Opinion: Why selling kidneys still won't work

If the price was right, would you sell your kidney to someone who desperately needs a transplant? A new article by Canadian researchers argues that payment could increase the scarce supply of kidneys available for those in need. I am not convinced.

In the study published in the Clinical Journal of the American Society of Nephrology, the authors suggest that if the government paid a flat fee of $10,000, many people who say they would not be living organ donors might be willing to become organ sellers for that price.

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They think that it is not unreasonable to change the law to permit kidney sales because even a 5 percent increase in donor organs would have a real impact on lives saved, the quality of life for those now on kidney dialysis machines, and overall savings as more people switch from costly dialysis to less-costly kidney transplantation.

A previous poll by the researchers found that more than half of those who weren’t willing to donate might change their minds for $10,000. Americans seem less moved by money, but there is some interest. A 2012 poll found that more than 40 percent were willing to consider selling an organ for the right price.

So why not give payment a try? There are plenty of people dying and suffering from kidney failure. Shouldn’t we do what is necessary to try and get them the kidneys they need? Yes, but markets — even regulated markets with fixed payments — are no guarantee that more kidneys will become available or that harm will not be done to the rest of the organ transplant system.

Also, several religions — including Catholicism, many conservative Protestant sects and others — strongly oppose any form of organ sales. Their theology says that you do not own your body, it is a gift from God, so it is not something you can choose to sell. Pope Benedict, the last Pope to speak on the subject, said that buying and selling of organs is morally unacceptable.

Why is that an issue? If those with religious objections don't want to sell kidneys, why should that stop others from getting that chance? The reason is very simple. If the members of major religious groups stop donating organs because they see markets as immoral, then there is a very real risk that fewer kidneys and other organs will be available. Trying to eke out a 5 percent increase in donations by allowing payment of thousands of dollars is a very real gamble given the strong, long-standing opposition among large numbers of people for religious reasons.

Nor is it clear that $10,000 would really be enough to prompt many people to have a kidney removed. Kidney surgery is still major surgery, living with one kidney is a bit risky and there is a very real danger of various complications. While they won’t kill you, the problems could keep you in the hospital for days or weeks.

There is also the problem that markets only work for kidneys. We have two kidneys, which is one more than most people need. But markets won’t help obtain more hearts or livers or lungs. That means running one part of the transplant system with payments and the other based on altruism. Those involved with kidney transplants want to give markets a try. Those doing heart transplants don’t — they worry that a market will dry up the altruism they must rely on to get those organs.

Lastly, putting $10,000 on the table to get people to sell a kidney should not happen unless and until there are national standards for who can safely decide to sell one. The sicker you are or the more mentally unstable you are, the harder it should be to let you sell your kidney. But there are no agreed-upon criteria about either minimal health or mental competency to sort out those moved only by money to sell.

The idea of trying markets to increase the supply of kidneys is the whack-a-mole of transplant policy. Every other year someone does a study, tosses out a model or just proclaims that a market will solve the kidney shortage problem. But there is more than money involved when it comes to body parts, and until proponents of payment can engage those concerns, it is not likely that we will see a shift from academic talk to political action.

Art Caplan, Ph.D, is the director of the Division of Medical Ethics at New York University Langone Medical Center and a frequent contributor to NBC News.