Should We Allow a Kidney Market?

[Marat]

People suffer terribly while waiting on dialysis for a kidney transplant, and thousands die waiting. Because only a tiny percentage of people die in circumstances which allow a kidney to be used for transplant, cadaver-source kidneys can never meet the demand for replacement organs. A healthy person can donate one kidney with no damage to health or reduction of life expectancy, but few people are generous enough to donate a kidney for free. To reduce the terrible human suffering and high death rate in the dialysis population, some have proposed that we permit a government regulated kidney market to operate, in which healthy donors would be allowed to give one kidney for a set price to someone with no kidneys.

 

However, such a market would now be illegal in almost the entire world, and last year most of the world's countries got together to pass the Istanbul Declaration which committed them all to introduce even harsher statutes to prohibit such a market from ever being established. U.S. federal law now punishes kidney patients trying to save their life by buying a kidney with a five-year prison sentence.

 

A major argument against such a market is that it would exploit poor people by inducing them to sell a kidney for money, but in a bargain which would logically have to be to their disadvantage, even though they voluntarily elected to make it and it would have no significant negative effects on their health. It seems to me that rather than exploiting poor people, such a market would provide an empowering option to poor people to escape their poverty by a new means which is now inaccessible to them.

[Mr Skeptic]

The basic concept is that many people are thoroughly irresponsible and unable to make their own decisions, particularly when it comes to getting cash now. I don't really think a little extra money would help this sort of people. I think the entire demand for kidneys could be met by people willing to part with theirs for under a thousand dollars, and within a year any benefit from that money will be gone. Two kidneys are better than one, but not by much. No kidneys of course is horrible.

 

I think that the proper thing to do is for the government to place a minimum price at which organs may be sold. This will both prevent poor people from being exploited too much (at least they will get good compensation), and also allows to be more selective to get kidneys from healthier people (so they are less likely to suffer and also for the good of the recipient). This could probably be paid for from the money that would otherwise have gone to constant dialysis.

[DJBruce]

Would said market allow those who need a kidney to bid on them? If it would I could see that causing major problems. If the system allowed for the people seeking a transport purchase them at an unset price those with more financial resources would be favored to receive kidneys, and survive. So any market, which allows for the purchasing of kidneys by patients would be one I would not favor.

 

That being said, I am not entirely sure if a kidney market would prove to be successful. In my opinion the reason that most people decide not to donate organs is because they are afraid of the possible complications, and the process would be a major hassle. The money earned from selling a kidney could overcome the inconvenience of the procedure itself. I highly doubt, however, that any amount of money will pacify the worries of people afraid of the worst case scenario.

[rogerxd45]

well i can say i would be FAR more likely to "donate" a kidney if i were to get like 100k

 

invest half into my retirement account and the other half towards a house.

 

i think the minimum i would take would be in the 50k range.

 

i dont see any reason to deny such a market, its a win win. patient gets kidney and i get compensated for taking the risks and pain involved.

 

how would this be any different then the girls that "donate" their eggs for upwards of $5k?

i have known several girls that have done that and i seriously doubt they would have done it if they weren't getting money out of it.

[Marat]

There are many possible versions of a regulated kidney market. In one, the government would pay for all kidneys acquired and then distribute them according to medical need to the people waiting for a transplant. Since Medicare now pays for dialysis for all people of whatever age who require it, and this costs $60,000 a year, the government would ultimately save money by getting people off dialysis by paying $240,000 for a kidney transplant operation for them. The government would then rationally have to spend about $15,000 to keep these patients going with anti-rejection drugs, but the longer the transplant lasted, the more the kidney purchase would work out to the benefit of the taxpayer. The purchase price of the kidney would also have to be factored in, but even if this were $75,000, a renal graft surviving 7 years would start to turn a profit for the taxpayer. Also, since most dialysis patients are too exhausted to work, while renal transplant patients have close to normal health, the return of transplanted patients to the workforce would have further benefits for the government tax revenue and for the economy generally.

 

Even if patients were allowed to pay privately for a new kidney, the removal of rich patients from the transplant waiting list would increase the availability of transplants for the poorer patients, so the rich could not gain without automatically helping the poor.

