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Kidneys for sale

| Wednesday, June 28, 2006

When I was in law school in the early 1990s I suggested to a classmate that government should not prevent kidney donors from bargaining for and being paid market prices for their donated kidneys. Her initial reply was a look of horror. When finally she composed herself in the wake of this gruesome revelation, she said "But, but, but ... poor people will be exploited!"

"How?" I asked.

"How?! How do you think• They'll sell their kidneys to rich people. When they can't pay the rent or the car note, they'll sell their kidneys. The poor will become kidney farms for the rich."

I learned that my classmate's fears are not uniquely hers.

But these fears are baseless and an insult to poor people. People such as my law-school classmate presume that someone with only a modest income is so short-sighted that he'd prefer to sell his kidney in exchange for a few car or rental payments rather than to economize elsewhere or to drive a less-expensive car or live in a less-expensive apartment.

Perhaps some Americans are so poor that they have no ways to economize further. Maybe this (very small) group of people are the ones my classmate worries about. If so, her concerns remain insulting and dangerous. If someone is so poor that he judges selling his kidney to be worth the money it will bring to meet current expenses, we must still presume that he is the best judge of his welfare.

The problem in this case -- and it is a genuinely serious problem -- is this person's desperate poverty. Selling his kidney is a way to help him relieve the consequences of that poverty. How does denying him this opportunity for some extra income help him?

At this stage of the argument, opponents of kidney sales often sneak in the assumption that selling a kidney seriously imperils the seller's life. If the seller's life is not seriously imperiled, then it's difficult to mount an argument against letting people sell kidneys.

But most people can live normal, healthy and long lives with just one kidney -- which is why the number of kidney transplants likely will jump significantly if kidney sales are no longer outlawed. And keep in mind that by eliminating the kidney shortage, the risk of suffering lasting kidney problems will fall, thereby making donating a kidney even less dangerous than it already is.

Today, a kidney donor who turns out to need a kidney transplant in the future must endure the uncertainty and length of a long waiting period. But if kidney sales are legalized, any kidney donor needing his own kidney transplant down the road will be likely to get a healthy kidney in short order.

Nevertheless, I do not deny that most kidney sellers would be people whose incomes fall on the lower part of the American scale. Would this fact be evidence of exploitation• No -- not any more than is the fact that most supermarket cashiers, house painters, and used-car salesmen are people whose incomes fall on the lower part of the American scale.

Would we make these workers better off if we announced that they are free to give away their labor at such jobs but cannot receive payment for it?

Seems to me that the real exploitation is to demand that kidney donors not receive payment for donating their valuable bodily organs.

A related argument against legalized kidney sales is that people should not profit from other people's serious illnesses. But physicians, nurses and pharmaceutical companies, along with many other folks and firms, routinely profit from other people's illnesses. Would we improve our world by prohibiting doctors, nurses and pharmaceutical companies from ever being paid• Of course not.

It's time that practical concern for the very real lives of very real people replaces a lethal commitment to wooly aesthetic and philosophical notions.

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