Kidney Shortage for Transplantation

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As of this morning almost 102,000 Americans were waiting for a kidney. If that number doesn’t strike you, then consider that this number is 1/3 of the total number of kidneys ever transplanted in the United States.

Only 15,000 of these 100,000 potential recipients are expected to receive a kidney before the end of the year, which means that 85,000 will still be waiting for surgery come the new year.

The unmet demand for kidney transplants grows while the number of donors plateaus. Some commentators have suggested that permitting organ sales would solve this crisis. in fact, the Wall Street Journal published an article in support of an organ market in January of 2014. The authors emphasized,

Any claim about the supposed immorality of organ sales should be weighed against the morality of preventing thousands of deaths each year and improving the quality of life of those waiting for organs.

The conversation also simmers at the local level. At SUNY Downstate‘s 2nd Annual Transplantation Symposium “Controversies in Kidney Transplantation”, Dr. Eli Friedman (pro) and Dr. Lainie Ross(against) debated the possibility of opening a market for kidney sales in the United States.

Like the writers at the WSJ, Dr. Friedman took a moral relativistic stance. We’ve already allowed selling our bodies (eggs, sperm, bone marrow, sex) so why not add kidneys to the list? His “Trial Plan” consists of 5 components:

  1. Remove Legal Strictures
  2. Set Price ($25,000/deceased)
  3. Retain UNOS and Supervision
  4. Live Donor Payment ($50,000)
  5. Evaluate at 1 and 2 years

Dr. Ross was appalled that patients could be reduced to their parts for financial gain. She denied that markets are merely efficient means to distribute goods because the poor will be coerced to sell their newly commoditized organs, corrupting the value of a kidney. In our egalitarian society, there is no room for a kidney market, she says.

Her most compelling argument was that organ donors/vendors are currently lost to follow-up and suffer negative economic, psychological, and medical consequences. Physicians take on donors and vendors as their patients by virtue of harvesting their organs. Thus, physicians have the obligation to act in accord with the ethical principles of beneficence and non-malficence. Given the current standard of donor/vendor post-op care as indicated by Dr. Ross’s literature review, it would be immoral for physicians to support organ sales.

But what if we could improve the economic, psychological, and medical outlook for the sellers? If there was no reason to believe that kidney sellers were at a concrete disadvantage compared to kidney donors, then could we really argue against the market?

Perhaps a two-pronged approach of fostering a culture of organ donation and allowing kidney sales with guaranteed economic, psychological, and medical support could close the gap between the number of patients transplanted and those who are still waiting. That is until, technology catches up, and patient’s are transplanted with organs grown from their own cells.