 

This does seem like a win-win situation, since the poor kidney vendor could escape poverty, the dying dialysis patient could return to health, the government could save money, and the economy could expand by the creation of a new and extremely valuable commodity in saleable kidneys. Yet interestingly, this idea is condemned by the United Nations, forbidden by the European Union, and rejected by the Istanbul Declaration signed in 2009 by 180 countries. The arguments opposed to a kidney market are usually emotive and romantic, waxing poetic about the sacredness of the body, the duty of the West not to exploit the poor in the Third World by buying their kidneys, the racism of rich Caucasions buying kidneys from poor Blacks, etc. But given that the world-wide ban on the black market kidney trade will kill 10,000 dying dialysis patients a year who will now have no way to get a replacement kidney in time, these romantic arguments ring hollow against this mass murder.

[rigney]

There are many possible versions of a regulated kidney market. In one, the government would pay for all kidneys acquired and then distribute them according to medical need to the people waiting for a transplant. Since Medicare now pays for dialysis for all people of whatever age who require it, and this costs $60,000 a year, the government would ultimately save money by getting people off dialysis by paying $240,000 for a kidney transplant operation for them. The government would then rationally have to spend about $15,000 to keep these patients going with anti-rejection drugs, but the longer the transplant lasted, the more the kidney purchase would work out to the benefit of the taxpayer. The purchase price of the kidney would also have to be factored in, but even if this were $75,000, a renal graft surviving 7 years would start to turn a profit for the taxpayer. Also, since most dialysis patients are too exhausted to work, while renal transplant patients have close to normal health, the return of transplanted patients to the workforce would have further benefits for the government tax revenue and for the economy generally.

 

Even if patients were allowed to pay privately for a new kidney, the removal of rich patients from the transplant waiting list would increase the availability of transplants for the poorer patients, so the rich could not gain without automatically helping the poor.

 

This does seem like a win-win situation, since the poor kidney vendor could escape poverty, the dying dialysis patient could return to health, the government could save money, and the economy could expand by the creation of a new and extremely valuable commodity in saleable kidneys. Yet interestingly, this idea is condemned by the United Nations, forbidden by the European Union, and rejected by the Istanbul Declaration signed in 2009 by 180 countries. The arguments opposed to a kidney market are usually emotive and romantic, waxing poetic about the sacredness of the body, the duty of the West not to exploit the poor in the Third World by buying their kidneys, the racism of rich Caucasions buying kidneys from poor Blacks, etc. But given that the world-wide ban on the black market kidney trade will kill 10,000 dying dialysis patients a year who will now have no way to get a replacement kidney in time, these romantic arguments ring hollow against this mass murder.

 

I'll have to give you a: "Bong, Bong, Bong" on that, since I've had relatives and close friends suffereing the dilemma that are gone, gone, gone. And mostly, 'cause we didn't have the money to make up the difference. If you can live another day and can afford it, do it!

Edited August 10, 2010 by rigney

[Severian]

The trouble with society is that to take part, you really need to behave like everyone else does, or put yourself at a short term disadvantage. For example, imagine that the kidney trade became so commonplace that your were expected to do it in order to fund your education. If you didn't do it, you don't get educated, so end up in a low paid job. People would then feel they had to sell a kidney.

 

In other words, placing a monetary value on something can result in indirect coercion to give that something up.

[Marat]

But so many things would have to change in so many unpredictable or non-necessitated ways for the creation of a kidney market to wind up forcing people to sell a kidney that it would be difficult to draw any direct causal link between the creation of the market and the compulsion to sell a kidney. For example, until the mid-19th century selling life insurance was legally forbidden because such contracts were thought to be immoral for betting on someone's death, which was regarded as a sacred event determined by God. But once life insurance became legal, opening the market for bets on people's life expectancies did not force people to rely on life insurance pay-offs from their grandparents to pay for college tuition, though that was certainly possible.

[Sisyphus]

The trouble with society is that to take part, you really need to behave like everyone else does, or put yourself at a short term disadvantage. For example, imagine that the kidney trade became so commonplace that your were expected to do it in order to fund your education. If you didn't do it, you don't get educated, so end up in a low paid job. People would then feel they had to sell a kidney.

 

In other words, placing a monetary value on something can result in indirect coercion to give that something up.

 

Well it couldn't be that commonplace, because the number of people who need kidney transplants is far less than the total population. Demand for human kidneys as functioning organs (so, I'm ignoring the possibility that they will become a culinary delicacy or something) is constant and low - it just happens that supply is currently even lower. Make the market legal, supply will skyrocket, prices will plummet, and then supply will stabilize too.

