What’s so wrong about selling your kidney?

What’s so wrong about selling your kidney?

From The Times
June 4, 2007

The Big Donor Show turned out to be a hoax. Instead of being a tasteless reality show on Dutch television in which three patients competed for a terminally-ill cancer sufferer’s kidney, it was a stunt to raise awareness of the shortage of organ donors. At which point all the commentators turned their outrage meters back to normal (merely frothing).

What a pity. Now that we’ve had our awareness raised, we should be concentrating on some pesky ethical questions. Why, for instance, when we use markets to supply the essentials of food, energy and clothing, don’t we use one to supply us with kidneys? The standard response from ethicists is that kidneys, like life itself, are too important to involve filthy lucre. The supply of transplant organs is best left to good old altruism.

But the result of this inability or unwillingness to understand how private greed can, with the correct incentives, be turned to public good, is that 420 people died in the UK in 2004 while waiting for a kidney. Yes, transplant rates are rising (1,845 in 2004, 2,098 in the most recent year) but then so are the waiting lists (5,126 to 6,333). The average wait is two years – but that figure is masked by sufferers who can be on dialysis for nearly a decade.

So in the name of ethics – and our refusal to consider an alternative system that actually works – we condemn a number of our fellow citizens to an early and painful death; after years of draining dialysis, of course.

This might shock those who consider Iran to be an outpost of Barbary where crazed zealots hunger for a nuclear bomb – but there is no waiting list for kidneys in Iran. In Iran there is also a regulated market in which live donors get paid for their donation of a kidney. It is not a coincidence that when the State offers what amounts to roughly a year’s average income to those willing to save the life, lives actually get saved. It’s worth pointing out too that kidney donation itself is of the same order of risk as carrying a surrogate child.

Here in Britain, dialysis costs on average £30,000 a year. Imagine that sum, a figure well over the typical annual income, paid as a fee for a donation; it would surely tempt many to offer up a spare. No one is suggesting that there should be an unlimited market in which desperate would-be donors appear at the A&E, clutching a bloody, self-excised kidney and bargain a price with doctors. But what is surely feasible is a regulated market with financial incentives to encourage the saving of lives.

It won’t happen, of course. The discussion will not even begin and preventable deaths will continue all because commonly accepted “ethics” prevent us from accepting that there are some things just too important not to have markets in. Now, that antimarket bias really is unethical.

http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article1878559.ece