Letting people make a buck for donating their kidneys might sound like a dystopian nightmare—but it could actually be a kidney disease sufferer’s dream come true.
Don’t put up a Craigslist ad quite yet—thanks to a 1984 law, it’s illegal to sell your organs (bummer, I know). But some activists and legislators—as well as conservative free-market devotees—say you should be able to get financial benefits of some sort if you decide to give away a kidney.
Given the staggering number of people on the waiting list for kidney transplants—and the fact that nearly two dozen people die every day because they can’t get a healthy kidney—more and more voices are emerging in support of allowing financial benefits for people who opt donate.
It’s a controversial position, given the horrors of black market human organ sales. But think tank scholars, activist leaders, and congressmen are pushing their colleagues to be more open to the idea of letting kidney donors walk away with more than just virtue-as-its-own-reward good feelings. People who take the medical risk of donating a kidney should be rewarded, advocates of policy change say. It’s a matter of body autonomy—and, more important, of life and death.
Derek Khanna, a conservative attorney and former Republican staffer, describes the situation in urgent terms.
“The result of this Congressional inaction is, I believe, one of the leading preventable causes of death in the United States,” he wrote in a Medium post last year pitching a variety of ways to incentivize organ donation.
The National Kidney Foundation estimates that 13 Americans die every day while waiting for life-saving kidney transplants, and that 3,000 new people join the waitlist every month. So even though making the case for anything that sounds even remotely like organ sales is incredibly politically difficult, activists and legislators are giving it a shot.
Later this month, Rep. Matt Cartwright, a Pennsylvania Democrat, plans to introduce legislation to allow for the creation of a five-year, government-run pilot program, monitored by an ethics control board, to test the effectiveness of offering non-cash rewards to kidney donors.
Those rewards could include health insurance, tax credits, contributions to the donor’s favorite charity, or even tuition reimbursement, according to sources familiar with the legislation. Cartwright’s office is gathering congressional co-sponsors and courting organ-donation advocacy groups for their support.
Rep. Lacy Clay, a Missouri Democrat and a co-chair of the Congressional Organ and Tissue Donation Awareness Caucus, said he would probably support the legislation.
“We do want to increase the possibility of people getting organ and tissue donations,” he said. “And so if you can incentivize it in that way, I would not be averse to that.”
An activist who works in the tissue-donation community, (and who asked to remain anonymous to discuss the issue candidly) said he suspected Cartwright’s idea would have widespread support among those trying to increase access to kidney transplants. But, he added, anyone who suggests kidney donors should receive financial benefits stands to face noisy condemnation from groups like the National Kidney Foundation. So unless legislation like Cartwright’s seems genuinely politically viable, they’re likely to keep mum.
The National Kidney Foundation didn’t provide comment on this specific legislation, but it wholeheartedly opposes any financial benefits for organ donors.
“Any attempt to assign a monetary value to the human body, or body parts, either arbitrarily, or through market forces, diminishes human dignity,” the foundation’s site says. “By treating the body as property, in the hope of increasing organ supply, we risk devaluating the very human life we seek to save.”
Despite the foundation’s likely opposition, Cartwright will find plenty of powerful boosters.
Grover Norquist, the head of Americans for Tax Reform, said he supports the plan for philosophical and humanitarian reasons.
“It’s an individual liberty question, not just economic,” he said. “You get to choose to do what you want with yourself and your body.
“I understand the ick factor,” he continued. “But if you can walk through it and have people look at it, the size of the problem you’re solving is substantial, dollar-wise. The human suffering that you’re alleviating is substantial, and why, if somebody’s willing to make this sacrifice for somebody else, would you not want to make it possible for them to get compensated for it? I don’t get it.”
It’s not just a philosophical question; end stage renal disease patients make up just 1 percent of the Medicare population, according to a 2013 report from the U.S. Renal Data System, but account for a whopping 7 percent of Medicare spending. The U.S. spent more than $40 billion every year on kidney dialysis. And people with this disease face significant suffering; dialysis is painful and immensely time-consuming.
So proponents of Cartwright’s approach argue that there’s nothing morally troubling with rewarding people who risk their own health to donate a kidney. They add that any censure should be directed at groups that make it harder for sick people who need new kidneys to get them. Sally Satel, a scholar at the conservative American Enterprise Institute, received a kidney donation and is a strong proponent of allowing financial rewards for donors.
“You could argue it’s an exploitation not to pay people at all,” she said. “Financial and humanitarian motives are intertwined all the time; why should this opportunity be any different? Why should it exist in a hermetically sealed bubble where none of the usual rules of human engagement apply?”