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Life Arts    H4'ed 2/18/12

Legalized Market for Human Kidneys: a Problem or a Panacea?

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Message Reza varjavand
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You may have seen the TV commercial by MasterCard Company informing us that "There are some things money can't buy; for everything else, there's MasterCard." Even though I do not agree with the implied premise of this advertisement--that MasterCard is some kind of money, which it is not--the opening adage is of course accurate. We cannot buy everything with money, and the human kidney is an example of just such a thing.

Even just the thought of trading kidneys in a market is repulsive to many people, at least initially, demonstrating how difficult it is to find a balance between economic considerations and moral values. 

People seem to be disgusted by the idea of trading kidneys in a market for money, partially because they are influenced by their moral values and religious beliefs, or they are not aware of the dire consequences of the organ shortage. In any case, if they realize that many lives may be saved, often without destroying one, they may become more open to the idea of a legalized market for human organs. The statistical facts and figures concerning organ transplantations are staggering. According to the Organ Procurement and Transplantation Network, 18 people die each day because of the shortage of donated organs. A new name is added to the national organ transplant waiting list every 10 minutes. Out of a total of 113, 000 patients who are waiting for organ transplants, as of Febuary 8th 2012, almost 91,000 of them, more than 80%, are waiting for a kidney. Additionally, the number of kidney donors is 12,090, indicating that there are only thirteen donors for every 100 patients on the waiting list. Almost 6,861 of donated kidneys come from cadavers and 5,229 from living donors. 

Evidently, there is a severe kidney shortage in the United States thus creating the possibility of alleviating it through monetary incentives. Realizing that they may not find a good matching donor, many patients may not even bother to put their name on the waiting list, making the shortage more severe than what is being reported.

Medical science tells us that we may have only one kidney and still be able to live a healthy life. Thank God we have been given two so we can donate or sell one of them--the one we don't need! There is, therefore, an opportunity for an open market to trade kidneys, not only from live donors but also from cadavers. There is no question that with improvements in medical technology and the status of our public health, our life expectancy continues to increase, and with that the instances of kidney failure. Massive consumption of fatty and processed food that is preserved for a long time using chemicals, and the ensuing increase in the rate of obesity can further elevate the need for kidney transplantation. 

I believe that regardless of the allocation system, there will always be a shortage of kidneys. But the critical question is: Will the shortage be eliminated, or at least alleviated, if we have an active market for kidneys like we have for ordinary products? This is the question to which we do not have any definitive answer because there is no such market in any country in the world with the exception of one, Iran. Iran is the only country in the world in which selling kidneys is legal. (Please see this documentary for further information

In addition, there is no empirical research on the academic level to rely upon for documentation of this, except scattered observations. Presently, selling kidneys or other human organs is outright illegal in the U.S.

Like many other normative subjects, trading human kidneys for money is a controversial question with no valid right or wrong answer. There are, however, plenty of pros and cons, depending on the angle from which you look at this issue, your moral values and religious beliefs as well as your political persuasions. Nevertheless, there is no disagreement when it comes to the apparent shortage of kidneys for patients in need of one. Economists will argue that the reason we have a persistent shortage is because under our current system, price has failed to function as a rationing mechanism. If the United States had allowed the selling of kidneys in a free market, we would not be facing this ominous situation. They suggest that because people respond to monetary incentives, given that these incentives are enticing enough, having a legal open market for kidneys would increase the number of donors. The thinking is that the higher the incentive price, the larger the number of donors and the better the chance that this shortage will be eliminated, or at least alleviated, especially in the long term. While such a suggestion sounds plausible and works effectively for ordinary goods, it is doubtful that this would work for something as atypical as human kidneys.   Even if this suggestion does work in relation to kidneys, it generates a number of serious concerns.


