Why Not Sell Your Kidney for Personal Gain?

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The Canadian Society of Transplantation tellson its website a story that is a mirror imageof what is happening all over the world. More than two times as many Canadiansare on waiting lists for transplant organs than there are suitable donororgans. Reportedly about 200 Canadians died last year while waiting for suitableorgans. Most people on the waiting list are desperate for transplant kidneys. Southof our border about 80,000 Americans are on waiting lists for kidneytransplants. The current situation is not only unacceptable because people diepreventable deaths when they could be looking forward to a productive and happylife, it is also immensely wasteful as kidney dialysis is a hugely expensiveundertaking. How can we close the gap between the number of patients in need of transplantorgans and the availability of suitable organs?
Dead donorsA number of different policies aimed atincreasing the number of transplant organs in an ethical manner have beendiscussed and implemented in various countries around the world. I ampersonally in favor of an idea currently debated in PEI. Theproposal is on the table that we should switch from an opt-in to an opt-outsystem of consent. The idea here is that for everyone who does not expresslyrefuse to donate their organs after their demise the reasonable assumption ismade that they would be happy to see their organs utilized to preserve afellow-Canadian’s life. However, some don’t like this proposition. As far asthey are concerned, this is not just a question of solidarity but one ofownership. After all, nobody is entitled to take my car after my demise either,just because I have forgotten to stipulate that it should go to my loved-ones.
Living donorsHere is where an alternative idea comes intoplay: perhaps we should consider incentivizing potential sources of transplantorgans, ie people like you and me. I am focusing here primarily on living donorkidneys. We have reasonably persuasive datatoday suggesting that it is perfectly safe for most healthy people to donatekidneys. As the autonomous owners of our bodies we are entitled to makedecisions with regard to how we wish to use our bodies. There are lots ofthings we are morally and legally entitled to do with our bodies, includingengaging in risky activities like playing rugby, scuba diving in shark infestedwaters and many others. Strangely, when it comes to the use of our bodies formedical research or transplantation purposes, the response we get frequentlyfrom religious leaders, medical ethicists and others is that we shouldcontribute from the goodness of our hearts, rather than from a less altruisticmotive. Any sensible medical system would focus here on outcomes instead,namely a maximization of the number of available suitable transplant organs, ratherthen a second-guessing of vendors’ motives. Given that we already acceptaltruistically motivated living donor kidney donations, it does not strike meas particularly plausible that people should continue to lose their preciouslives because of an unreasonable societal squeamishness when it comes to payingpeople for their spare kidneys for transplantation purposes.  It is important to recognize that our currentsystem is not working in many ways. Precious lives are unnecessarily lost yearafter year. Desperate patients travel overseas and obtain kidneys frequently underquestionable circumstances, often exploiting vulnerable impoverished people indeveloping countries. The list goes on. Suffice it to say: leaving things asthey are is not a cost neutral choice!
Let’s try itWhat I am proposing is to run a pilot programaimed at investigating whether strictly government regulated incentives forliving donor transplant kidneys would result in additional available transplantorgans with a resultant decrease or elimination of the current waiting lists.  The objective of this pilot program would betwo-fold: 1) develop a system that would create successful incentives for organvendors to offer their spare kidneys while at the same time 2) ensure thatsufficient safeguards are put in place to guarantee that whatever incentivesare offered do not generate additional harms. Benjamin Hippen, a US basedtransplant specialist sumsup what features a government regulated marketfor transplant organs should have: It prioritizes the safety of bothvendors and recipients; it must be transparent with regard to risks to vendorsand recipients; it must safeguard institutional integrity regarding guidelinesfor cooperating with kidney vendors, and last but not least it must operate undera robust legal framework.