Filed under: Health
Megan McArdle thinks the legal prohibition against paying for kidneys is indefensible, and challenges anyone to provide a defense of it which does not involve the following:
- Huffy declarations that anyone who disagrees with you must be amoral
- Appeals to the fact that many other people are also against organ donation
- Invoking the infamous “ick” factor involved in selling a body part
I am determined to exercise one of our most important rights on this issue: the right not to have an opinion. But this pretty standard argument from a 2002 article in the New England Journal of Medicine opposing payment for organ donation doesn’t seem to me to involve any of the above shibboleths:
The fundamental truths of our society, of life and liberty, are values that should not have a monetary price. These values are degraded when a poor person feels compelled to risk death for the sole purpose of obtaining monetary payment for a body part.
I don’t consider this to be an overwhelmingly convincing argument in the case of kidney donations, particularly because they don’t involve much risk of death, as Megan points out. Kidney donations are a unique case among organ donations in that they don’t entail much impairment of the donor’s health. Meanwhile, there are a huge and growing number of people with chronic kidney disease, and it seems implausible that the pool of voluntary donors could ever be made large enough through non-financial incentives. There are estimates that thousands of people die every year due to shortage of kidney donors, and this paper argues that kidney transplants save society at least $90,000 per patient over dialysis, not counting the increased quality-adjusted life years for the patient.
But to see why the moral case against paid organ donations isn’t as content-free as Megan paints it, consider this argument for a market system for kidney donations, from Drs. EA and AL Friedman in the journal “Kidney International”:
The case for legalizing kidney purchase hinges on the key premise that individuals are entitled to control of their body parts even to the point of inducing risk of life.
This premise seems to me to be utterly wrong. 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”.
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