Yesterday, Gizmodo asked a handful of doctors and bioethicists about permitting the sale of kidneys. For the most part, it was another classic instance of medical professionals hand waving about human dignity and altruistic motivation, including this high-density bologna from Tarik Jašarević of the World Health Organization:
Payment for cells, tissues and organs is likely to take unfair advantage of the poorest and most vulnerable groups, undermines altruistic donation, and leads to profiteering and human trafficking. Such payment conveys the idea that some persons lack dignity, that they are mere objects to be used by others.
I took on each of these objections in my paper in defense of compensating bone marrow stem-cell donors. They apply equally to compensation for kidney donors, as the great Sally Satel will tell you. For now, though, I want to simply highlight the Gizmodo contribution from Dr. Arthur Matas, Professor of Surgery and Director of the Renal Transplant Program at the University of Minnesota, Minneapolis:
There’s no data that donation goes down [when selling kidneys is legalized]… And I would argue that if the total number of donations goes up, who cares? Maybe you’re eliminating some of the people who feel pressure to donate because there’s no other choice. That’s why I’ve always argued that we need to do a trial to find out some of these things; if the total number of donations goes down, then the answer is clear. But what if the total number of spousal or relative donations went down ten percent, and the total number of donations went up three hundred percent. Would it matter?
Ask for the data! This is what a true scientist ought to say. The dirty little secret of the WHO’s ideological opposition to compensation for organ donors is that it traces back to extremely thin and ideologically motivated research from the 1970s — specifically, Richard Titmuss’s influential book The Gift Relationship, which argued that payment to blood donors would crowd-out altruistic donors based on anecdotes, donor questionnaires, and his mere speculation. Hard data from field experiments, on the other hand, demonstrates that many compensation models undoubtedly induce far more donors than they dissuade.
Hat-tip to the inimitable Frank McCormick for sharing this article with me. McCormick is a co-author of “A Cost-Benefit Analysis of Government Compensation of Kidney Donors” (2015). From the abstract:
From 5000 to 10 000 kidney patients die prematurely in the United States each year, and about 100 000 more suffer the debilitating effects of dialysis, because of a shortage of transplant kidneys. To reduce this shortage, many advocate having the government compensate kidney donors. This paper presents a comprehensive cost-benefit analysis of such a change. It considers not only the substantial savings to society because kidney recipients would no longer need expensive dialysis treatments—$1.45 million per kidney recipient—but also estimates the monetary value of the longer and healthier lives that kidney recipients enjoy—about $1.3 million per recipient. These numbers dwarf the proposed $45 000-per-kidney compensation that might be needed to end the kidney shortage and eliminate the kidney transplant waiting list. From the viewpoint of society, the net benefit from saving thousands of lives each year and reducing the suffering of 100 000 more receiving dialysis would be about $46 billion per year, with the benefits exceeding the costs by a factor of 3. In addition, it would save taxpayers about $12 billion each year.