Imagine that you’ve been diagnosed with chronic kidney disease. Your doctor tells you that your best option is to be put on dialysis until you can receive a donor kidney. Kidney dialysis will keep you living for the three to five years that it will take to acquire a kidney, but your quality of life will drastically decrease (considering that you will have to have your blood filtered by a machine multiple times per week). You tell your doctor that this is not an option and have the money to ensure a more permanent solution immediately, but she has no solutions for you. You eventually discover that the only way to have a transplant is to travel overseas and illegally pay for a kidney. After deciding to do this, you negotiate with a kidney broker. He facilitates your travel to India and procedure for $150,000, and you return home relatively burden free. Your only worries are to attend doctor check-ups and take daily medicine, and you are content knowing that you may live up to 17 years longer than if you were on dialysis and remained on the waitlist.
This series of events do not seem so drastic, considering that in 2011, there were 90,363 registered candidates for the kidney transplant waitlist in the US, but only 16,855 operations. Since then, the gap between the number of people needing a kidney and available kidneys has widened. America needs a more effective solution, and making a legalized market for living organs, organs like kidneys or sections of livers than can be harvested when the donor is still alive, may be it. Nevertheless, the act of exchanging money for organs is illegal everywhere in the world, except for Iran.
The whole argument for a legal organ trade seems inherently unethical: selling your own body parts, which are part of your identity, for profit. However, opening up the market to a legal kidney trade in the US will most likely save more lives, but at what cost? Here are the arguments:
Benefits of a legalized market
- A legalized market will increase the living kidney supply, because people will be more inclined to sell a kidney than to donate one. This means that patients will receive better kidneys and live longer, considering that recipients of living donations live an average of 12 years longer compared to deceased donor kidneys. The increased supply will also mean that the quality of kidneys will increase, since a large supply will mean the option to choose from the best kidneys available.
- The current high costs of illegal kidney transplants will be driven down with the advent of a legalized market. With an increased supply of organs, competition will likely push down the cost. If demand and supply are equal, then people will not die from lack of a new kidney (thus saving over 5,000 people per year that die waiting for a transplant).
- The most significant claim to the supporting argument is that a legalized market is very cost effective. Considering that most people are on dialysis for around 5 years before receiving a kidney, they (or their insurance, depending on how much they have) will pay about $635,000 ($75,000 per year for dialysis and $260,000 for the actual transplant, not to mention non-medical costs such as food or travel). If an organ trade were legal, then patients would only have to pay the $260,000 for the cost of transplant and the cost on one kidney (which is estimated to be between $5,000-$25,000 or even as high as $50,000). This is less than half the price of the current situation, not to mention the increase in quality of life that will come with receiving a donation immediately rather than waiting 5 years.
- If organ trade markets become legal in other countries as well, then foreign black markets will be dissolved, and many citizens of poorer countries, specifically, will not have to suffer under the control of organ trade crime rings that are known for extorting organs out of the desperate. For example, there have been many instances in Nepal where impoverished people are promised a large sum of money for donating what the patients come to believe as “meat” that will “grow back”. One man in particular, Nawaraj Pariyar, was cheated out of receiving $30,000 when he was transferred to India to have his kidney removed without his consent. This is in direct contrast to Iran, where kidney trade is legal. People looking for organs are not allowed to work with a middle-man, nor are they allowed to contact that donor. This ensures complete and safe regulation by a third-party independent organization. Since the installation of a legalized market in Iran, the number of transplants per year has doubled. The recipients are also provided with subsidized medication and health insurance. However, it is difficult to assess the exact statistics in regards to the national waiting list.
Concerns with a legalized market
- Selling organs is unethical. The human body is priceless and cannot be quantified. Also, based on religious arguments, organs should not be sold; rather, giving organs should only be a charitable act. This is because God has gifted one’s body and it is not an individual’s place to make money off of it.
- The organs will go from poor givers to rich receivers. People in desperate situations will have no option but to donate a kidney because they need the money. In a CBS interview with Dr. Arthur Caplan, the director of the division of medical ethics at NYU Langone Medical Center, Caplan asks, “Who’s going to run down and sell a kidney who’s got a job or is relatively well off? It’s going to be poor people who do it […] Aren’t you really taking advantage of their poverty to get a body part?”
- Similar to the above argument, if people are coerced into selling their organs, then they may also lie about their health to receive payment. If screening procedures for finding blood borne diseases are not adequate, then recipients could contract HIV, Hepatitis, or other diseases.
Overall, we can agree that the organ shortage, specifically the kidney shortage, is a very relevant problem. The current system of altruistic donation is crippled by a lack of supply, long waits, and astronomical prices. Some action needs to be taken, whether that be in the form of a legalized market system, increased education and awareness, or switching from an opt-in system for organ donation, to an opt-out system, which is the standard in some European countries. Nonetheless, in the midst of these arguments, saving lives remains the highest priority.
Sara Miller, president of ORGANize at Washington University in St. Louis, contributed to this article.