Making The Case Against Kidney Donation

by Patrick Appel

Larissa MacFarquhar of The New Yorker joins the debate:

It is often assumed that at least permitting compensation for kidneys would result in more living donors, but this is not necessarily the case. Under the current system, a person who needs a kidney will usually turn to his family, and possibly his friends, for help, but if he could obtain a kidney from a stranger, paid for by his insurance, would he ask a person he loved to undertake the nuisance and risk of surgery? (Of course, this assumes that there would be enough kidney sellers to supply the need.) In Israel, where until recently the practice of transplant tourismgoing abroad to receive a kidney transplantwas widely accepted, donations from living relatives were relatively rare. It seems likely, too, that the sort of person who might now donate to a stranger for altruistic reasons would not do so if the donation were a commercial proposition (one altruistic donor asks compensation proponents to consider whether an offer of cash from a boyfriend would increase the probability that the girlfriend would have sex with him)though there are so few altruistic donors that their numbers don’t much affect the calculus.

But those in need of a kidney who have family members to ask will still ask for a kidney from a relative should a payed donor be unavailable. I also don't understand why MacFarquhar doesn't bring up Iran, the one country that has allowed kidney compensation and has eliminated the donor list. Matt Steinglass highlights what I take as the strongest (but still flawed) argument against allowing payment for kidney donation:

A society in which rich smokers went around buying poor people’s lungs would be contemptible. When you get to the point where market forces allow some people to take physical possession of vital, irreplaceable parts of other people’s bodies, you are entering the territory of slavery. It’s a territory in which some of the inalienable rights that underpin a liberal democratic society and the inalienability of one’s possession of one’s own body, as in habeas corpus, is fundamental to all other rights – can disintegrate in the face of inequalities of wealth. That’s the moral basis of the anxiety over paying for organ donations in general, and it is warranted.

In fact, the case for legalizing kidney purchase hinges precisely on the fact that it is not like other organ donations: having just one kidney does not seem awfully risky to the donor’s life. (Further, one can mitigate the risk by placing the few kidney donors who subsequently develop renal disease at the top of the list for transplants, a measure that has been advocated as a non-market way to encourage donations.) As the harm to the donor goes down, tissue donations become more similar to donating blood. Donating blood has long been (slightly) financially compensated without fear of a “slippery slope” to a paid market for, say, eyes. But that’s not to say we should allow people to sell their eyes. It’s to say that perhaps donating blood and donating kidneys are special cases, and should be treated individually rather than as part of a blanket policy towards donating “organs” or “tissue”.