A Kidney in Every Pot

As of today, 83,904 Americans are waiting for a kidney transplant, the oldest and most cost-effective organ transplant surgery, according to the United Network for Organ Sharing, which comprises data from all transplant programs in the country.  In 2006, there were 18,052 kidney transplant operations performed, and while that figure has been trending up from 3,785 in 1980, because the five-year survival rate for patients requiring dialysis is only 33%, the prospects look rather grim.  To a parent, helpless to donate to her own child, they are heartbreaking.

The simple libertarian solution derives from our assertion that we and we alone own our bodies, and may therefore sell our spare parts if we choose.  (Another of The Free Agent’s guiding principles, ‘if it’s legal to do it for free, it probably should be legal to do for money’ also applies to the donor situation, it’s legal to donate a kidney, just not to receive money for it.)  The BBC reports that in Iran, where it’s legal to sell organs, donors are complaining of a glut of donated kidneys, resulting in depressed prices.  The obviously-foreign website sellkidney.com quotes $70-$80,000.  I’d get that in cash.

Of course, this “simple solution” is illegal in the United States, and is likely to remain so.  The lion’s share of objections to selling organs seem to be an attempt to protect the poor from “exploitation”.  (Which only begs the question, is there a point at which a person is rich enough to gain the right to sell her kidney?)  A market of sorts has arisen among desperate families who find one another over the Internet, in hopes that they will be compatible with each other’s patients.  Only 74 of these paired donation surgeries were performed in the U.S. in 2006.

Voila, the “even simpler solution”–combining paired donation with the current waiting list.  Paired donation is inefficient because patients have to find each other.  But if I am willing to donate a kidney for my patient, why not just donate it to the first match on the donor list, and in return, “my” patient goes to the top of the list for the next matching kidney?  Those who believe the money motive is immoral will not object, I am donating out of “pure” motives, to cure my own loved one.  And the influx of new kidneys into the donor pool will benefit many patients, even if they have no one to donate on their behalf.

What would the effect be on the 80+ thousand patients awaiting kidney transplants?  The Free Agent won’t speculate on how many friends, family members, or fans would donate a kidney for her, but she can instantly name a dozen people to whom she would gift Old Lefty.  Just as long as we don’t taint our pure love with filthy lucre.

6 comments for “A Kidney in Every Pot

  1. March 16, 2010 at 11:50 am

    The current system already allows what you’re proposing. Someone with an incompatible donor can have that person give to the waiting list and, in return, go to the top of the waiting list for a cadaver kidney. But it’s a bad trade, because a cadaver kidney lasts half as long, on average, as a living donor kidney. There were 127 such exchanges in 2009.

  2. Janet Hopf
    March 16, 2010 at 10:48 am

    Another great non-coercive, non-authoritarian idea!

  3. March 16, 2010 at 9:52 am

    Over half of the 106,000 Americans on the national transplant waiting list will die before they get a transplant. Most of these deaths are needless. Americans bury or cremate about 20,000 transplantable organs every year. Over 9,000 of our neighbors suffer and die needlessly every year as a result.

    There is a simple way to put a big dent in the organ shortage — give organs first to people who have agreed to donate their own organs when they die.

    Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren’t willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

    Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at http://www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

  4. Janet Hopf
    March 16, 2010 at 8:45 am

    Thanks for the links, it’s good to see the donation problem is working around the payment ban.

    What I’m suggesting has two features not currently utilized by the National Kidney Registry. First, it harnesses the recruiting power of the recipient’s family and friends to find any transplantable kidney. Secondly, it would use the existing waiting lists to move the recipient to receive the next matching organ. There’s an immediate reward for the future recipient, and the existing allocation procedure remains intact, so no one vested in the status quo (however the lists are compiled) has to deal with a paradigm change. And since the pool of kidneys only increases, patients who can’t find a willing donor also benefit.

  5. March 15, 2010 at 4:57 pm

    Developed in considerably more detail, including discussion of donor chains, here: http://www.theatlantic.com/magazine/archive/2009/07/with-functioning-kidneys-for-all/7587/

  6. Mark Axinn
    March 15, 2010 at 3:46 pm

    Recent Stossel piece with Virgina Postrel and the woman to whom she donated kidney on this very subject.

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