Organ Failure

[okarol]

Organ Failure
By Sally Satel, M.D.
Posted: Monday, August 18, 2008
   
Early this summer, the American Medical Association voted to lobby Congress to permit the study of financial incentives for organ donation. With nearly 100,000 people on the national transplant list and 18 dying every day for want of an organ, the AMA resolution to address the organ shortage could not be more timely.

And yet the National Kidney Foundation, the nation's largest advocacy group for people with kidney disease, won't be a reliable ally. The NKF, which has a $32 million annual budget and is to kidney disease what the American Lung Association is to asthma, says it laments that thousands "die while waiting for that 'Gift of Life.'" But instead of locking arms with the AMA, the kidney foundation is poised to sabotage the association's efforts--in keeping with its recent practice of blocking any attempt to explore the possibility of compensating organ donors. Why the stubborn opposition?

Imagine the American Cancer Society bragging about having derailed an experimental project that might help breast cancer patients--especially when other respected groups were in favor of the measure.

When I spoke with Dolph Chianchiano, senior vice president for health policy and research at the NKF, he told me that "compensating donors would cheapen the gift" and lead to fewer people donating overall. As a kidney recipient, I find this hard to fathom. When I was facing years on dialysis, any healthy kidney, paid for or not, would have been precious to me. What about would-be donors? Won't some be more likely to donate their kidneys, or the organs of their family members, because of the prospect of a financial reward? And if others don't benefit in this way themselves, will they really be dissuaded because other people somewhere in the country accepted a form of payment? When asked in a 2005 Gallup poll commissioned by the U.S. Department of Health and Human Services whether "payments" would affect their willingness to give a family member's organs, 19 percent answered "more likely," while 9 percent said "less likely." That margin favors donation. Young people were especially receptive. One-third of 18-to-34-year-olds said the offer of incentives would make them "more likely" to give a family member's organs, compared with 7 percent who said "less likely."

There's additional evidence that the NKF is wrong here. Paying for other products of the body, such as sperm, ova, and wombs (as in maternal surrogacy) is accepted and has not created shortages. When someone donates his or her body to science, medical schools and tissue processing companies cover the costs of cremation or the burial costs of the entire donated body after dissection or experimental use.

The NKF also makes the standard argument that compensation for organs "could propel other countries to sanction an unethical and unjust standard of immense proportions, one in which the wealthy readily obtain organs from the poor." But India, Pakistan, China, the Philippines, Colombia, and other countries already harbor flourishing underground markets. Compensating donors in America won't spur more wealthy patients to travel abroad for organs. It's more likely to show other governments how to conduct a safe and transparent system of exchange under the rule of law. In the end, more people will receive transplants in their home country.

In the end, of course, the effect of compensation on organ supply is a question that only pilot projects can answer. This is what the NKF is trying to suppress. And yet the foundation once understood the need to experiment. In 1993, the NKF endorsed payment of burial expenses for deceased organ donors, a plan passed by the Pennsylvania Legislature. The foundation also supported a House bill in 1999 that would have granted a $10,000 life insurance policy to families with benefits payable upon transplantation of the deceased's organs. At the time, the chairman of NKF's Office of Scientific and Public Policy testified, "We would support at least a pilot study on financial incentives."

It is unclear why the NKF has become less tolerant of incentives as the organ shortage grows more critical with time. But whatever the reason, it forcefully obstructed efforts at reform in 2003--the last time Congress debated bold incentives. That year, House legislation called for noncash rewards, specifying life insurance policies or annuities to the families of the deceased, not an unfettered free market. But the NKF denounced the proposal, railing against "global economists who would import a poor person into this country" to sell an organ. The bill died in committee, partly because of the NKF's efforts. On the Senate side in 2003, the NKF used its clout to kill a provision to study incentives. Afterward, the NKF boasted on its Web site that "a successful advocacy effort by NKF resulted in the removal of the provision." Imagine the American Cancer Society bragging about having derailed an experimental project that might help breast cancer patients--especially when other respected groups were in favor of the measure.

I have long been mystified by the NKF's stalwart opposition to pilot studies. I was spurred to write now about my puzzlement by a recent encounter with the long arm of the foundation. At the end of July, I was invited to speak about the case for donor compensation at a regional transplant conference. Three days later, I was disinvited. Apparently, my chagrined host had not vetted the topic with the local NKF chapter, which was co-sponsoring the event. "I regret that I am having to withdraw my invitation," he wrote me. The co-sponsoring NKF affiliate, he continued, "was very much concerned about repercussions from the New York office, which they think would view the talk as a repudiation of the party line." The NKF similarly tried to stifle a debate on organ incentives at the American Enterprise Institute in 2006.

