Time to Implement a Pay for Kidney Program

Early last week I received a somewhat sobering WhatsApp message about an old friend whose lingering illness has become considerably more serious and is in dire need of a kidney transplant. There were found no suitable matches from anyone in his immediate family, so he is on a regimen of dialysis treatments until something from the standard search registers becomes available. He is not, apparently, expecting anything miraculous. The message concluded with a request to include Shimmy (Shimon ben Chana) in my prayers for a speedy recovery.

A few days later, there was a report in the local media about a single mother – let’s call her Leah –  who posted on Facebook her readiness to sell one of her kidneys as a way of dealing with the financial difficulties she was experiencing. She was most certainly aware that the sale and procurement of organs from a living donor is absolutely illegal in Israel, but circumstances forced her to overlook what she viewed as a “technicality”. Leah was prepared to live with a single kidney if the sale of the other one would relieve the crippling debt that was slowly burying her and her two children. What I found strange, though, is that the story focused, for the most part, on the plight of wage earners whose low salaries failed to meet the demands of our relatively high cost of living. The commercialization of the woman’s kidney was deemed less important than the endless struggle to make ends meet.

The priority of what is most important, though, needs to be reevaluated. Granted, living on or near the poverty threshold is no trivial matter, and there can be no denial that the difficulties Leah faces on a day-to-day basis dare not be ignored by the current or subsequent governments. What no one seems to be overly concerned about, however, is the fact that there are considerably more individuals in need of a kidney transplant than there are available kidneys. The established protocol for assisting those in need of a kidney replacement is woefully inadequate. It doesn’t, though, have to be.

We hear, from time to time, of those who willingly volunteer to donate a kidney to a perfect stranger. Such acts are undoubtedly heroic, although I can’t help but wonder about the wisdom of taking what is unquestionably a considerable risk. A family member or close friend might, at some point in the future, find themselves in need of the kidney that was magnanimously donated as an act of kindness. That aside, such altruistic acts are by no means commonplace and assist a very small percentage of those whose lives are wobbling on a very narrow tightrope.

Currently, it can take up to five years for a suitable kidney to become available, and many have found it necessary to travel abroad to find a way to obtain the treatment they are in dire need of. Thailand and China, among other places, do a brisk if grey-colored business (“transplant tourism”) in the sale of body parts from living donors. With the number of renal failures in Israel steadily increasing, perhaps the time has come to initiate a discussion on paid kidney donations.

Or, rather, reopen it. The subject has been studied for at least the last two decades and despite the overwhelming advantages of such a program, any thought of legislating such a protocol were repeatedly overridden by the howls of protest. Those protests, though, can no longer be a determining factor in the debate centering on allowing kidneys to be privately sold. The benefits to both the seller and buyer are too great to ignore. If governed by proper constraints and medical approvals, the potential for a win-win situation demands that this subject be very carefully looked into.

That such activities are already taking place under the radar is well known. Every so often we hear of unscrupulous medical practitioners or lawyers who quietly negotiate the sale of kidneys, which are usually sold for an exorbitant fee. Although details of such transactions are never fully revealed, we can assume that the surgical treatment in both the removal and placement of the brokered kidney is shadowy at best. Legalizing and regulating the process of paid kidney transplants would, if nothing else, remove desperation as a factor in the transaction and ensure greater safety to both donor and receiver.

There are those who will undoubtedly argue that even if the price of a kidney was limited by government intervention, it might still be unaffordable for the less well-off. Perhaps, but surely that is precisely the same in other fields of health and well-being. Some families, for example, can afford to have their children’s teeth straightened by top-of-the-line orthodontists, while others have no choice but to allow their children to be practiced on by dental students. And bearers of private health insurance can often bypass the long waits for necessary examinations and treatments that those who rely solely on the health maintenance organizations (kupat cholim) must endure.

Not unexpectedly, objections based on moral, religious and ethical principles have been raised, but, really, have little substance. Voluntary donations from living donors have been declared to be acceptable and is even encouraged by even the most stringently applied standards. Kidneys transplanted from living donors have a greater chance of success than those removed from cadavers. And, finally, there is no mitzvah greater than one that saves the life of another, which has been likened to saving the entire world.

Our current Minister of Health, Aryeh Deri, is currently looking into how to control obesity and diabetes in response to the protests over the cancellation of the tax on sugary soft drinks. He must, in addition, look into how to narrow the waiting time for kidney transplants, including the possibility of creating a program of paying willing donors. Israel’s National Transplant Center has prepared detailed protocol covering all aspects of such a program, concluding that while there are most certainly drawbacks to commercializing the donorship of kidneys, the benefits are far too substantial to ignore. I urge Minister Deri to form a committee of representatives from varied and relevant specialists to look into this matter with an open mind and sensitive heart. The Shimmy’s and Leah’s of this country deserve nothing less.