By David H. Nguyen, Ph.D.
Economists Gary S. Becker and Julio J. Elias propose in the Wall Street Journal that they have calculated a system of legal payments for kidney donations that would cut costs and reduce shortages in America.
The authors propose a system in which making it legal to pay someone for one of their kidneys is economically feasible on a national scale, while dramatically cutting down the time patients would need to wait for a matching donor. At face value, the proposal sounds good. However, as someone who studies the plight of the most vulnernable and exploitable, I must say that such a system would need to be accompanied by highly stringent informed consent safeguards — probably more stringent than the informed consent envisioned by the authors. Hypothetical scenarios that are formulated in a “vacuum” where all things are equal often grossly underestimate the ingenuity of the underground business world. Organized criminal activity has an uncanny ability to coerce or exploit the most vulnerable in societies — much like organized criminal activity that exploits business ethics on Wall Street.
The authors state that “the sale of organs would make them more availble to the poor, and Medicaid could help pay for the added costs of transplant surgery.” This statement serves to suggest that a system of legal payment for kidney donations would benefit not just the rich, but the poor. While there is merit to this statement, it is worth noting that the authors’ definition of “poor” involves the word Medicaid. This qualifier excludes the vast majority of poor people in the world, the very people who would be exploited by illegal organ traders. And, in light of the authors’ statement that “today, the rich often don’t wait as long as others for organs since some of them go to countries such as India, where they can arrange for transplants in the underground medical sector,” I see evidence of the very concern I am here presenting.
The authors’ proposal is very noble and I think that it is worth considering. They are conscientious about weighing costs in a situation that presents multiple moral dilemmas. However, as with any market where there is already evidence that the most vulnerable are exploited, we must proceed with caution.
David H. Nguyen, Ph.D., is Editor-in-Chief of Cancer InCytes magazine. He is also a tumor biologist who dabbles in human rights issues from the biomedical science perspective.
Gary S. Becker and Julio J. Elias. “Cash for Kidneys: The Case for a Market for Organs.” Wall Street Journal, January 18, 2014. Accessed January 18, 2014.