To be fair, the NKF does some good. It holds scores of fundraising charity events. It offers the public free screening for kidney disease and makes research grants to scientists. The NKF vigorously lobbies Medicare for better reimbursement rates for dialysis care, and, for better or worse (as some nephrologists will tell you), the foundation's guidelines for dialysis set the standard of care for the 380,000 U.S. patients who receive that treatment.

Congress listens to the NKF because it is a major force within the transplant community. But the foundation's recalcitrance on financial incentives for organ donors is hurting the very constituency it purports to serve. Last year, 4,000 dialysis patients died because they could not survive the wait for an organ. When Congress returns in the fall, the AMA will begin its push for demonstration projects on incentives. The NKF will have a chance to return to its earlier common-sense philosophy about rewarding organ donors. Unless it grasps the opportunity, the foundation should not call itself a true advocate for kidney patients.

Sally Satel, M.D., is a resident scholar at AEI.

http://www.aei.org/publications/filter.all,pubID.28476/pub_detail.asp

[stauffenberg]

This is a good example of what sociologists call 'institutional capture,' in which an organization established to cure a problem becomes so identified with the continuing existence of that problem that it eventually resists efforts to eradicate it. Thus police departments fear the legalization of marijuana, the Juvenile Diabetes Research Fund has spent a billion dollars of research donations over the last thirty years only on the most useless treatments it could find, and has consistently rejected all promising avenues of research, and now we see that the National Kidney Foundation is following the same pattern, fighting desperately to keep dialysis patients dying on dialysis so that it will forever have a reason to exist.

[KT0930]

Thus police departments fear the legalization of marijuana...so that it will forever have a reason to exist.

WTF??? There are much bigger problems than marijuana or any illegal drug. PD's will forever have reason to exist because there are people in society who do stupid things and need to be removed from society, even if only temporarily.

Now back to the topic - the NKF will also forever have reason to exist because there will forever be people with kidney disease who do not qualify for a transplant for one reason or another. Stauffenberg, I know that you think (or appear to think, anyway) that anyone related to the medical field is completely incompetent and out only for their own gains, but the NKF does do some work on topics other than transplant. So regardless of whether donors get paid or not, the NKF will have a reason to exist. I'm not claiming to understand why they're fighting this so hard, but I really don't think they're in any danger of running out of work to do.

[stauffenberg]

While I certainly agree that there will always be need for a police force, even if cannabis were legalized, the police would certainly face considerable trimming of their budgets, their opportunities for promotion, and their social power if soft drugs, which take up so much of their time, were legalized.  They need things like this not only to serve their material needs for employment, advancement, and authority, but also for a sense of social importance.

The National Kidney Foundation spokesman in the article above justified the death of the 4000 people in the US who died in 2007 waiting for a life-saving transplant on the 'reasoning' that permitting an increase in the number of transplants by offering payment to living donors or the families of cadaver donors would, by some mysterious process the spokesperson did not bother to explain, "cheapen the value of the gift."  If I give a friend a car for Christmas, the gift is not cheapened by the fact that the car can also be purchased; quite the contrary, the fact that I could have gotten money from someone else for the car but chose to give it away to a friend enhances the value of the gift!

So on the basis of indefensible reasoning, the NKF is willing to throw its full weight in the scales in favor of promoting the death of the people it exists to protect!  Before acting so as to increase the death rate of any group of humans, we had better be sure, if we have a shred of morality, that we are 100% certain that the value for which we are slaughtering thousands of people a year is so sacred that it absolutely necessitates these preventable deaths.  Any yet what is the reason the NKF offers?  It "cheapens the gift"?!  If every gift ever made in the history of mankind became utterly worthless by reducing the death rate of dialysis patients by one person a year it would be worth it. 

Talk about institutional capture, this is more like institutional hypnosis!  The NKF has gotten so used to its life-and-death, paternalistic 'ownership' of the patients trapped on its 'dialysis plantation' that it can't even think straight anymore.

