Kidney Transplants-Private Profits-Socialized Losses

[NDXUFan]

One of the main reasons that I am for the selling of kidneys for transplants, is that it would eliminate the shortage of kidneys. Think of it this way, private profits and socialized losses. In other words, in the bank bailout of 2007-2008, taxpayers bail out Fannie Mae and Freddie Mac, along with private banks. Yet, those institutions are allowed to keep their profits while the taxpayer picks up the loss. In a kidney transplant, hospitals will examine your wallet before giving you or anyone else, a transplant. This enables the hospital to make a big profit and keep that profit. However, who is paying for the loss of the kidney, the taxpayer or Medicare. In other words, as in the banking situation, it is private profit and socialized loss.

I am curious, why is the hospital allowed to profit, while the donor is not? Does the hospital know about the needs or situation of the donor, I seriously doubt it. Does anyone believe with almost 100,000 individuals needing a kidney on a list, that this policy is doing a good job of meeting the needs of the individuals on the kidney transplant list??? Actually, you have less than a 30% percent chance of receiving a kidney transplant from the list. In other words, just a fortunate few are receiving transplants from that list, is that any better than rich people receiving transplants because they have money? Clearly, this transplant policy is not working, only a fortunate few are receiving transplants. The same people that complain about the fortunate few rich people receiving transplants are silent when only a fortunate few on the transplant list receive their transplants.

I hear people talking about "greed." When you work at a job, do you insist on being paid? Do you work for free without monetary compensation? If you insist being paid any monetary amount, you are "greedy." Do you think Hitler rewarded virtue? Do you think the Soviet Communist Party rewarded virtue? The Soviet Communist Party shopped at special stores, while the majority of people waited hours in line for basic food items. In kidney transplants, it is not any different. The hospital and the fortunate few who receive kidney transplants are shopping at the special store, while the vast majority of kidney patients are suffering and waiting with inadequate dialysis treatments, suffering from raging thirst, malnutrition, and feeling washed out and hopeless. They have to listen loud and moralizing lectures from individuals who have been catered to at the special store. The individuals who have been catered to a the special store insist that they as a third party know what is best for them, not allowing them to make their own decisions. The catered people would never, ever allow third parties to make life altering decisions for them or their freedoms. As long as they have their freedom and they are not living the way that they demand of masses, what do they care?

Ladies and Gentlemen, you are being scammed.

[cassandra]

Might be an idea to just have an 'opt out' system like in the few countries that don't have (much) of a waiting list.
But that would mean people leaving organs behind, unneeded in heaven of course. And less profits for D providers, D product manufacturers, hospitals doing kidney removals from healthy people.

[Bill Peckham]

As soon as I hear people waiting for a heart or lung advocate for an organ market I'll reevaluate my opposition. Kidney patient's needs are not the primary concern, they have access to life sustaining treatment.

[Simon Dog]

It would make sense to have a "point" system, based on the % of days of your "of legal age adult life" that you were registered as a donor - and give this credit to anyone, not just those with good organs, to be "fair" (a dubious word).     Tell kids who turn 18 "If you register as a donor now, you'll have the best score possible (100) if you ever need an organ".    It's just not right that people who are unwilling to be donors in death are perfectly willing to accept donation while they are alive.

[Rerun]

NDXUFan !!  Amen Sister (or Brother)  Let the rich people get their kidneys and GO!!!  Then the poor people could move up on the list.  They (the rich) would still go through the same grueling process to be matched and safety first etc..  They pay the price and get on with life. 

This is a voluntary process anyway.  No one will be forced to sell a kidney.

   

[Riki]

I'm wondering if I am one of the "fortunate few" considering that I've had 2 kidney transplants in my lifetime.  I am by no means rich.  I live with my mother, and between her wages and my pension, we make about $23,000 a year.  I've never paid for a kidney, nor would I.  I believe it's called the "gift of life" for a reason.

[MooseMom]

Is it really true that rich people get to move up the list?  Who do we know who has paid to move up the list, and where is the hard evidence?

