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Rethinking kidney markets

Last year, 3,916 Americans died waiting for a kidney transplant. About 70,000 Americans are on the national waiting list for a kidney, and most of them undergo dialysis - a painful, invasive, continuous and time-consuming set of medical procedures that temporarily treat kidney disease. The federal government should address these problems by lifting the ban on kidney sales immediately.

According to recent data, the median wait for a kidney transplant is four years. Thousands of patients don't have enough health or good fortune to hold out for that long. There were about 17,000 kidney transplant surgeries performed in 2006, but far more than 17,000 new patients joined the waiting list during the same period. Furthermore, the waiting list understates the actual number of needy patients since it excludes many indigent, elderly and unhealthy people.

The ban, implemented in 1984, makes it a federal felony to provide valuable compensation to an organ donor. Yet monetary payment provides one of the most powerful incentives to donate. The restrictions have created a state-imposed purgatory for everyone suffering from kidney disease. Patients, deprived of the opportunity to provide financial compensation, will always outnumber willing donors by a wide margin.

In a legal kidney market, patients would compensate donors for the inconvenience and mild health risks associated with transplant surgery. Many people oppose kidney markets, viewing them as exploitive or unfair. In reality, kidney sales would reduce exploitation and promote equity.

Critics of kidney sales often imagine grisly scenes in which rich patients harvest organs from the desperately poor. But studies of kidney donors indicate that the long-term health risks associated with kidney transplantation are nonexistent or minor. People normally have two functioning kidneys, but they only need one.

A 1997 study tracked 430 people who donated kidneys between 1964 and 1994. Not a single subject died of kidney disease. A 1992 study compared the health of 57 donors and their siblings. The medical evaluations, conducted 20 or more years after surgery, indicated no significant health differences between the two groups.

Kidney donors do face a 0.03 percent chance of death or irreversible coma resulting from the surgery, but that does not provide a compelling argument for a total ban on kidney sales. A commercial truck driver runs the same risk of death each year. Unless one also favors a total ban on commercial trucking and numerous other professions with tempting salaries but unhealthy effects (boxing, construction work, coal mining, pro-football, etc.) minor health risks cannot justify prohibition.

In all likelihood, the ban on kidney sales hurts the very people it aims to help. One recent study estimated that the legal market price of an American kidney would be about $20,000. That sum would give donors the resources to buy a car, pay off debts, support their family or help pay for a house. These things will prove substantially more important to some adults than one extraneous appendage.

Instead of exploiting donors, an American kidney market would forestall the truly exploitive transactions that occur outside of the United States. Every year, droves of well-heeled travelers from Europe and the United States flock to Iran, Pakistan and Bulgaria to buy kidneys on the black market. These organs often come from unwilling victims. While American donors enjoy state-of-the-art, minimally invasive, low-risk surgery, foreign "donors" are slashed down the side in a frequently debilitating and rarely hygienic procedure.

The exploitation of would-be donors is a powerful reason to endorse kidney markets, not reject them. But critics may still object that a kidney market does not offer equal access to treatment. The only patients who can buy a kidney on the market are those who can afford one.

As it turns out, kidney sales would make healthcare outcomes more equal. Chronic dialysis treatment costs about $100,000 more than the combined expense of a kidney, transplantation surgery and post-operative treatment. Whoever currently pays the bills for dialysis patients (most health care in the US is provided by third parties, not patients) would save millions of dollars per year by funding transplants for rich and poor patients alike. Right now the only people buying kidneys are those rich enough to travel abroad and acquire them from ethically suspect sources.

So why is the government banning consensual arrangements that would save thousands of lives, alleviate suffering, increase equal access to healthcare and give money to those who need it most? People are dying to know.

Former Herald Senior Staff Writer James Shapiro '10 will pay $50,000 for a heart.


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