[Hemodoc]

No one has a right to demand a kidney from another person.  It is our disease.  It saddens me that you and me and millions of other people have this dreadful disease, but yet it is our disease and not our neighbors or the poor farmer in Pakistan that is trying to feed his family.  Sally Satel offers a very selfish explanation for her views in my opinion.  For those that have received the gift of a renal transplant, good for them.  Yet, they should never, ever forget the sacrifice a person made, a family made, a mother made or a wife, child or husband made in offering that kidney.  I am quite saddened also by those that stand in a tirade and rant about their RIGHT to have others kidneys.  Sorry, but that type of selfishness is not defensible.

Here is my response to the Satel article on Bill's page.

Just my opinion.

http://www.billpeckham.com/from_the_sharp_end_of_the/2008/08/bashing-the-nat.html

[Rerun]

Hemodoc, are you actually on dialysis yet?  From reading your response, I think not.  Dialysis is only as good as you access.  I'm on nocturnal 8 hour dialysis and Sunday night my arterial needle stung the whole 8 hours.  Not fun.  Why live on dialysis when a normal person can live fine on 1 kidney? 

You would let a family starve before parting with your 6 figure income to let them sell you a healthy kidney that they don't need?  Tests and more tests are done before they let a donor be a donor.

The gift of life is wonderful, but the only one not compensated is the donor.  If it is such a great benevolent act why isn't it all free.  The surgeons, the labs the hospital.  XXOO

There is a bigger reason for the NKF for flip flopping on this issue.   We might ask BIG OIL and see if they have an answer.       

[Hemodoc]

Thank you rerun for your response, I think.

The short answer to your question, is yes, I am on hemodialysis for over a year and a half. Not much fun at times, yet not anywhere as bad as most folks portray it as well.  I have been fortunate to date to not have any dialysis related complications and with my exercise program, I am able to still stand upright on "all fours" so to speak.

Now, perhaps you should go back and read my article and you will see that I am not in the least advocating against renal transplantation if that is your choice, I am instead making note that no one has the right to demand a kidney.  It is sad that my two kidneys that I was born with no longer can sustain my life.  Yet, that does not give me any right to demand a kidney from someone else.  Obviously, there are many that have given the gift of a kidney to many others and we must all focus on this simple fact that it is and always will be a gift of great sacrifice and potential risk for the living and a great sacrifice in time of tragedy for those that have died and donated. 

Now, that so called normal person in your response appears to have no adverse consequences by your statement which is not true in the least starting first with a 1/3000 risk of death.  If you wish to have that normal person's healthy kidney, that is fine to wish for such a thing, yet you still have no right to demand that sacrifice.

I stand firm in my support of the NKF and many others who continue to oppose cheapening the gift and turning human organs into a commodity for sale at the right price.  I assume the position that my opposition is a failing opposition since there is a lot of money behind the effort to place payment systems into place.  Just wait a little while and perhaps you will be fortunate to live in a society like China that will not only get you a kidney, but heart, lungs, pancreas and liver if you need them as well from some poor peasant who stole a chicken or pig just to eat or some other egregious capital crime. 

In fact, why not move to Iran or China now?  Well the answer to that rhetorical question is that yes, Iran has "no waiting list" (well they start by excluding most women and anyone over 50) but most Americans would not feel comfortable in the rest of their society.  Likewise, most Americans would not like the rest of the social pleasantries of "red" China as well.  That rerun, is the purpose of my opposition to payment for renal donation in the consequences to society when the ethical standards are lowered no matter for what utilitarian good that people can conjecture will come from it.  We do not live in a glass bubble, there are consequences to isolated choices when expanded to the entire society in general.

For instance redefining death for the benefit of more renal and heart and liver donations in the isolated realm of cadaveric donations might be generalized into much darker sentiments for those that define death as the loss of upper thought processes and apply that same definition to demented people, brain damaged people or even mentally ill people.

There are consequences to our actions.

So, if you wish, then move to Iran and get your kidney now real cheap.  And then stay and live there for long as you want and enjoy your new kidney.

I will on the other hand thank my wife, my daughter, my in laws in the Philippines for offering me a kidney and instead do the best I can with the opportunity to start daily dialysis as soon as I can.  It is my choice, and I choose not to place the burden of my disease on another person with no health problems.  It is my disease after all, not theirs.

Just my own opinion.

