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Humanize From Discovery Institute's Center on Human Exceptionalism

A Market in Human Kidneys Is a Bad Idea

Originally published at The Epoch Times

It is sometimes said that desperate circumstances require desperate measures. But desperation can also lead to the exploitation of the vulnerable. Such would be the case if we created a market in live-donation human kidneys.

The need to increase the number of kidneys for transplant is, of course, very real. More than 100,000 patients are on waiting lists to receive “the gift of life” in the United States. Moreover, currently the supply from dead and altruistic living donors is insufficient to meet the need, which is why some advocates want to pay people to sell one of their two kidneys.

The latest such call can be found in a recent New York Times op-ed column, written by journalist Dylan Walsh, whose own life was saved by his father’s living kidney donation.

“Hundreds of millions of healthy people walk the streets quietly carrying two kidneys,” he writes. “They need only one. The head-scratcher is how to get kidneys from the people who have one to spare into the people who need one. Getting them from genetically modified pigs, as was recently found possible, won’t be a widespread solution for a very long time. There’s a simpler and long overdue answer: Pay people for their kidneys.”

I understand the appeal, but we should not go down that road. Why? First, there is the issue of safety. Strictly speaking, it is true that people can live well with one kidney. But Mr. Walsh’s claim that we don’t need two is also misleading. One kidney is simply not as good as two.

While the vast majority of living kidney donors do just fine, studies show there are about three deaths per 10,000 live donation surgeries. That’s minuscule — unless you are among the three. Donors may also experience other potential adverse health consequences. “Kidney donors typically experience a 20 to 30 percent decrease in kidney function (as measured by the glomerular filtration rate) after donation,” the Cornell Living Donor Kidney Center reports.

In addition, a study in the British Medical Journal found, “Live kidney donation may reduce life expectancy by 0.5–1 year in most donors,” and, the data indicates, “1%–5% of average-age current live kidney donors might develop ESRD [end stage renal disease].”

A different study found that the “projected 15-yr observed risk of ESRD [is] 3.5 to 5.3 times greater in living kidney donors compared to age-matched nondonors.”

Then, there are the usual risks attendant with any serious surgery, such as bleeding, infection, and complications from anesthesia.

It is one thing for a donor to risk these complications to save a loved one’s life or out of the pure goodness of their hearts. But it is quite another to seduce people to become sellers — suppliers who would mostly be poor or desperate — and persuade them to risk their health or life for money, tax credits, or a mortgage down payment — some of the suggested enticements being proposed to persuade people to give up a kidney.

Beyond safety and exploitation concerns, a market in human kidneys would harm the culture by converting our bodies into a potential commodity, thereby adding to the growing trend toward human instrumentalization. Indeed, Mr. Walsh justifies his advocacy on the basis that we already allow certain body parts and functions to be commercialized:

“Though markets exist for human tissue, bone, amniotic stem cells and blood plasma and for the use of a woman’s womb and her eggs, organs cannot legally be bought and sold,” he complains.

But that “If we can do A, we should also be able to do B” thinking is precisely the problem. Once we start allowing body parts and functions to become commercialized, that seemingly limited license soon justifies the next step down the road to human commodification — and indeed, permits actions that are increasingly risky to sellers. For example, harvesting plasma is all but risk free. But not so for women selling their eggs, which can result in serious side effects such as “ovarian hyperstimulation syndrome (OHSS), ovarian torsion (twisting), kidney failure, stroke, loss of fertility, and premature menopause.”

Where would it end? What would come next — selling pieces of liver? Perhaps even lethal organ removal from people who want euthanasia? Or what about paying women who want to abort to gestate to a later stage of pregnancy so the baby’s organs can be harvested?

No, Wesley! That goes too far!

Oh really? Such a crass scheme was proposed by the influential bioethicist Jacob M. Appel, who wrote: “Unlike living kidney donors, who must then advance through life with only one functioning kidney, pregnant women who provide fetal kidneys could do so repeatedly without incurring the medical consequences of adult organ loss.” Imagine the commercial possibilities!

Making matters worse, people might be induced to legalize kidney selling as much by the profit motive as by the altruistic desire to save lives. Organ procurement is very remunerative for organ distribution organizations, transplant surgeons, hospitals, and others within the organ transplant industry. Those who procure or transplant organs often do quite well by doing good. When organs are donated, this fact of organ transplant medicine is of lesser concern. But when money incentives are offered, the risk to vulnerable patients increases.

Organ donation is to be applauded. Indeed, more can be done to make living donation easier — such as paying for more out-of-pocket expenses incurred by donors than currently permitted. People should not be forced to pay to save a life.

But the wellbeing of the healthy matters too. Turning a precious “gift” into a flesh product and donors into “vendors” would risk terrible inequity in which only the financially desperate would sell for the benefit of those with greater means. Such a plan would also further our society’s ongoing descent into a crass utilitarianism that looks upon the weak and vulnerable as resources ripe for the harvest. In summary, the laudable end sought by establishing a market in human kidneys does not justify the exploitive means.

Wesley J. Smith

Chair and Senior Fellow, Center on Human Exceptionalism
Wesley J. Smith is Chair and Senior Fellow at the Discovery Institute’s Center on Human Exceptionalism. Wesley is a contributor to National Review and is the author of 14 books, in recent years focusing on human dignity, liberty, and equality. Wesley has been recognized as one of America’s premier public intellectuals on bioethics by National Journal and has been honored by the Human Life Foundation as a “Great Defender of Life” for his work against suicide and euthanasia. Wesley’s most recent book is Culture of Death: The Age of “Do Harm” Medicine, a warning about the dangers to patients of the modern bioethics movement.