Paying to live

By R.M. | WASHINGTON, DC

ALEXANDER BERGER is a saint. Tomorrow Mr Berger plans to donate one of his kidneys to someone he's never met. He's a bit nervous, but he believes in what he's doing.

Most people think this sounds like an over-the-top personal sacrifice. But the procedure is safe and relatively painless. I will spend three days in the hospital and return to work within a month. I am 21, but even for someone decades older, the risk of death during surgery is about 1 in 3,000. My remaining kidney will grow to take up the slack of the one that has been removed, so I'll be able do everything I can do now. And I'll have given someone, on average, 10 more years of life, years free of the painful and debilitating burden of dialysis.

Mr Berger would be angry that I called him a saint. He thinks "deifying donors only serves to make not donating seem normal." He'd rather such donations be seen as "one of the many ways a reasonably altruistic person can help others."

But that's not how organ donation is viewed in America, which is why the number of donations (whether from living or deceased donors) does not keep up with demand. There is a growing waiting list for kidneys, for example. "More than 34,000 people joined the waiting list in 2010; fewer than 17,000 received one," notes Mr Berger. "Thousands of people die waiting each year."

So what can be done, apart from donating your own organs? Mr Berger suggests lifting the ban on organ sales, a solution that assaults the moral senses of many Americans. In the comments on Mr Berger's piece, a number of people praise the young man's decision but find his suggestion unethical. A market for organs would rely on vulnerable people desperate to get out of their economic straits, they argue. "Would there emerge from lower and working classes a permanent caste of people willing to be kidney dispensaries for the ill who are better off financially—or have superior health insurance coverage? Likely so, and to the detriment of our collective human dignity," says one commenter.

It is odd that we consider this ethical dilemma when presented with the idea of organ sales, yet largely ignore it when considering similar transactions. What is so different about paying a young man for his kidney and paying him to go off to war or perform any number of jobs that harm his health? All rely, to some extent, on the desperation of the lower-class. In the mid-2000s, as the Iraq war reached its bloody peak, the Pentagon recruited heavily in economically depressed areas. And black-lunged coal miners are rarely the sons of millionaires. Yet there is something icky about organ sales that seems to set it apart.

Unfortunately, the public's aversion to organ sales hasn't stopped them from taking place. There is already a caste of people willing to be kidney dispensaries for the ill and at present they navigate a horrific black market in order to sell their goods. In these shady deals they are often manipulated and misled and the risks to their health are much greater than they need to be. The transaction is nearly as risky on the other end, where recipients practicing "transplant tourism" may go home with an organ that is diseased or unsuitable. Would it not be better for everyone to regulate this market and clear the waiting lists for organ transplants?

There are also strong utilitarian arguments for allowing the regulated sale of certain organs. With kidneys, for example, donors like Mr Berger see only the slightest increase in their risk of dying from kidney disease. And their altruism is likely to lead to more than a decade of improved and prolonged life for the recipient. Donations are also cost-effective. As we noted in a previous report on the topic, "the cost of one kidney operation and a lifetime's supply of anti-rejection drugs equals that of three years' dialysis." And we have proof that such systems do fill the needs of the ill. Iran adopted a system of paying kidney donors in 1988 and within 11 years it became the only country in the world to clear its waiting list for transplants.

If you are unconvinced by the regulated-market solution to the world's organ-shortage problem there are still other ways forward. For example, payment could be restricted to families of deceased donors. Or America could move from an opt-in system for organ donations, whereby people must agree to make such gifts, to an opt-out system, under which consent of the deceased is presumed. Such systems (commonly found in Europe) do not always lead to higher donations, but there is a good chance that it would in America, where an advanced transplant infrastructure is already in place. For individuals looking to encourage donations, there is the option of joining a group like LifeSharers. That organisation assures that your organs go first to people who have agreed to donate their own organs upon death. And, of course, the easiest thing one can do to help those in need is to simply register as an organ donor.

(Photo credit: Getty Images)