[Hemodoc]

Steve Jobs was able to "move up the list" by getting into an area with a shorter wait list. He went to Memphis. The way the rich game the system is by paying their own travel and evaluation costs since most insurance companies will not pay for several transplant center evaluations. I can't fault a person with wealth engaging in such a basic survival type of behavior.

On the other hand, what is not being spoken of yet on this thread is the potential cost to the vendor giving his kidney for pay. If you look at the limited studies on vendors in third world nations, they don't get a lot of financial benefit and in fact many end up in poor health and worse financial situation after selling their kidneys.

The ethical concerns about selling kidneys are quite real and should keep us from that consideration.

[NDXUFan]

As soon as I hear people waiting for a heart or lung advocate for an organ market I'll reevaluate my opposition. Kidney patient's needs are not the primary concern, they have access to life sustaining treatment.

Bill, on that point, we have a serious disagreement.  I think the transplant industry is filled with hypocrisy.  You sound like Kent Thiry of Davita. 

[NDXUFan]

Steve Jobs was able to "move up the list" by getting into an area with a shorter wait list. He went to Memphis. The way the rich game the system is by paying their own travel and evaluation costs since most insurance companies will not pay for several transplant center evaluations. I can't fault a person with wealth engaging in such a basic survival type of behavior.

On the other hand, what is not being spoken of yet on this thread is the potential cost to the vendor giving his kidney for pay. If you look at the limited studies on vendors in third world nations, they don't get a lot of financial benefit and in fact many end up in poor health and worse financial situation after selling their kidneys.

The ethical concerns about selling kidneys are quite real and should keep us from that consideration.

NDXUFan:
Basically, you are making the point that because the system was not perfect in the past, it cannot be greatrly improved and that because of actions in the past, kidney patients should be required to suffer.  If the "rich" get their kidneys, that will lessen the stress on the organ donation system.  The incredible suffering of kidney patients is worth it to you?  Kidney patents have been on the very bottom of the list for years, look around.  Much of the whining of the transplant industry is hot air hypocrisy.  I am curious, why should I be forced to live my life according to your beliefs and viewpoints? In other words, because my grandmother was discriminated against, 100 years ago, someone should give me a position of employment because of what happened to my grandmother, 100 years ago?

[NDXUFan]

Steve Jobs was able to "move up the list" by getting into an area with a shorter wait list. He went to Memphis. The way the rich game the system is by paying their own travel and evaluation costs since most insurance companies will not pay for several transplant center evaluations. I can't fault a person with wealth engaging in such a basic survival type of behavior.

On the other hand, what is not being spoken of yet on this thread is the potential cost to the vendor giving his kidney for pay. If you look at the limited studies on vendors in third world nations, they don't get a lot of financial benefit and in fact many end up in poor health and worse financial situation after selling their kidneys.

The ethical concerns about selling kidneys are quite real and should keep us from that consideration.

It is easy for you to be "compassionate" about the suffering of other people. How much compassion is there for a hospital to charge $250,000 to someone who needs a kidney transplant?  I thought you and Bill detested "greed." 

[Hemodoc]

Steve Jobs was able to "move up the list" by getting into an area with a shorter wait list. He went to Memphis. The way the rich game the system is by paying their own travel and evaluation costs since most insurance companies will not pay for several transplant center evaluations. I can't fault a person with wealth engaging in such a basic survival type of behavior.

On the other hand, what is not being spoken of yet on this thread is the potential cost to the vendor giving his kidney for pay. If you look at the limited studies on vendors in third world nations, they don't get a lot of financial benefit and in fact many end up in poor health and worse financial situation after selling their kidneys.

The ethical concerns about selling kidneys are quite real and should keep us from that consideration.

NDXUFan:
Basically, you are making the point that because the system was not perfect in the past, it cannot be greatrly improved and that because of actions in the past, kidney patients should be required to suffer.  If the "rich" get their kidneys, that will lessen the stress on the organ donation system.  The incredible suffering of kidney patients is worth it to you?  Kidney patents have been on the very bottom of the list for years, look around.  Much of the whining of the transplant industry is hot air hypocrisy.  I am curious, why should I be forced to live my life according to your beliefs and viewpoints? In other words, because my grandmother was discriminated against, 100 years ago, someone should give me a position of employment because of what happened to my grandmother, 100 years ago?