Arguments Against Legalization

Foremost, there are many things people do charitably that they are not willing to do for money. Donating an organ is a compassionate act, while selling it is considered callous and mercenary and our society is not yet ready to sanction it. Even though the monetary reward is tempting, most people donate a kidney for the good feeling of personal satisfaction, the pride that comes with a selfless act of kindness, and the joy of saving someone's life. Commoditization of the human body will undermine such altruistic gestures, and diminish the dignity and inviolability of human life. Moral and ethical values, according to these people, should not be sacrificed for monetary gain.

Second, people obviously do not sell their body parts unless they are economically desperate and doing so will help them to ease the financial pressure they are under. Also, a person may not be aware of the impending health risks that can result from harvesting a kidney from a live donor. These are some reasons why most kidney transactions take place in rural areas of poor countries, particularly in India and in Pakistan where there is not due attention given to the peripheral concerns and related risks.    

Third, i f we start selling organs, chances are that many people who might otherwise consider organ donation will no longer offer to do so for free or even for money, thereby exacerbating the shortage and leaving needy patients in bigger jeopardy. There is also a good basis to argue that more people would sell a kidney for money, but only if the price is high enough to help them overcome the feeling of guilt and the emotional stigma attached to selling a kidney because it is viewed as a socially unacceptable deed.   As such, in a legalized market, the price of a kidney will escalate as will the overall cost of organ transplantations since supply will never catch up with demand. Price hikes, therefore, will cause the exclusion of some people who now can obtain a transplant under our current free system. In addition, who is going to absorb the additional costs, the patients or the insurance companies?

Needless to say, the persistent and growing demand for such a lifesaving commodity will bid up the price to a level where only the rich will be able to afford to buy a kidney. And, understandably, most people who are in need of a kidney are not rich so they will be priced out of the market. The rich can afford to buy the best kidneys offered on the market by healthier people, leaving less privileged patients with inferior kidneys offered by less suitable or deceased people. This would increase the chance of rejection and other complications. Poor individuals who sell organs under a market system may suffer from illnesses that the buyers will pay good money to avoid. High costs may further deepen the class division in American society, which is already compartmentalized according to the money and wealth. One can argue that if there is no legal market, and regardless of the distribution scheme, the wealthy individual can still afford to purchase a kidney on the black market instead of going on a waiting list, or can afford to simply travel to other countries, like Iran or India, to get the implantation.  

Fourth, trafficking in human kidneys possibly will create a new generation of criminals who may contemplate killing people just to sell organs for profit, or incentivize the involvement of various organized crime syndicates to kidnap and kill people to sell their organs. China was once accused of selling organs harvested from death row prisoners for hefty prices to foreign patients who needed organ transplants. A grisly tale that raised serious concerns about the possibility that repressive regimes try to create a source of income by selling the organs of executed prisoners can be accessed from   Have you seen the movie Repo Man? It is the story of a man who works for a company that sells human organs to transplant patients on credit. If a patient fails to pay, the company sends its repo man to take back the organ and, as you probably guessed, in a very violent way! Even the thought of something like that happening is very frightening.

Fifth, high organ prices may create yet another possibility. For instance, if an identified organ donor is in an accident, there is fear that he or she will not receive earnest lifesaving efforts at the scene, or perhaps will be denied proper lifesaving follow-up treatments just to get an organ after the person is dead. Such possibilities may sound unthinkable, but you cannot imagine the extent to which some people are willing to go for the sake of money.

Sixth, thank God that in the U.S. the payment for medical services is completely separate from the delivery of medical care to patients. Who wants to think about upfront money while devastated by the serious illness of a loved one in need of a kidney or any other vital organ? If organ donation is turned into a business enterprise, price will be most likely negotiated between a donor and the family of the recipient, and because the family is in such dire need of this vital commodity, chances are they will be duped into paying a high price, especially if the transaction is brokered by greedy middlemen or procurement agencies such as was the case in Repo Man.

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Reza Varjavand (Ph.D., University of Oklahoma) is associate professor of economics and finance at the Graham School of management, Saint Xavier University, of Chicago. He has been an avid participant in many professional organizations and active in (more...)
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