Deliver the Kidney (Oh Yeah!)

In law school, I took a class that was a bioethics seminar (the title of my final paper was a line from a Van der Graaf Generator song!). Among the issues we discussed was whether the law should recognize and enforce commercial contracts for surrogate motherhood. In other words, should you be able to pay someone else to carry a pregnancy to term with you.

A lot of people seemed to be OK with “altruistic” surrogacy, where a friend or family member agrees to carry the pregnancy for free (although usually with some consideration for medical expenses). Add money to the equation, however, and things changed. There was something cheap or tawdry about renting your body out for cold hard cash. I objected to the disparate treatment. It shouldn’t matter whether the surrogate you’ve got is a friend doing a favor or a woman who advertised on Craigslist. Either the whole surrogacy thing is wrong or it isn’t right?

So why don’t I feel the same way about people selling kidneys?

The other day in the New York Times, Alexander Berger made the case for creating a heavily regulated market for kidneys. Not a libertarian free for all, mind you, but federally regulated. Berger suggests paying willing donors $50,000 for their trouble.

The argument is pretty simple. There is currently a vast discrepancy between the number of people who need kidney transplants and available donors. Unless you have a friend or loved one who will make an altruistic donation to you, you pretty much have to wait for somebody to die and move up the list of transplant candidates. Only half of the people who made it onto that waiting list actually got a kidney.

So, offer a cash incentive to the public and the gap disappears, or at least narrows considerably. After all, most folks have two healthy kidneys and can make do with one. The operation, according to Berger, is very low risk, especially if you’re young and healthy. People will line up for the easy payday, right?

Well, maybe. For one thing, Berger oversells things just a bit. If the donation process is so easy, why pay $50,000 for it? After all, the average American only earns a little over $48,000 per year. A year’s salary for one operation? For a few days work, 50 grand is a hell of a payday.

For another, Berger hints at the concern of a lot of people, which is that in dire economic times like this, the wealthy will essentially harvest the poor for spare parts. His federally regulated market would limit purchasers to the government or certain nonprofit organizations, not private citizens. But there is still something skeevy about people needing to sell body parts to make ends meet.

But, then, why is that any different than the surrogacy situation? Why should someone with the connections to procure a volunteer donor live while someone without should die? I can’t really give a good answer to that.

In the end, I think I have to admit that my objection to creating a (legal) market for kidneys, or any other disposable organ, has its basis in the “ick” factor. That’s not good enough. In the end, we need to do better with organ donation. If cold hard cash on the barrel head is the best way to do it, I might have to learn to live with that.