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Ethical Considerations Organ Markets

Paying for Kidneys – One More Time (for the last time)

Once again, the idea of paying folks for kidneys is making the rounds of media outlets, so once again I’ll voice my well-researched and considered thoughts on the matter – probably for the last time. Any further discussion of this topic will result in a link to this very post, because I am SO TIRED of talking about this.

 

1. Every study from every country (without exception) with legal, illegal or quasi legal kidney markets has shown the paradigm to be beneficial for recipients, doctors, hospitals and governments but highly detrimental to the kidney donor/vendor/seller.

  • deceased physical health
  • increased psychosocial difficulties
  • greater financial struggles
  • lower quality of life.

The U.S. transplant industry and/or government has not adequately regulated or protected living kidney donors in the near 60 years since the first one occurred. They’ve implemented no national standards of care, collected no data, given inadequate informed consent, and provided no psychological aftercare. Creating a market will not improve this situation. Quite the opposite.

 

2. Kidney transplants are NOT cures, but treatments for kidney disease. The vast majority of recipients will need multiple transplants to achieve a normal lifespan. Exactly how many two-kidneyed people should be harmed to treat one recipient?

 

3. Focusing solely on the supply side will NEVER produce an adequate solution. According the USRDS, 44% of kidney failure is caused by diabetes; another 26% by hypertension. The ONLY REAL SOLUTION to the so-called organ shortage is to implement robust prevention, diagnosis and treatment programs for both disorders.

 

As I write this, OPTN claims that 98,271 folks are waiting for a kidney.

Approximately 1/3 are ‘inactive’ at any given time, leaving us with 64,859.

44% with diabetes = 28,538

26% with hypertension = 16,863

Even if prevention/treatment could prevent half from progressing to ESRD or kidney failure, that’s 22,701 less people right now that would be waiting for a kidney.

And if approximately 15% of the wait list at any given time have undergone at least one prior transplant – that’s at least 3405 more kidneys, a number that would grow over time (think of the whole “she’ll tell two friends, and they’ll tell two friends” commercial from eons ago).

 

4. And finally, donating a kidney is not like giving up a pint of blood. It’s a procedure rife with both short and long-term risks. Is $10,000 (the number tossed around in this newest argument) worth someone’s life, or long-term disability? Is it worth shaving who knows how many years off one’s life expectancy?

And if it’s not, how much money is worth all those risks? How do we quantify a human life?

After we decide that, where does this payment originate? The recipient? The recipient’s insurance? The government?

Such a scheme, no matter the answer to the prior query, necessitates a belief that some people’s health and lives are worth more than others.

 

The argument ‘for’ kidney markets is always one-sided and short-sighted. The reasons for opposing them are not. Sure, there’s a strong moral component (an ick factor), but for me, the objection is pragmatic – such a thing simply will not work, short or long-term. To think otherwise is to willfully ignore not only pre-existing evidence, but our infrastructure and human limitations.

 

 

 

For other posts on this topic, click on ‘organ markets’ in the categories drop-down in the right-hand column.

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