Opinions that kill

An Israeli was arrested in Cyprus last week for encouraging poor people to sell their kidneys. Conventional wisdom thinks selling kidneys is immoral. Prestigious physicians, such as Israeli neurologist Avi Reches and Harvard-trained Frank Delmonico, agree. But just because a physician is well-trained in his field of medicine does not make him the definitive moral authority or even give him a finer sense of morality than other thoughtful people.

If a poor person is aware of the medical risks, is given time to think about his decision, is given a meaningful sum of money that can extricate him from poverty and is given free health-care for the rest of his life, then after he sells his kidney he has not only saved a life but he is in a better physical and social position than he was before. If you don’t believe me then you haven’t seen malnourished poor people.

Problems in kidney selling arise because it is currently illegal and thus unregulated. Kidney sellers do not get adequate compensation or life-time health care. Legalizing and regulating a quasi-free market would be the most moral thing to do.

About a 100 Israelis and 7,000 Americans needlessly die every year waiting for that organ that just never arrives. Altruism is not working. Period. Full stop. How many deaths do we need – year after year – to prove altruism is not enough?

The paternalism that prohibits the sale of kidneys has killed almost a 100,000 people in the Philippines alone. Let me repeat that number so the enormity of it sinks in. One hundred thousand people have unnecessarily died due to this new policy.

Until 2009 the Philippines had a legal and regulated market allowing poor people to sell their kidneys. Indigent people were saved from poverty and starvation while people on dialysis were saved from dying from a dialysis infection. (Most people die on dialysis within 7 years due to infection.)

Ironically, during this time period a member of Israel’s Knesset – who is against payment for organs – flew her nephew to the Philippines to buy one when his kidneys failed.  And why not, she could afford it. Wealthy people win all the time leaving the poor people screwed, whether it is a poor person who needs a kidney and can’t afford to fly to the Philippine’s to buy one or a poor person who sells a kidney in an unregulated market and doesn’t get adequate compensation.

So what happened in 2009?  Due to the uninvited and unwelcomed efforts of Dr. Frank Delmonico, international pressure was brought upon the Philippine Ministry of Health to close down its program. The result? More than 10,000 Filipinos now die every year waiting for a kidney donation that never comes because no one is incentivized to donate their kidney. Altruism just isn’t working – anywhere.

I usually hear 7 objections to selling kidneys:

  1. ‘It’s illegal.’
    This is not a moral point. Just because something is illegal doesn’t mean it is immoral. And the very point of this article is to galvanize the public to demand from its politicians to legalize selling kidneys.
  2. ‘Giving up a kidney entails great medical risk.’
    Not true. The mortality rate of donating a kidney is 0.03 percent. You have a greater chance of dying during child birth or a ‘Tummy Tuck’ procedure than you do donating a kidney. If altruistically donating a kidney is medically acceptable, then getting paid money to do so doesn’t increase the medical risk. Either it has an acceptable medical risk or it doesn’t. And people who have only one kidney live a normal life span.
  3. ‘Selling organs commodifies the human body!’
    So what? This statement implies there is something inherently wrong with commodifiying the human body without saying what exactly is immoral about it. And society already allows for commodification of the human body. It is legal to sell hair, blood, sperm and eggs. And if you think the difference is that these things (besides eggs) grow back and kidneys don’t, you are implying there is something medically wrong with only having one kidney in which case I refer you back to explanation number two.
  4. ‘The kidney seller’s motives are not pure!’
    His motives are pure! He is doing it for money. What is wrong for doing something for money? A paid fireman takes a risk running into a burning building and does a good deed in the process. A paid physician takes a risk treating an infectious patient and does a good deed in the process. There is nothing immoral about being paid to take a small medical risk and in the process do a good deed. Money is a great means to incentivize admirable behavior.
  5. ‘Paying for organs will crowd out altruistic donors.’
    This assumes that altruistic donors will be turned off from donating given the commercialized flavor attached to donation. There is not enough data to support this assumption. In Iran, for example, when paying for kidneys became legal in 1988 the percentage of people altruistically donating organs remained stable at 12%. Even if it were true, the financial incentives offered will attract more people to sell their kidneys resulting in a net increase in organ donors.
  6. ‘It’s a slippery slope inviting kidnapping and murder.’
    This is a practical argument and not a moral one. Life insurance invites murder. There was a case in Jerusalem where a man murdered his parents just to get the insurance money to pay off his gambling debts. But no one says we should outlaw life insurance because of the slippery slope. Why? Because overall it brings great benefit to society. And just because there is concern for consequential abuse does not mean the abuse will happen. In the early 70s, for example, anti-abortion advocates warned that legalizing abortion would open the door for infanticide. That never happened. In addition, procedures could be put into place to stop abuse such as only buying organs from living kidney sellers who are made well aware of the risks, who have had a year cooling off period, etc. And finally, legalizing payment will increase supply bringing down the price of a kidney removing the financial incentives for anyone to procure a kidney illegally.
  7.  ‘You’re exploiting and coercing poor people.’
    First, if you like you can legislate that only middle class people can sell their kidney. Now there is no financial pressure. Just greed. Second, it is a bit paternalistic to tell a poor person we will not give you food nor shelter nor healthcare and we have also decided for you that it is not in your best interest to sell your kidney so we will prevent you from doing that as well. Third, in all cases of coercion a person’s choices are reduced. In our situation, we are giving the person a new option. Poor people are people too. Period. They have agency and the right to make their own decisions about their own bodies.

If selling kidneys was legal I would sell mine. I’m not embarrassed to say so. If you think I should do it for free, have you donated yours for free? And if you think I’m greedy for wanting money so be it. I want to be paid for my kidney and do a good deed in the process.

If you think payment for kidneys should be legalized please sign the petition here. http://organdonorincentives.org/petition/online-petition/

[Please note: 1. While I am the founder and director of the Halachic Organ Donor Society (http://www.hods.org), my opinion about paying for organs are mine alone. There are board members of HODS that disagree with me. 2. None of these objections apply to a cadavaric donation. At the very least, payment should be allowed to incentive people do donate organs upon death.]

About the Author
Robby Berman has a Masters (MPA) from Harvard's Kennedy School of Government, a Masters (MBA) from the Baruch School of Business and is the founder & director of the Halachic Organ Donor Society (www.hods.org).
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