Dear NDXUFan. My kidney disease is my burden to bare. Transplant tourism is one of the most heinous practices of the rich and affluent that I can think of putting the burden of my disease on a poor and impoverished person who has the hope of a sacrifice to improve his life that ends in many cases adding many further burdens.

Moreover, the health status of the vendor has been shown to deteriorate after paid kidney donation. A high prevalence of depression and psychosomatic reactions has been reported. Furthermore, those who developed chronic diseases after vending could not access medical care.[41,54] Thus, it is obvious that the donors targeted in an unregulated system are unlikely to safeguard their well-being and thus are highly susceptible to adverse physical and psychosocial consequences of participation in the organ trade. This is in sharp contrast to altruistic kidney donations, which generally lead to no change or an improvement in psychosocial health of the donor and stronger family relationships in cases of living related donations.[55]

Unfortunately, evidence also indicates that neediness often is aggravated in donor households participating in the organ trade. Most vendors receive only a fraction of the price paid for the kidney. In a recent political corruption case in the United States, a suspect in Brooklyn allegedly acquired kidneys from vulnerable donors for $10,000 each, then sold them at the marked-up price of $160,000.[56] The amount that paid donors receive typically is spent on acute needs, such as purchasing food and clothing and paying off debts, and thus most individuals remain in significant debt after organ donation and experience a decrease in median household income. This is not a surprise given that there is no "quick fix" for poverty.

http://www.medscape.com/viewarticle/716188_4

So, I am not the least discriminating against you in any manner. I am only advocating to protect those that will be turned into human commodities out of false hope and end up worse off financially and health-wise. In a sense, that is being my brother's keeper of my brethren in Pakistan, Iran and the Philippines. My wife is Filipino and I could easily have used my connections there to buy a kidney very cheaply. However, I never once considered this in any manner. My disease is my burden. My wife and daughter offered their kidneys. I turned them both down. I have looked at the data and there is no way that I would choose to place any burden upon them in any manner that could endanger or end their lives. Those are real risks of renal donation even if minimal in the eyes of some. A 3/1000 to 7/1000 chance of dying is nothing to dismiss quickly.

As Bill has already stated, we have the dialysis option where we can not only extend our lives but can do so in a rather grand manner where some have even ridden down the Grand Canyon in a raft.

If someone wishes to willingly donate a kidney and take that risk, so be it as long as they truly understand all of the risks entailed. However, subjecting a poor peasant into selling a kidney in a rather coercive manner and mind you some believe this is done through kidnapping and extortion not to speak of the executions in China making informed consent for the vendors truly null and void. I believe this quite unethical and selfish behavior reminiscent of colonialism.

So, I don't envy you your burden from renal disease which I likewise share with you, but I believe it is unethical and simply wrong to shift your burden upon someone else who under the duress of financial coercion or more would sell you their needed kidney.

[MooseMom]

Hemodoc, I had been in favor of at least considering the idea of people being able to sell a kidney, but after reading your post, I have changed my mind.  Thank you for a very eloquent argument.

Oh, after 2 years on the list at a Chicago tx hospital, my neph insisted I get listed in Wisconsin which had a shorter waitlist.  I ended up getting my tx in Madison.  It's actually a shorter drive from my house to Madison than it is to Chicago, especially during rush hour.  I am certainly not rich, but it's probably an advantage that I don't live in California.  I didn't know that Steve Jobs went to Memphis.  I wonder how he chose Memphis.  Do they have the shortest wait time in the nation or something?

[rocker]

I see two issues being conflated in this thread.  One is the issue for compensating donors.  The other is the issue of exploitation of the poor in less developed countries.

So, to separate the two issues, what is the argument against compensating US donors who are not poor? Iran has eliminated their waiting list by officially compensating donors. No one's complaining about being exploited, there are no middlemen getting rich from the exchange, and the donors are honored and taken care of (free healthcare) afterwards.