[Rerun]

Hemodoc, I agree 100% that you should not and cannot demand someone else to give you a kidney.  That position is a long way from buying an organ for a "fair" amount of money.  You cannot demand a Honda dealer to give you an Accord, but you can buy one and everyone walks away happy.  Although, with organ donation there is no 7 year 12,000 mile warrenty!     I feel the same as you and would never let any of my friends donate a healthy kidney to me.  My family has not offered probably because they have heard me say I would never take a live kidney.  Someone who has the unexpected loss of life and their family has given their loved ones organs for donation is a different story.  Even then, as I have accepted this gift, it is very hard to accept.  In our society, we have a hard time accepting "gifts".  Does your wife get extra gifts at Christmas just in case someone shows up at the door with a gift for your family?  Then she can say "Oh, my here is a gift for you too"......  Yeah, I do it too.  I felt so beholden to that family it made me sick to my stomach and I had to work through it.  After I met the family I left them money in my will.  I've now changed that since my kidney failed. (See how we Americans are).  Buying a kidney would be the only organ that would be for sale obviously.  We are not China, or we would have our children working 14 hour days. As it is here you can't get a kid to work 1 hour. America would put more restrictions than Sandoz has pills on purchase of organs. That is like people saying that same sex marriage will lead to sex with animals.  So ridiculous!  What buying of KIDNEYS would bring is relief from the current transplant list.  Those that could afford it would get off the list so the POOR in America would move up on the list.  There is NO way that the black market would bring over poor Filipinos and take their kidney because the Transplant evaluation team would not let that happen. They barely approve good Samaritan donors until the donor cries and pleads with them.  It would also relieve the recipient of the guilt for someone dying so they could live.  I can't even express how bad that made me feel.  I thought about that poor person and his family for years!  I would rather pay my money and go on with my life.  Right now if someone who can't have children goes and pays $10,000 for invetro fertilization and it doesn't work.... they know there is no going back for a second try.  You get one shot and then you pay again and start over.  Seem unfair?  That is already understood and accepted before they even try.  So, it again would be a written agreement for organ donation.  Believe me, and I've thought this over for 20 years, payment for organs in the United States would be a big relief for everyone.  Think of the young Law Student or Pharmacy student (both of my nieces) who are in debt to the Universities in this country hundreds of thousands of dollars... if they could sell a kidney and pay off their debt and finally get on with their lives as well as the recipient.
How wonderful is that for both? 

Another thing you should realize Hemodoc is that it already happens in the Unites States.  People are paying for organs very discretely.  I know if I had a good Samaritan approach me and want to give me a kidney They would end up with a Honda Accord in their yard!   A green one!

I don't want another transplant because of the loss I felt when I lost mine.  I lost my life support for freedom, I lost my best friend, my job and my way of life and my 5 figure income.  The biggest problem with buying organs is what is going to be considered a "fair" price.  To me it would be what I could afford.... a new Honda Accord.  But, that would be the big question.  This is not China sir, this is the United States and we already have standards set in place.  I wish you the very best with daily dialysis.  I know nocturnal made a huge difference for me.  I just wish my access was better.  I refuse to get another access placed in my leg, so my days are very numbered.  I wish I had the opportunity to buy a kidney, but in this country I don't.

[Hemodoc]

Dear Rerun,

I am sorry to hear of your difficulties with your access.  You are correct that is the biggest issue with dialysis.  I understand that there are some surgeons doing remarkable grafts and fistulas with thoracic and abdominal arteries and veins.  I don't know if you have discussed that with your surgeons, but yes, avoiding access in the legs is something that I can sympathize with you that it is not the best.

I hope that you are able to obtain the kidney you need soon.  I just don't believe that we should go to system of paying for kidneys.  Unfortunately, even a system of paying for organs would not likely meet the demand for kidneys and in such a situation, with high demand and low supply, most patients in need of a kidney would not be able afford it anyway. 

My thoughts and prayers are with you and I truly hope that your days are not really as short as you believe they may be.  There are no quick and easy answers for our disease. Fortunately, we have more options than many other patients with other forms of organ failure.  Life is precious indeed.

May God bless,

Peter

[okarol]

Patients fees for kidneys would be standardized and paid by the insurance or Medicare.

Rerun has said she does not want another kidney transplant.

[Rerun]

No, I really don't want another transplant because losing one after you build your life up is too damn hard.  But the other reason is the guilt of getting THE GIFT.  If someone would like a new Green HONDA ACCORD give me a call.  Of course the license plate would have to say
"PD4WTHKDNY".   Probably too many letters.

