I did not want my first column of the semester to be a response to a fellow columnist and friend, but my Democratic heart could not help itself after reading James Shapiro's Sept. 6 column "Rethinking Kidney Markets." To be fair, the column highlights a lot of very real problems with the kidney donation system (and the organ donation system overall) as it exists in the status quo. However, the solution does not lie in trading organs on the open market. I will offer two alternatives that do not incur the same negative moral repercussions. In doing so, I hope to advance the idea that we can make the system work better for every American, rather than just a privileged few. No citizen should be socially or economically induced to "part with an extraneous appendage" in order to "help pay for a house." One's second kidney is far from extraneous - it's a life insurance policy on oneself and one's family that working Americans should not have an economic incentive to eschew.
First, let's make one distinction perfectly clear that the original column did not - there are two different paths by which a kidney gets from a donor to a recipient. According to the National Institutes of Health, while one source of kidneys is living donors (the source that James's column focuses on), about two-thirds of the roughly 17,000 kidneys transplanted into the bodies of recipients each year come from the recently dead.
Shapiro says, "Critics of kidney sales often imagine grisly scenes in which rich patients harvest kidneys from the desperately poor. But studies of (live) kidney donors indicate that the long-term health risks ... are minor." This argument doesn't deny that rich people would still exploit the destitute; instead it just urges us not to feel bad about it because the vast majority of poor folks donating will be okay. Even this assertion, however, is dubious. Shapiro touts a 1997 study that tracked 430 donors who donated kidneys at some point during a 30-year period; none died from kidney failure. But in the last 19 years alone, 83,616 living people donated one of their kidneys to someone in need. For those of you without a calculator handy, 430 is about 0.5 percent of 83,616. We cannot universalize from a sample size this small.
The question, however, is not ultimately about the health risks. It is about the values of our society and what kind of message we send when we allow the desperate to go under the knife and risk their lives (and their family's well-being) to benefit society's most advantaged. Shapiro claims that people take riskier or more dangerous jobs all the time in exchange for higher wages, but those jobs are usually vital to the very survival of society itself. The world we all live in would be very frightening with no military, no law enforcement and no firefighters to protect us, for example. Hence, the wages they earn must include a premium to compensate them for the danger they incur. Unfortunately, the very act of adjusting a person's wage by considering death risk inherently cheapens the value of human life by assigning a monetary value to it.
As a consequence, we try to minimize economic transactions that have these negative social impacts (like the commodification of human life or human dignity) as much as we can. That's why we make it unlawful for people to sell themselves into indentured servitude, prostitute themselves, sell their babies in a compensated adoption market, or broker contracts with would-be mad scientists as subjects in wholly unethical medical or behavioral experiments. We similarly outlaw a cash-for-kidneys exchange and should continue to do so.
Upholding our most cherished American values and helping people in need of kidneys are not mutually exclusive. One way to solve the kidney shortage problem is to change organ donation from an opt-in system to an opt-out system. Many people are simply apathetic and resolve to "become a donor eventually," then die before getting around to it. If the default position was "donor," those who for religious or personal reasons want to be buried with all of their organs could still have those final wishes respected. Everyone else who doesn't care enough to fill out the "opt-out form" and places higher value on getting the hell out of the Department of Motor Vehicles three minutes earlier is still included. In the event of child death, parents could act as proxies for the deceased. This would add significantly to the pool of available organs and could greatly reduce the need for family members or close friends to engage in live donation.
Another reform might be to give yearly tax credits to those who register as organ donors, as the states of Georgia and Wisconsin have done - after all, donors are saving the taxpayers money from being spent on costly dialysis treatments. Smart economic policy gives people an economic incentive to do something good, rather than something that is self-destructive (or exploitative). The government's job shouldn't be to intervene in free markets - its job is to ensure that market systems are structured in a way that inspires us to live up to our highest and best selves.
Don Trella '08 thinks Brown should nevertheless hang on to the Hutchings-Votey organ for itself.