What are the objections to that model?  Why should an altruistic donor be expected to bear all the financial burden (lost wages, possible followup care) of donating?

[MooseMom]

So, to separate the two issues, what is the argument against compensating US donors who are not poor? Iran has eliminated their waiting list by officially compensating donors. No one's complaining about being exploited, there are no middlemen getting rich from the exchange, and the donors are honored and taken care of (free healthcare) afterwards.

What are the objections to that model?  Why should an altruistic donor be expected to bear all the financial burden (lost wages, possible followup care) of donating?

Would anyone in the US who is not poor sell a kidney?  I doubt it.

I guess it depends upon what kind of compensation is offered.  I would be fine with, say, free healthcare for life for the donor, but I don't think a cash payment would not be exploitative in some way. 

[KarenInWA]

I personally don't see anything wrong with the payor (Medicare and/or Private insurance) compensating a live donor for their kidney (or liver or bone marrow, for that matter). Think about it - the live donor is potentially saving Medicare/Private insurance hundreds of thousands to potentially a couple of million $$'s per dialysis patient. I see nothing wrong with giving some kind of compensation - from the payor - to the donor.  Just my 

KarenInWA

[MooseMom]

I guess there is a difference between "compensating" a donor and "paying" a donor.  I'd love to see a workable plan of "compensation".

[Hemodoc]

Not a simple issue my friend. Why compensate the rich? I thought you were against that sort of perk.

Secondly, what rich person will be motivated by a small compensation package? That would not be an incentive to them. Thirdly, there is a real concern that the current altruistic donation system would suffer despite great strides in increasing living donation especially with donation chains.

Thirdly, yes, even here in the US, it would be the poor who would step up to sell kidneys once again broaching the ethical issue of financial coercion of such a system. Whether here in the US or over seas, the same ethical constraints apply. If you are interested, Sally Satel has written extensively promoting this system of payment for organ donation. Fortunately, to date, her efforts have not born any fruit. The hypocrisy of Sally Satel's writings is that she HERSELF had a complete stranger donate a kidney to her. Well, rather a remote acquaintance to put it more correctly. Her donor became her friend when she donated. Yet, despite this amazing altruistic donation, Sally Satel paradoxically is one of the greatest critics of the altruistic donation system in the US.

As an aside, I wrote a critique of one of Satel's articles and the pair of articles became an English writing assignment by a college professor comparing and contrasting the arguments. The kids put their opinions online and it was quit interesting to see how well they understood or didn't understand the issues at hand.

http://www.billpeckham.com/from_the_sharp_end_of_the/2010/04/dsen-goes-to-college.html

Where the real problem exists in our ever increasing burden of renal disease each year. We are quite focussed on the transplant issue when in fact the real problem is the rate of growth in renal patients far outstrips the growing number of donors. Poorly controlled HTN and Diabetes, both potentially treatable or reversible conditions bolstered by our outrageous obesity rates are the real heart of the matter. What many of the proponents of payment for organ donation fail to truly grasp is that even their system could not keep up with the demand for kidneys. If we cannot stem the tide of new or incident patients entering ESRD, then no system we could ever devise will suffice.

For instance, looking at the Iranian system where they claim to have solved the wait list issue, what you don't hear is that it favors males vs females due to their culture and one of the exclusions the last time I looked was age over 50. In addition, Iran is a totalitarian dictatorship without full access to all of their data. Who knows what the real story is vs their propaganda.

In any case, there remain serious ethical obstacles against an organ vendor system in the US and that in my opinion is a good thing.

[Bill Peckham]

One thing that should be understood is that Medicare will not be the one paying the majority of the time if an organ market came to pass. Medicare does not become your insurer until you've had ESRD for 33 months (the thirty month clock starts after a three month lag) so if you're imagining Medicare paying $20,000 you should also be imagining private insurers paying 5 times more, or more. So consider this - if you're selling a kidney, who would you sell to, Medicare or the private insurers? If you are a 24 year old, with a sterling medical history, and a perfect match how much is that kidney worth vs a 50 year old who has lived an eventful life, with a kidney that is a close match? What would be a fair price for your private insurance to pay your twin brother for his kidney? How much for your kid's kidney? - young and related! Not to mention the self payers, now that's where the real money would be for the healthy young donor. How much would a millionaire spend for a perfect kidney?

