New ethical trends in medicine usually turn up in obscure medical journals first. Witness the academic argument for legalizing trade in human organs in a report in the Clinical Journal of the American Society of Nephrology. Written by researchers at the University of Calgary and published in July, it escaped mainstream media notice until late October; presumably, the annals of kidney medicine are not summer reading for journalists.
But this idea was newsworthy: the government should pay living kidney donors – or more accurately, vendors – $10,000 to cut the dialysis cost of those waiting for transplants. The proposal totally contradicts accepted views on the role of government and the ethics of organ donation.
To pay or not to pay
The researchers theorize that if government health authorities paid $10,000 for a kidney, and thus increased the supply by, say, five percent, it would actually save the health system $340 per patient and increase “quality-adjusted life-years” by one month.
That seems a paltry reward for violating the World Health Organization’s prohibition against the sale of organs. Though black market organs are still sold almost everywhere, especially in poor countries, the WHO has given governments three reasons to suppress the trade: it is “likely to take unfair advantage of the poorest and most vulnerable groups, undermines altruistic donation, and leads to profiteering and human trafficking.”
The researchers counter that on their new rules, in time more people would sell, and the savings to the medical system per kidney would increase to as much as $4,030, and life-expectancy to .39 years. Of course, that’s not taking into account the cost of government administration, or the recovery costs of the vendor.
The only country in the world that has completely ignored the WHO is Iran. There donors are paid $1,200 for a kidney and waiting lists have vanished. However, studies have found that at least 70 percent of donors are among Iran’s poorest people, and that many suffer health complications as a result.
Reduced but not eliminated
The University of Calgary researchers didn’t mention the pitfalls, perverse incentives and moral hazards that legalized organ trading has brought with it where it has been tried. Organ marketing was legal in China, for example, until the media reported widely in 2007 that the government was routinely harvesting organs from executed prisoners. Though still legal, the practice is now considerably reduced.
Similarly, until 2008 the Philippines was a popular transplant mecca where foreigners could buy “all-inclusive” travel packages including organs for about US $25,000. Kidney “brokers” scoured Manila’s poorest slums for vendors, often leading to deaths from complications. The country banned foreigners from getting transplants in 2008 but as the 2013 award-winning documentary Tales from the Organ Trade depicts, desperately poor Philippinos are still pressured into selling their organs abroad.
As one Philippino minister observed about the organ market to the New York Times: “The poor always end up as the ones being abused.”
- "Paying kidney donors could be 'less costly, more effective,'" CBC News, Oct. 24, 2013