Just kidding!

Peter, I hope we can agree to disagree.  I'll hang in there or die trying!   

[lola]

No, I really don't want another transplant because losing one after you build your life up is too damn hard.  But the other reason is the guilt of getting THE GIFT.  If someone would like a new Green HONDA ACCORD give me a call.  Of course the license plate would have to say
"PD4WTHKDNY".   Probably too many letters.

Just kidding!

Peter, I hope we can agree to disagree.  I'll hang in there or die trying!   

with a green bow too

[stauffenberg]

Within two years of initiating its financial payment plan for live kidney donors in Iran in 1997, the waiting list for kidney transplants was reduced to zero.  So much for the false argument that there will never be enough kidneys generated by organ purchase to meet the need.

As for no one owing a kidney to dialysis patients nearing the maximum limit of their vastly foreshortened life span on dialysis, what one person 'owes' another is a highly artificial social construct of where the margins of public responsibility begin and where the limits of private selfishness end.  I would have thought a Christian would be in favor the assumptions of the legal structure underpining the social concept of rights and duties promoting more individual social responsibility and less personal selfishness when it comes to using a spare organ to save someone's life, but then again, Christians never cease to surprise me by the ways they interpret their own supposedly authoritative texts.

Suppose America had been invaded by the Nazis in World War II, and the invaders announced that while they did not intend to harm the general population, they intended to kill all the Jews they captured.  This is essentially what the Nazis actually attempted to do in Denmark, where the general population was treated well for not having put up armed resistance to the German invasion, but efforts were made to collect the Jewish population for execution in the death camps.  Now suppose your country announced that it was drafting people into the army to resist the invasion, compelling people under threat of severe criminal sanction to undergo a risk of serious bodily injury or death infinitely higher than that faced by the donor of a kidney, all for the sake of rescuing the small minority (2%) of Jews in the population.  Would you oppose the draft on the reasoning that "no one has a right to demand injury to the body or perhaps even the death of another person just to save his own life," which is exactly your reasoning in asserting that no one has the right to demand a kidney from another person to save his own life?  Why does your reasoning sound utterly selfish, terribly racist, and profoundly unchristian in the example of refusing to save the Jewish minority by accepting the corporeal risks of a military draft, but roll so comfortably off your tongue when you argue for exactly this same selfishness with respect to organ distribution, even if it has lethal consequences for the oppressed minority of renal patients?

[Joe Paul]

Within two years of initiating its financial payment plan for live kidney donors in Iran in 1997, the waiting list for kidney transplants was reduced to zero.  So much for the false argument that there will never be enough kidneys generated by organ purchase to meet the need.

As for no one owing a kidney to dialysis patients nearing the maximum limit of their vastly foreshortened life span on dialysis, what one person 'owes' another is a highly artificial social construct of where the margins of public responsibility begin and where the limits of private selfishness end.  I would have thought a Christian would be in favor the assumptions of the legal structure underpining the social concept of rights and duties promoting more individual social responsibility and less personal selfishness when it comes to using a spare organ to save someone's life, but then again, Christians never cease to surprise me by the ways they interpret their own supposedly authoritative texts.

Suppose America had been invaded by the Nazis in World War II, and the invaders announced that while they did not intend to harm the general population, they intended to kill all the Jews they captured.  This is essentially what the Nazis actually attempted to do in Denmark, where the general population was treated well for not having put up armed resistance to the German invasion, but efforts were made to collect the Jewish population for execution in the death camps.  Now suppose your country announced that it was drafting people into the army to resist the invasion, compelling people under threat of severe criminal sanction to undergo a risk of serious bodily injury or death infinitely higher than that faced by the donor of a kidney, all for the sake of rescuing the small minority (2%) of Jews in the population.  Would you oppose the draft on the reasoning that "no one has a right to demand injury to the body or perhaps even the death of another person just to save his own life," which is exactly your reasoning in asserting that no one has the right to demand a kidney from another person to save his own life?  Why does your reasoning sound utterly selfish, terribly racist, and profoundly unchristian in the example of refusing to save the Jewish minority by accepting the corporeal risks of a military draft, but roll so comfortably off your tongue when you argue for exactly this same selfishness with respect to organ distribution, even if it has lethal consequences for the oppressed minority of renal patients?

With what all you just said, what were you trying to say?