But that isn't even my main issue. Changing the kidney transplant market would not happen in a silo. It would change altruistic kidney donation but I don't hear much concern about that, or is it that there would be no need for altruistic donation because all living donors would be paid?  Going all in on paid donation could profoundly change post mortem kidney donation (sorry people waiting for kidney/pancreas) and post mortem donation generally.  For it to be moral to even consider an organ market for kidneys you have to know what would happen to post mortem donation. You have to know that the number of post mortem donations would not decrease. I don't know that. I don't think anyone knows that.

[jeannea]

NDXUFan, you seem really hung up on this point. First, you posted under Hypocrisy. That was only a couple weeks ago and many of us commented. Now you bring it up again. Your arguments read to me not that you want to discuss it but that you believe you have the only right view. None of us say anything that can even make you say intersting point. What is your goal?

Are you on dialysis or are you looking to sell a kidney? If you're on dialysis, how long have you been on the waiting list?

For your position, exactly how much is a kidney worth? Also, there are things now that keep you off the waiting list, would the doctor have to transplant you if you buy a kidney? Would you take their discretion away?

I get the feeling you have an ulterior motive. Please be honest with the people here. Don't treat us like idiots like you do when you say we're being scammed.

[jeannea]

How long have you been a member? I'm looking for your intro post and can't find it. I went back about 2 years.

[rocker]

One thing that should be understood is that Medicare will not be the one paying the majority of the time if an organ market came to pass. Medicare does not become your insurer until you've had ESRD for 33 months (the thirty month clock starts after a three month lag) so if you're imagining Medicare paying $20,000 you should also be imagining private insurers paying 5 times more, or more. So consider this - if you're selling a kidney, who would you sell to, Medicare or the private insurers? If you are a 24 year old, with a sterling medical history, and a perfect match how much is that kidney worth vs a 50 year old who has lived an eventful life, with a kidney that is a close match? What would be a fair price for your private insurance to pay your twin brother for his kidney? How much for your kid's kidney? - young and related! Not to mention the self payers, now that's where the real money would be for the healthy young donor. How much would a millionaire spend for a perfect kidney?

But that isn't even my main issue. Changing the kidney transplant market would not happen in a silo. It would change altruistic kidney donation but I don't hear much concern about that, or is it that there would be no need for altruistic donation because all living donors would be paid?  Going all in on paid donation could profoundly change post mortem kidney donation (sorry people waiting for kidney/pancreas) and post mortem donation generally.  For it to be moral to even consider an organ market for kidneys you have to know what would happen to post mortem donation. You have to know that the number of post mortem donations would not decrease. I don't know that. I don't think anyone knows that.

Oh how I love a detailed response.   

Ok, first.  I referenced Iran.  In Iran, compensation is handled by a central authority nationwide.  Donors are paid for time lost from work and given an award amount from the government, and "a majority" receive gifts from charitable organizations. The Medicare/private insurer disparity could easily be regulated by law. The only transplant programs eligible in their system are university hospitals.

Another aspect of the Iranian program is that it compensates only living-unrelated.  I'm not sure I agree with that aspect.

Now, one thing I do agree with is that this would change altruistic donation. I just don't think it would be clear whether the change would be for the better or worse.

Consider the current situation.  I define an "altruistic donor" as someone who says "I want to give a kidney to make someone's life better - I don't care who." What do they face in our system?  First, a medical team driven by two main emotions - eagerness to get the kidney (and the donor knows full well that the medical team will profit), and suspicion.  I've read loads about how it's important to "examine the motives" of altruistic donors.  What a warm welcome for their gift. And if they were compensated - well, that suspicion pretty much goes away.  Everyone will assume they know why the donor is doing it, and not subject them to the third degree.