 

I think it's safe to say that kidney sellers will be limited almost entirely to people in bad financial situations, and be rarer even than, say, surrogate mothers are now.

 

Plus, I suspect that organ transplants will eventually be largely replaced by artificial organs, anyway.

[Marat]

I agree. There are only about 400,000 people in the United States with endstage renal failure, and of these, many are so old or ill that they would not benefit from an organ transplant even if a replacement kidney were available. So the total number of kidneys needed would be only perhaps half that number, which would make a very small impact on the overall economy. Iran, which did introduce a kidney market a few years ago, has had no significant side-effects on its wider economy from that program, but it has cleared the list of patients waiting for a transplant.

 

Using stem cells to recreate kidneys or some other novel method to generate a supply of natural, immunologically inactive replacement organs would solve the problem, but given that it would take medical scientists ten to twenty thousand years to invent a way to open doors if you gave them a schematic diagram and a working model of a doorknob to work from as a head start, I doubt that any such advance will appear in the next 50 years.

[Moontanman]

The first $500k takes my kidney but you have to pay all hospital costs.....

[skyhook]

a case in my country, a wealthy businessman buy a kidney from a man from indonesia. They lied to the medical governing body that they are relatives and no money was involved. There is a middleman or agent, who took a percentage of the transaction. when that was found out, the three of them went to jail and were fined.

and I've always heard you can get a transplant in china from some death row inmates. maybe it is a rumour.. 

and there are some risk involved in operations, like infections and such.  india black market link 

 

http://www.time.com/time/world/article/0,8599,1709006,00.html

Edited August 15, 2010 by skyhook

[Marat]

The UN now estimates that about 10,000 kidneys are purchased a year on the current black market. As in any black market, the fact that governments make the trade illegal causes the trade to become dangerous, since criminals have to facilitate the exchanges. But if a government-regulated, legal market were introduced, such as they have in Iran, then such tragedies as arise from an illegal, unregulated market would not occur.

 

Imagine living in a society where irrational religious beliefs, superstitions, and vague, undefined moral sentiments made dentistry seem unethical to most people. Governments would respond by making the practice of dentistry illegal, and then every so often the moral outrage of the public would be reassured by sensational media stories about people dying from back alley quack dentistry. Everyone with good teeth and healthy gums would self-righteously shake his head and express his disgust with that horrible trade, at least until he or someone in his family needed dentures.

[Severian]

What about other organs? For example, if someone wanted a hand transplanted on (if that were possible) would it be OK to buy one from someone?

[Marat]

The ethical issue will be different with every organ traded, since they each carry their own risks and benefits. I suppose a heart transplant would be excluded, since life with an artificial Jarvik-7 heart is short and dreadful, though on the other hand, so is that of someone in need of a heart transplant. There is a case of a father who is serving a very long prison sentence who has already donated one kidney to save his child, but now that the kidney has been rejected, another is needed, and the father wants to give his last kidney for transplantation to his daughter. This has ethicists concerned, since the father would make himself a dialysis-dependent patient in order to get his daughter off dialysis, which is a gain in terms of what both parties want, but not a net gain in health for the two parties considered as a pair, since the father's donated kidney will fail as a transplanted kidney after around 20 years, but it would have lasted another 50 years had it not been transplanted.

 

This then raises the interesting question of whether there should be a kidney draft, in which the government would order enough healthy young persons a year to provide a kidney for all those who needed a renal transplant, perhaps in return for free medical care for life plus expenses. This would produce a utilitarian gain, since people who would have died without a kidney transplant will now live, at no more cost than the burden of enduring an unnecessary operation for the forced donors, plus some very small increase in health risks. But in terms of autonomy rights it would represent a huge cost, since the government would force people to lose a kidney against their will. But doesn't the government already claim the right to force people to risk and perhaps lose a limb, an organ, or life itself after being drafted to fight in a war fought often for less tangible benefits than saving the lives of dying kidney patients?

[Mr Skeptic]

This then raises the interesting question of whether there should be a kidney draft, [...] But in terms of autonomy rights it would represent a huge cost, since the government would force people to lose a kidney against their will. But doesn't the government already claim the right to force people to risk and perhaps lose a limb, an organ, or life itself after being drafted to fight in a war fought often for less tangible benefits than saving the lives of dying kidney patients?

 

Interesting thought.