[Rerun]

The fact of the matter is no one is demanding anyone to give anyone a kidney.  We are trying to buy them for a fair price.  Like any other commodity.  Transplants do increase the quality of life for the recipient 95% of the time unless God forbid something goes wrong. 

I can't force my brother to give me a kidney.  I would not let him give me one because I'd owe him for 'freaking' ever!  I could hear it now..."after all I did give you a kidney the least you could is wash my car 'for life').  But, I would BUY his kidney.  Now we are talking fair and square.  He takes a very slight medical chance for $37,000.  (the price of a green Honda Accord with navigation system)

I'm a Christian and there is nothing in the Bible that says you cannot buy or sell organs.  God gave his Son for all our sins.  Don't you think Jesus would have just as soon given a kidney?   
                                                                 

[okarol]

WWJD = What would Jesus Donate?

[Chris]

Hmmm, gonna have to think of a reply when I read it again

[flip]

I think I'll pass on this one.

[Hemodoc]

Actually, Jesus gave his all for all of us which is the basis of the longstanding ethical altruistic renal donation that is now in place.  Jesus did not lay his burdens upon another man, but instead took up his own cross, bearing the sins of many upon his back and gave freely that we might be saved freely.  Altruistic giving is at the heart of the gospel as a free gift to those that will receive it.  He carried the cost himself.  When is a gift not a gift?

The Bible further goes on to tell us that we are to bare our own burdens as well as the burdens of others.  In complete contradistinction to the false portrayal by Stauffenberg, altruistic giving is the model from the Christian faith.  In addition, the burden of our disease is ours to bare as well, yet when another man or woman is burdened with our burdens and gives a gift, that is following in the steps of Christ's example.  There is no contradiction whatsoever to the gospel of Christ and the altruistic donation out of love for a fellow man burdened by disease.  This has been and will be the most powerful motivator of good in this and other societies.

Just my opinion.

[Chris]

I think I'll pass on this one.

I'm taking flips lead, passing on this one too.

[circleNthedrain]

I'll be sitting over here with flip and Chris.

[Zach]

Actually, Jesus gave his all for all of us which is the basis of the longstanding ethical altruistic renal donation that is now in place.  Jesus did not lay his burdens upon another man, but instead took up his own cross, bearing the sins of many upon his back and gave freely that we might be saved freely.  Altruistic giving is at the heart of the gospel as a free gift to those that will receive it.  He carried the cost himself.  When is a gift not a gift?

The Bible further goes on to tell us that we are to bare our own burdens as well as the burdens of others.  In complete contradistinction to the false portrayal by Stauffenberg, altruistic giving is the model from the Christian faith.  In addition, the burden of our disease is ours to bare as well, yet when another man or woman is burdened with our burdens and gives a gift, that is following in the steps of Christ's example.  There is no contradiction whatsoever to the gospel of Christ and the altruistic donation out of love for a fellow man burdened by disease.  This has been and will be the most powerful motivator of good in this and other societies.

Just my opinion.

Amen.

[mikey07840]

Mikey and Queen Ruth will sit on the side with Circle, Flip and Chris.

[Joe Paul]

People back then didn't need kidney machines or transplants, Jesus laid hands on them and healed them, some were healed by faith alone.

[Rerun]

Actually, Jesus gave his all for all of us which is the basis of the longstanding ethical altruistic renal donation that is now in place.  Jesus did not lay his burdens upon another man, but instead took up his own cross, bearing the sins of many upon his back and gave freely that we might be saved freely.  Altruistic giving is at the heart of the gospel as a free gift to those that will receive it.  He carried the cost himself.  When is a gift not a gift?

The Bible further goes on to tell us that we are to bare our own burdens as well as the burdens of others.  In complete contradistinction to the false portrayal by Stauffenberg, altruistic giving is the model from the Christian faith.  In addition, the burden of our disease is ours to bare as well, yet when another man or woman is burdened with our burdens and gives a gift, that is following in the steps of Christ's example.  There is no contradiction whatsoever to the gospel of Christ and the altruistic donation out of love for a fellow man burdened by disease.  This has been and will be the most powerful motivator of good in this and other societies.

Just my opinion.

I would agree except no one else participating in the transplant process is into giving.  They are into taking!  They charge an "ungodly" amount for what they do for such a benevolent process.  Greed cannot be in the same boat.  So, let's all get on the same page and get what we can for that kidney.  Fair is fair.

Zach?