Assume they are deemed a suitable donor.  Now what are they told? Their hospitalization will be paid for.  Ok, good.  If they work, they may have to take a month or more off.  That will be at their own expense.  They will need checkups post-procedure - how long is that covered for?  What if they have a problem a month or a year down the road - at some point, that becomes their own expense.  Also in the past (though this changes with Obamacare) they would be told that they would likely never be able to purchase their own health insurance policy. (All major insurers had "organ donation" as a policy exclusion.)

Isn't it enough that they're giving up a kidney? Do they have to also know that this will likely be a major financial burden on them as well?  How many donors are we excluding with this policy - people who would love to help out, but simply can't afford the cost?

As for decreasing post-mortem donation - I don't know what has happened to pm donation where this has been implemented.  My first thought is - wouldn't it be great if this eliminated pm donation, because all donated kidneys came from living donors?  We all understand that pm organs are not the best - they are simply the best alternative if one doesn't have a living donor.

And there is another whole avenue of discussion regarding compensating families for pm donation.  I recognize that I don't understand a lot of the objections raised, because I don't have any feelings that a corpse is sacred, and I know other people do.  My feelings are more along the lines that the body of a deceased person is a lot like their house - a place they lived for a while, and now have no more use for.

So what I'm proposing is not eBay for kidneys. What I'm proposing is a regulated system that does all it can to eliminate incentives for fraud, ensures that everyone involved in the process is trained and monitored, and makes the donation process far less burdensome for those who wish to do so.

[Bill Peckham]

Here is a recent review of the Iranian system http://www.nature.com/ki/journal/v82/n6/full/ki2012219a.html  the charity gets a donor and a recipient together, and provides them with a room where they can haggle about the price. That's not something I think most people in the US would welcome.

The Iranian system reports limiting donors to those between 18 and 35. It would make more sense to me that donors and recipients should be the same age + or - . A 65 year old should only be able to buy the kidney of another 65 year old. Part of the ick-factor in all this is the idea of an entitled elderly harvesting the kidneys of the desperate young, at least make it ones desperate peers.

But the main issue with the Iranian model is that it is happening in Iran. There is no way to know what is happening behind their theocratic vale. Their incidence rate suggests an age restriction - population ~90 million, ~2,300 transplants and of those transplants how many go to foreigners? It is acknowledged that there is some transplant tourism, that Iran is a Kidney exporter to the Gulf states, but that segment of the Iranian transplant industry is not ever described. Given the need in Iran for hard currency and the ability of Saudis and Kuwaitis to pay, the temptation to sell Iranian kidneys to the highest bidder would be significant. That’s not happening at all?

Each proponent of a kidney market has a very different idea of what it would look like – some imagine people receiving an honorarium and/or a lifetime benefit, some hold the idea that a person ought to be able to do whatever they want with their body – including selling their kidney to the highest bidder. There is a lot of money at stake, if the state limits the price paid to some nominal amount when in fact people are willing to pay hundreds of thousands of dollars there will be corruption. The fact that no corruption is described in the Iranian model suggests a problem with the reporting rather than the virtue of the system.

But really that is all navel gazing. It would be a disaster if we eliminated post mortem donation – or even negatively affected post mortem donation rates. The needs of people waiting for heart transplants, to take one example, come way before the needs of people waiting for a kidney. It isn’t some idle question, you have to know what will happen before it’s even worth thinking about what is being suggested.

[Simon Dog]

I know that the waiting list is theoretically "no favoritism", however, I find it interesting that I have read of numerous celebrities (Joe Moakley; Larry Hagman; Gregg Alman, Steve Jobs; Mickey Mantle) getting a liver transplant but I have never read of a celebrity dying because (s)he di dnot come up on the waitlist.   Must just be coincidence.

[NDXUFan]

Steve Jobs was able to "move up the list" by getting into an area with a shorter wait list. He went to Memphis. The way the rich game the system is by paying their own travel and evaluation costs since most insurance companies will not pay for several transplant center evaluations. I can't fault a person with wealth engaging in such a basic survival type of behavior.

