Fair Market Value for a Kidney

Published Jun 27, 2014

299 Posts

What is fair market value....

By contrast, some transplant surgeons advocate regulated sale of kidneys to prevent death of as many as 100 000 people annually. At the American Transplantation Congress, Arthur Matas of the University of Minnesota transplant team, noting that a wait time of over 5 years, induces death on the waiting list of 7% annually, called for a regulated system of living kidney sales.¹² The Matas proposal includes careful donor medical and psychosocial evaluations with a fixed tax-free payment to the donor plus an option of short- or long-term health and life insurance. Matas pointed out that surrogate mothers are individuals who benefit others without losing their dignity or becoming victims. Similarly, paid organ donors are not victims who unable to determine what happens to their body.
In early 2006, the lessons learned from the wild and extensive racketeering spawned by America's 1920s 'Prohibition' of alcoholic beverages are pertinent. Clearly, legislation, per se, may not force human behavior compliance.¹³ Thus, while the sale of human organs is against existing law, in nearly every country, illegal kidney transplants are widely available through devious and often unsavory vendors in India, Turkey, China, Russia, and South Africa as described in the New York Times.¹⁴ Organs Watch, a non-government transplant monitoring organization, estimates that '...thousands of illegal transplants occur every year bought by patients from the Persian Gulf states, Japan, Italy, Israel, the US and Canada supplied by 'donor' nations, including India, Pakistan, Turkey, Peru, Mexico, Romania, and South Africa.'¹⁵ The late Michael Friedlaender, a transplant nephrologist at Hadassah University Hospital in Israel, remarked: 'What's happening now is absurd. Airplanes are leaving every week. I've seen 300 of my patients go abroad and come back with new kidneys... it's a free-for-all.'¹⁶Friedlander characterized today's kidney market as forcing potential kidney purchasers to be 'exposed to unscrupulous treatment by uncontrolled free enterprise.'
Voices favoring kidney sales are becoming more evident. For example, a surprisingly positive endorsement for legalizing human organ sales was provided by Robert Berman of the Orthodox Jewish Halachic (interpreted by orthodox rabbis) Organ Donor Society writing in the Jerusalem Post of 9 August 2005: 'The choice before us in not between buying or not buying organs. This is happening regardless of the law. The choice is whether transplant operations and the sale of organs will be regulated or not.'¹⁷
Nobel Laureate (Economics), Gary S Becker and his co-worker Julio J Elias established a 'market price' for a live donor kidney as a commodity.¹⁸ Assuming that an American earning a mean of $40 000 annually has a life valued at $3 million, faces a risk of death from nephrectomy of 1%, a decrease of 5% in quality of life, and will lose $7000 of income due to convalescence from surgery, they calculated a kidney purchase price of $45 000. Using a more probable death risk of one in 300 nephrectomies (the true reported risk is three in 10 000);¹⁹ reduces the kidney price to $20 000. Our current non-system promotes a kidney black market available only to the wealthy who bear the total expense for what may be inadequately screened, suboptimally matched organs inserted by unregulated (inferior?) surgeons. Becker and Elias's proposal would end advantages of wealth in organ acquisition since poorer individuals would obtain their kidneys via Medicaid or Medicare.
Each of us may opt to engage in risky behaviors (e.g. sky diving, volunteering for military service, working on oil rigs, and smoking cigarettes). Lacking wealth does not preempt making a rational decision. Prohibiting the poor from donating organs leaves them still poor; consequently, according to Matas, withholding the ability to be paid for donation eliminates one path to improve a person's financial situation. Just what is so ethically wrong? How is it worse than selling one's sperm or egg cells, actions now legal and widely advertised? Indeed, commercialization of semen and ova is more morally questionable than organ sale because those cells might create entirely new human beings.
Introducing appropriate legalization to regulate and manage kidney sales through a national regulatory body would be a 'natural' extension of the present end stage renal disease network collaborating with United Network for Organ Sharing and the OPTN. Eliminating black market brokers would divert funds to kidney sellers. Money saved by decreasing the number of dialysis patients might fund additional kidney transplants. Reservations that adoption of a federal organ marketing scheme necessitates further 'socialization' of our health care system are reasonable. Insertion of yet another federal agency to 'supervise' presently over regulated nephrologists and transplant surgeons is a less than attractive proposition. But, the mandate underlying this essay is consideration of endorsement of a strategy for resolution of a problem that has grown into a serious conundrum. At the least, debating the controlled initiation and study of potential regimens that may increase donor kidney supply in the future in a scientifically and ethically responsible manner, is better than doing nothing more productive than complaining about the current system's failure.