cover costs associated with transportation, hotel rooms, and childcare), but working donors must secure time off from their jobs—often without pay. Down the line, donors may have trouble getting health or life insurance because they have just one kidney.
“Currently, there are financial disincentives to be a kidney donor,” Matas says. “All of us in transplantation think these disincentives should be removed. The debate is about whether there should be incentives.” The more innovative proposals include tax breaks for donors, health insurance for life, or—at the very least—paid time off from work during recovery. “We should have a way,” adds Kahn, “to not ask people to pay to do a good deed.”
Even those who have donated kidneys for free can see some value in Matas’s arguments. “Honestly, I probably would’ve taken money,” says Ziegler, the Elk River donor. “I have four children that are all going to need to go to college some day. [But] I also think it’s kind of sad that we have to go into capitalistic mode just to get people to live.”
So, would Matas ever step up to give a kidney? He closes his eyes and clasps his hands behind his head. A smile washes over his face. “My wife and I debate this all the time,” he says, his eyes open now. “If the package of incentives were good enough, I would do it.”
Emily Sohn writes about health and science for the Los Angeles Times, Science News, and other national publications. She lives in Minneapolis.