On the other hand, what is not being spoken of yet on this thread is the potential cost to the vendor giving his kidney for pay. If you look at the limited studies on vendors in third world nations, they don't get a lot of financial benefit and in fact many end up in poor health and worse financial situation after selling their kidneys.

The ethical concerns about selling kidneys are quite real and should keep us from that consideration.

NDXUFan:
Basically, you are making the point that because the system was not perfect in the past, it cannot be greatrly improved and that because of actions in the past, kidney patients should be required to suffer.  If the "rich" get their kidneys, that will lessen the stress on the organ donation system.  The incredible suffering of kidney patients is worth it to you?  Kidney patents have been on the very bottom of the list for years, look around.  Much of the whining of the transplant industry is hot air hypocrisy.  I am curious, why should I be forced to live my life according to your beliefs and viewpoints? In other words, because my grandmother was discriminated against, 100 years ago, someone should give me a position of employment because of what happened to my grandmother, 100 years ago?

Dear NDXUFan. My kidney disease is my burden to bare. Transplant tourism is one of the most heinous practices of the rich and affluent that I can think of putting the burden of my disease on a poor and impoverished person who has the hope of a sacrifice to improve his life that ends in many cases adding many further burdens.

Moreover, the health status of the vendor has been shown to deteriorate after paid kidney donation. A high prevalence of depression and psychosomatic reactions has been reported. Furthermore, those who developed chronic diseases after vending could not access medical care.[41,54] Thus, it is obvious that the donors targeted in an unregulated system are unlikely to safeguard their well-being and thus are highly susceptible to adverse physical and psychosocial consequences of participation in the organ trade. This is in sharp contrast to altruistic kidney donations, which generally lead to no change or an improvement in psychosocial health of the donor and stronger family relationships in cases of living related donations.[55]

Unfortunately, evidence also indicates that neediness often is aggravated in donor households participating in the organ trade. Most vendors receive only a fraction of the price paid for the kidney. In a recent political corruption case in the United States, a suspect in Brooklyn allegedly acquired kidneys from vulnerable donors for $10,000 each, then sold them at the marked-up price of $160,000.[56] The amount that paid donors receive typically is spent on acute needs, such as purchasing food and clothing and paying off debts, and thus most individuals remain in significant debt after organ donation and experience a decrease in median household income. This is not a surprise given that there is no "quick fix" for poverty.

http://www.medscape.com/viewarticle/716188_4

So, I am not the least discriminating against you in any manner. I am only advocating to protect those that will be turned into human commodities out of false hope and end up worse off financially and health-wise. In a sense, that is being my brother's keeper of my brethren in Pakistan, Iran and the Philippines. My wife is Filipino and I could easily have used my connections there to buy a kidney very cheaply. However, I never once considered this in any manner. My disease is my burden. My wife and daughter offered their kidneys. I turned them both down. I have looked at the data and there is no way that I would choose to place any burden upon them in any manner that could endanger or end their lives. Those are real risks of renal donation even if minimal in the eyes of some. A 3/1000 to 7/1000 chance of dying is nothing to dismiss quickly.

As Bill has already stated, we have the dialysis option where we can not only extend our lives but can do so in a rather grand manner where some have even ridden down the Grand Canyon in a raft.

If someone wishes to willingly donate a kidney and take that risk, so be it as long as they truly understand all of the risks entailed. However, subjecting a poor peasant into selling a kidney in a rather coercive manner and mind you some believe this is done through kidnapping and extortion not to speak of the executions in China making informed consent for the vendors truly null and void. I believe this quite unethical and selfish behavior reminiscent of colonialism.

So, I don't envy you your burden from renal disease which I likewise share with you, but I believe it is unethical and simply wrong to shift your burden upon someone else who under the duress of financial coercion or more would sell you their needed kidney.

HemoDoc:

I think you do make many good points in the vast majority of your posts.  However, I did not ever say or imply that any individual should be forced to sell a kidney, it should be done thru a decision of free will, not kidnapping or any other forced decision making.  I am for "Informed Consent."  I am not for execution of any prisoner for kidney donation, absolutely opposed.  I also never said that I would buy a kidney from someone in the third world.  Your post is making many assumptions.