[losfomot]

What about other organs? For example, if someone wanted a hand transplanted on (if that were possible) would it be OK to buy one from someone?

 

First 500k gets my left hand.

[Severian]

First 500k gets my left hand.

 

Really? Only £500k. That seems quite cheap.

[Mr Skeptic]

I'm pretty sure he meant 500,000 Zimbabwe dollars (about 10 US dollars).

 

I'm guessing people will value their organs differently depending on how old they are, for example. Very young people would get all $_$ at any significant amount of money and also due to not being paid as much, and would probably vastly under-price themselves despite them being able to get the most use out of their organs.

[Marat]

Something like what you describe has already happened in the Iranian kidney market, where potential vendors with rare blood types or with the right HLA-groups for a good immunological match for a particular purchaser have been offered additional payment under the table. This is why the best solution would be for the government to control every aspect of the market, say by purchasing all organs itself according to a fair price schedule and then distributing them strictly according to medical need. As things are now, about 15% of dialysis patients ultimately die because a vascular access can no longer be established to connect them to a dialysis machine, so these patients would be at the top of the distribution list in a rational market.

[dragonstar57]

my kidney goes to the first offer of ten million dollars(U.S.D)

but if there was a forced kidney donation law i would flee to mexico or Canada or Timbuktu

but I can imagine reckless people selling their organs for 50k just to get a sports car or something.

my grandmother suggested my brother sell his organs and blood on the black market when he asked if she could help him with the tuition to get into A major university. stuff like this would happen all the time if a kidney market were legal

but i would get ten million

Edited August 29, 2010 by cipher510

[Mr Skeptic]

stuff like this would happen all the time if a kidney market were legal

but i would get ten million

 

Nope, it goes to the lowest bidder. I'm guessing it would go down to a few thousand due to dumb people, unless there were a price floor.

[Marat]

Sometimes those objecting to a kidney market say that it would result in all sorts of desperate sales, such as extremely poor people selling a kidney to buy enough food for their starving children, etc., and so for this reason it should be forbidden. But in fact, our society allows such desperate bargains all the time already, such as when poor people join the army during a war simply because that is the only work they can find, or when impoverished families in West Virginia all work in coal mines, which are among the most dangerous places to work in the world, or when poor men from the inner city try to make money by becoming boxers. All these choices are both legal, risky, and potentially damaging to health or lethal, just a selling a kidney on an unregulated market could be.

[Mr Skeptic]

What about the potential for artificial kidneys?

http://www.sciencedaily.com/releases/2010/09/100902161253.htm

[Marat]

A Dr. Humes has been working on making such a bioartificial kidney for decades now. I am suspicious of this new version, however, since it advertises itself only as replacing 'most' of the functions of a normal kidney, so some form of hemo- or peritoneal dialysis might still be required, which would not seem to be much of an advance. The problem is that the normal kidney does so much more than just filter out toxins and maintain the normal electrolyte balance. It also produces hormones which regulate the blood pressure via the renin-angiotensin system, and which make red blood cells with erythropoietin. People who have a kidney which functions at a reduced glomerular filtration rate also suffer from a reduced output of renal hormones, so I wonder how well this contraption will work if it has just a few real nephrons in it functioning at less than full capacity because they are operating behind a differentially permeable membrane to protect them from rejection by the immune system. There are already clinical tests on human subjects of an artificial pancreas which uses pig pancreatic beta cells encased within a differentially permeable membrane to let out insulin but also keep out immunologically active cells, but so far this has functioned very poorly, since the pig cells die off quickly due to an inadequate oxygen supply and poor removal of toxic by-products generated within the protective capsule. My guess is that the same thing would also happen with these encased nephrons.

 

Also, we have to ask where the nephrons in this contraption come from? If they have to be human nephrons, then we bump up against the same problems of lack of supply as currently limit the renal transplant solution.

 

Finally, medical science always advances at a glacially slow pace which would be incomprehensible in any other area of science, in part because of the FDA's approval process, which costs about $300 million and takes 12 to 15 years to navigate before a new treatment can be introduced into clinical practice. Also, for reasons not entirely clear, if you were to give most medical researchers a schematic diagram and a working model of a door knob, it would take them ten thousand years to figure out a way to open a door without having to use an axe. So when they say that this bio-artificial kidney may 'someday' be able to replace dialysis, I would guess that the kidney market idea will be relevant for a long time to come.