Human Kidney Suppliers Should Be Donors, Not Vendors

There are some 91,000 people with severe kidney disease waiting for transplants. Alas, cadaver and living donors are insufficient to fill the need. That has some well-meaning activists pushing to increase the number of available kidneys by legalizing organ-selling.

The psychiatrist and American Enterprise Institute senior fellow Sally Satel is probably the premier proponent of this approach. She has skin in the game, having received two living-donor organs. Writing in the Free Press, Satel promotes a bill that would allow kidney suppliers to become vendors and receive a tax credit. From, “I Had Two Kidney Transplants: I Want Donors to Get Paid.”

But now, legislation is on the table that would save these patients’ lives while eliminating those concerns. On April 7, the House introduced the End Kidney Deaths Act, bipartisan legislation that would dramatically increase kidney transplants by providing a $50,000 refundable tax credit, payable over five years, to any living donor who gives a kidney to the next person on the waiting list.

Under the EKDA, buying organs would remain illegal—but the federal government would reward donors for saving people’s lives. What’s more, disbursing the tax credit over an extended period—rather than offering an immediate lump sum—along with standard informed-consent requirements, would ensure that desperate people do not rush to donate to score an immediate financial payoff and later regret it.

Good motive, bad idea. The government would be, essentially, paying people to harm themselves. Think about it. If you were in an auto accident and lost a kidney, wouldn’t you consider that a very serious injury?

Yes, kidney donation is generally safe, but it is a major surgery that requires deep anesthesia, and patients take weeks to recover. The risks include infection, side effects from anesthesia, and, in rare cases, death. Indeed, between 2012 and 2023, five donors died from their altruism. That’s a miniscule possibility, to be sure — unless you or a loved one are one of the five.

Then, there is the impact of the loss of a kidney. Strictly speaking, it is true that people can live well with one kidney. But, by definition, one kidney is simply not as good as two. Here are the long-term risks according to the Living Kidney Donor Center:

Long-Term/Medical Risks
Kidney donors typically experience a 20 to 30 percent decrease in kidney function (as measured by the glomerular filtration rate) after donation. The remaining kidney compensates for the loss of one kidney, through a process called hyperfiltration. Other complications that may occur in the long-term following surgery to donate a kidney include:

• Developing a disease that could affect the function of the remaining kidney such as:
  • Diabetes
  • High blood pressure
  • Obesity
• Natural decline in kidney function as get older
• Developing end-stage renal disease (ESRD)
• Increase in the amount of protein spilled into the urine
• Chronic pain
• Nerve damage

Additionally, a study published in the British Medical Journal determined that “live kidney donation may reduce life expectancy by 0.5-1 year in most donors.” And what happens if your remaining kidney becomes diseased or injured? The donor might need a donation to remain alive. It has happened before.

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 his heart. But it is quite another for the government to entice people to become sellers and persuade them to risk their health for tax credits. And who would do it for a $10,000 credit per year? Certainly not members of the well-off professional class. They would probably be people in debt or living paycheck to paycheck.

Beyond safety and exploitation concerns, a market in human kidneys would harm the culture by converting our bodies into a commodity, thereby adding to the growing trend toward human instrumentalization. Satel grapples with that objection:

Compensating donors is not crossing a practical or conceptual Rubicon. We already pay donors for products of the body: sperm, ova, blood plasma, bone marrow, and breast milk. We are the world’s biggest exporter of blood plasma to countries who do not pay their donors (and, therefore, do not have enough). The market in corneas is robust and growing.

Fears that the poor will hastily become organ donors out of desperation can readily be addressed. Transplants do not happen overnight. There is a monthslong medical clearance and education process, and the prospective donor can back out at any time. As for being poor, why doubt the capacity of a willing and informed low-income person to make the right decision for themself?

We have already strayed too far into the land of body commodification. Some of it is benign, such as selling breast milk, which entails no risk and is not invasive. Selling blood is also safe, but notice that those who engage in that rather crass mercantilist practice are generally the poorest among us. Bone-marrow-selling is far less invasive than kidney surgery.

Besides, the human commodification agenda has already gone too far. We allow women to sell their eggs — which can cause serious injury — and, in some jurisdictions, women are allowed to rent their uterus for gestation.

During the first Trump administration, Satel and I participated in an advisory process that led to the promulgation of new regulations expanding the types of expenses for which living kidney donors could be compensated. That was only right and just. People should not have to pay for the privilege of being altruistic. If the list of reimbursable expenses needs to be expanded again, I’m all for it.

But there are ample reasons why only one country in the world — Iran — allows kidney-selling. Not everything should be a sellable product. Kidney suppliers should be donors — not vendors.

Meanwhile, experiments offering the great hope of obtaining viable kidneys for human use from genetically engineered pigs need to proceed full speed ahead.