A ‘Gift of Life’ With Money Attached

December 22, 2009
Essay
A ‘Gift of Life’ With Money Attached
By SALLY SATEL, M.D.

“For the right price, yes, I would give up one of my organs to save someone’s life,” read the e-mail message, one of three dozen I received last month. “I live from paycheck to paycheck.”

What prompted this modest onslaught of correspondence was a tongue-in-cheek article by Mark Cohen in his “White Collar Reset” column for America Online.

Mr. Cohen, who describes himself as “a jobless 47-year-old suburban New Jersey magazine editor with two mortgages,” has been writing a series of columns exploring “previously taboo plans for recapitalizing our household.” In one such column, he mused about dispensing medical marijuana (if New Jersey ever legalizes it, of course). And last month, he turned his attention to vital organs.

“I’m considering selling one of my kidneys,” he wrote.

Because I’ve become fairly well known as an advocate of incentives for organ donation, Mr. Cohen called me to discuss the pros and cons of his plan. As someone who has become deeply concerned about the organ shortage after receiving a kidney a few years ago, I told him I thought he would be a perfect candidate for such a transaction: educated, a savvy consumer, someone who, with proper informed consent, would know what he was signing up for. The only catch is that getting anything of value in exchange for an organ is illegal.

I told Mr. Cohen I thought that if compensated donation were allowed, it would come to resemble surrogate motherhood. In some states, mothers who agree to carry a baby for an infertile couple are legally compensated for their time and for the risk they assume.

And while surrogate mothers surely welcome such payments, they are hardly the only factor in the decision; many say they are motivated by a strong desire to help another woman fulfill her maternal dream. At first, organ compensation, like surrogacy, would seem odd, but then it would become more generally accepted.

“The more Satel talked,” Mr. Cohen wrote, “the less selling my kidney seemed like some bizarre, macabre act of depravity, and the more I wondered why the hell I hadn’t thought of it before.”

Dozens of readers must have wondered the same thing. The first to write me was a mother of four named Jessica from Washington State. Several months ago, her youngest child was born prematurely and suffered major complications. “The reason I am telling the story,” Jessica wrote, “is because we spent everything we had in savings, pulled money from retirement, etc. ... to allow me to pay for day care so I could spend every day in the NICU.”

She continued, “I would seriously consider donating to someone who may die without it if it meant it helped save them and helped my situation also.”

Chip from Arizona was in a similar position. “In the past I have very seriously considered ‘donating’ an organ for compensation as my life is financially in ruins, to put it mildly.” He went on, “And to me, it makes better sense to ‘donate’ a organ than to go rob a corner gas station or liquor store for grocery money — safer too, for everyone, not to mention the ability to save/improve someone else’s life in the process!”

The messages kept coming.

“I am in good health and very interested in donating. Due to financial burdens, being compensated would be very helpful, and my organs could also benefit the receiver.”

“I was making $ 100,000 a year, and now I am not working. ... So yes, I would sell a kidney to someone who needs it.”

A number of writers rightly pointed out the need for strict protections for the donor, including careful education, medical and emotional screening, follow-up care and an enforceable contract to ensure the promised compensation.

Organ selling as a sign of the recession? No question. But it is much more than that. Almost every writer spoke of helping someone else, of combining financial with humanitarian motives.

The desire to do well by others — for pay — is as old as humankind. Think of firefighters, police officers, doctors and teachers. Their service is no less valuable because they are paid for it.

Yet it is all too easy to romanticize altruism. The “gift of life” is indeed precious; I received it. But I am not so starry-eyed about my good fortune that I am blinded to the reality that altruism is not producing enough organs: 83,000 Americans wait for a kidney; 13 will die today while waiting.

Sadly, the transplant establishment insists that sick people languish on dialysis for years or die waiting for a kidney. They fear, on one hand, that the patient might remunerate someone for saving his life and, on the other, that any donor in financial need can’t possibly make a rational decision about his own best interest.

The solution to this lethal paternalism, as I and others have argued, is not to create a direct exchange of cash for kidneys, but for Congress to let donors accept a carefully devised and regulated government benefit — perhaps a tax credit, a contribution to a retirement plan or early access to Medicare.

People like Jessica and Chip could get some help with bills. Desperate patients would be rescued from suffering and premature death. In reciprocity is salvation for both. There is nothing bizarre or macabre about that.

Dr. Sally Satel is a psychiatrist and a resident scholar at the American Enterprise Institute.

http://www.nytimes.com/2009/12/22/health/22essa.html