Dispatches From the Moderate Left

Saturday, November 19, 2005

The Black Market for Kidneys - Part II

Last post I looked at the negative effects that kidney shortages have on people in the third world who are effectively exploited in shady pseudo-legal kidney donation schemes. There's obviously scope for the people receiving kidneys to be scammed here, too. This is an informal, semi-illegal market where purchasers have no legal protection and reputation effects aren't strong enough to ensure a smooth transaction. Scams do indeed happens fairly regularly. The health effects of receiving a dud, poisoned or incorrectly inserted kidney are somewhat immediate and drastic. There are reports of people dying and if a scam occurrs there will be serious health effects. People are desperate enough to take these risks and not every transaction is problematic, but this is a very real effect of not having a formal market for kidneys.

Anyway, the question then becomes, do we just open it all up? Do we allow a free market for kidneys? There are a number of obvious and immediate advantages which would result from this. First there would be no more waiting for a kidney. The price of the organ could definately be set at a sufficient level to ensure that the limited demand would be met. No one's really estimated what this price would be, but it would definately be less than the tens or hundreds of thousands of dollars which are currently paid to get a kidney on the black market. Given the present, fairly large, cost of dialysis treatment there is basically no doubt that, even in places without government health care, anyone currently waiting for a kidney would be able to purchase one. Furthermore, a formal market, with appropriate controls, would eliminate the negative health effects which arise from the current informal transactions. Donors would receive sufficient post-operative care and donees wouldn't get a dud kidney.

So on the practical side of things this idea looks like a winner. There are two main moral objections to it. First only poor people would probably sell their kidney so the process would be exploitative. Second, this potentially violates some fairly serious principles about human dignity and could lead us down a very slippery slope.

I don't think the first argument relly holds much weight. That article I linked to earlier, which is from a fringe libertarian think tank somewhat more extreme than Cato, makes a fairly good point. People in poverty often don't have all that much to offer in the way of skills and consequently don't earn all that much. This is an eminently regrettable situation and governments should certainly attempt to fix problems associated with unequal access to education (and making people pay full fees for the most useful vocational university courses is a really, really bad step in the wrong direction). However, given that this is the situation, a ban on kidney sales prevents those who most need money from offering something of value which they can offer and receiving good compensation for it.

Which brings us to the second argument. It is certainly very, very icky when you do what I didn't and add the phrase "their kidney at the end of that last paragraph. We're talking about people commodifying their own body parts, and indeed society commodifying the body parts of the poor, and this is a big deal. The slippery slope looks something like this. Currently, to the best of my knowledge, in Australia it is illegal to sell any body part, people simply don't have property in them. If a service has been engaged in to modify or produce the body part (anatomical dissections and, uh, "reproductive fluids") some compensation is permitted, but it is not payment for the body part itself. In the US (and I think the UK), it's a little bit different. People are allowed to sell body parts which replenish themselves - ova, sperm, blood. But this is where the line is currently drawn.

When we move to kidneys we're moving the line further. You're selling a body part which isn't replacable but which doesn't, to the best of medical knowledge, cause any loss of function (the fact that you don't have a backup doesn't really matter as a replacement is relatively easy to buy now). Unfortunately there is evidence that drawing the line here causes the line to shift even further. There are credible reports of people in the areas which kidneys are "harvested" from in India and Brazil that people are selling their corneas - apparently they get about $30,000 for this. There are also anecdotal reports that the same people are selling their lungs (I'm no doctor, but I think this is only a tissue donation, not the entire thing). Now the line has been moved to selling body parts which do cause a noticable loss of function but which is duplicated, so you're only losing half function.

This is a very serious worry. There is a reason why the very phrase "a free market in kidneys" is troubling. Commidfying a body part is a step on the path towards commodifying your body itself which is, of course, slavery. You don't need to believe that the slope will slip that far to be troubled by the first step. Another indiciation of where this slippery slope leads is provided by corroborated reports from China that some executions are timed to co-incide with the needs of donees as the officials make good money from selling fresh kidneys (like I said, they're optimally transferred while the donor is alive or only recently deceased). This is the sort of attitude that is inclucated - the disposable and/or poor are only valuable for their organs (I know moral comparisons to the PRC are hazardous, but I think there's an element of applicability here).

Like I said, this is a moral mine field. On the one hand, denying people property in their kidneys creates massive medical problems for people waiting for a transplant which often never comes and prevents people who most need money from receiving good compensation for doing something which causes them no long term harm. On the other hand we have an intuitive "ewwww" which seems backed up by moral philosophy.

I'm not entirely sure in which way I'd resolve the dilemma. I think my Christian instinct towards preservation of the essence of human dignity at the expense of utilitarian outcomes would prevail if I was the one who had to make the choice, though. Something that would push me further in that direction is evidence, from Belgium I believe (I don't have my original essay on this computer, but I think it's Belgium), that cadaver donation rates can be improved to the point of surplus by making the system opt-out rather than opt-in. I don't have much problem violating the dignity of dead bodies, particularly if they had the option to opt out pre-death (and perhaps close family members having the option after death). A plan for this to be implemented in Brazil was shot down by the Catholic church in Brazil, but I think their tender concern for the dead is misplaced. I'm sure others might feel different, but I'm of the opinion that the rights of corpses can give way to the needs of the living in situations like this. I think this option is much less icky and should probably be explored before we create a kidney market.


  • Great blog I hope we can work to build a better health care system as we are in a major crisis and health insurance is a major aspect to many.

    By Anonymous Blue Cross of California, at 3:10 PM  

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