A market for kidneys

As of March 2010, in the US, there were 86,158 people waiting for a kidney transplant; but between 2005 and 2007, an average of only 17,670 transplants were performed and many people died waiting. Many have proposed that a legal market for kidneys from live donors could solve this problem. For the most part, objections come from a sense of discomfort and “repugnance”, because such trade “commodifies” the body and will lead to an unfair system, in which rich people can take advantage of the poor, particularly in underdeveloped countries.

However, many do not see a problem with these transactions as long as they are voluntary: they will increase the lifespan and improve the quality of life of kidney receivers at little health cost for the donors and their exact motivation is not very important. They also point that the current system is not much fairer, since most people have an extra kidney, while there are people in need of one. Increasing the number of deceased donors would appease both sides, but would not be enough to meet all the demand, because only a small part of them would have healthy organs. Also, evidence suggests that patient and graft survival are higher with living-donor transplants, which implies that there would still be willingness to pay for these organs.

A radical change from the current situation to liberalization is highly unlikely and that makes it more interesting to study middle-of-the-road options. The usual prescription to increase supply in a market is raise monetary incentives; but since these are the matter of contention, other forms of compensation have been proposed, such as contribution by the government to the living donor’s estate upon his death or in forms other than cash: tax credits, health insurance or future priority in organ waiting lists. These seem like sensible compromises that also help reduce the repugnancy effect. There has also been some focus on the exchange of kidneys between patients who have an incompatible donor; if several people are in this situation, they can create a chain of transplants with strangers. The development of a mechanism like this in larger scale can improve the outcomes quickly without changing laws.

Again, just as with the economic value of life, human instincts play a big role in this discussion, but the argument of repugnancy sounds too weak and vague to be used to restrict what two people can do voluntarily, especially if one of them is trying to save its own life. It has also been pointed that a paid voluntary organ donor system has similar characteristics to a paid volunteer army system and most people do not object to that. I would also add the example of abortion, which is legal in many western countries. It seems odd that most people agree that a woman should have the right to choose what to do with their bodies regarding fetuses, but not organs. Despite the discomfort that the idea causes, I cannot avoid the feeling of having left a free lunch on the table and I am sure that those afflicted by kidney diseases agree.

PS: Post nº 100