David Michael Miller
My wife’s aunt is suffering from end-stage renal disease. On Oct. 18, I will give her one of my kidneys, in hopes of making her better.
The doctors say I’ll be unable to work for a few weeks while I recover from surgery. Fortuitously, the U.S. Department of Labor recently ruled that organ donors like me are entitled to job-protected time off under the Family and Medical Leave Act.
Perhaps the agency’s ruling will encourage donations, and thereby mitigate the severe shortage of kidneys available for transplant. Of the 100,000 Americans who are waiting for a new kidney at any given time, 10 to 20 die each day for want of one.
If government really wanted to help, these grim statistics could be zeroed out almost completely. All it would need do is repeal the laws that prevent kidney donors from being financially rewarded.
The thought of commodifying human organs is, I concede, viscerally repugnant. It raises the specter of financially desperate people literally selling a piece of themselves. But the potential benefits of rewarding donors far outweigh the legitimate concerns. Cost/benefit analyses, not our collective viscera, should guide our decisions on life-or-death policy questions.
A few generous acquaintances have called my willingness to donate “noble,” or something equally laudatory. My ego would happily accept that kind of credit. But donating a kidney is not the risky sacrifice many people think.
According to the most dire estimates, about one in every 3,000 donors dies during surgery, or within 90 days thereafter. And studies agree that the risks to long-term health are negligible. Many jobs we don’t consider particularly hazardous, like being a trash collector, are actually more dangerous than donating a kidney. We wouldn’t stop a person who needs money from becoming a trash collector.
Paid donors would have to pass the same rigorous physical and mental competency tests that I did. The tests, and the many rounds of lab and committee analysis that follow, provide a built-in ‘cooling off’ period of several weeks, if not months.
The precise mechanism by which we compensate donors is of secondary importance, as long as the rewards are sufficient to eliminate the organ shortage. Iran, the only country that currently allows compensation, has a largely market-based system for allocating kidneys from living donors. (Iranians who cannot afford a live kidney receive, at no charge, a kidney from a deceased individual whose family is rewarded post-mortem.) Dr. Sally Satel of Yale University suggests that the U.S. launch a modest pilot program, wherein the government offers indirect rewards, like income tax credits or tuition vouchers. Iran’s experience and speculative market analysis suggest that, in America, incentives would have to be worth somewhere in the mid-five figures.
Though some insist that any kind of payment system would be a vehicle of exploitation, financially desperate people are, by definition, out of good options. For some, donation would be a godsend. It’s actually kind of crummy to close people off from what they perceive to be their least-bad option.
To be sure, some paid donors would come to regret their choice. But regret is a possible outcome of every choice we make. For the most part, people make good decisions for themselves. If they believe that selling a kidney will, on balance, boost their quality of life, they’re probably right.
When it comes to our public finances, the more transplants we can do the better. Through Medicare, almost 1 percent of the U.S. federal budget goes to pay for dialysis sessions, which keep patients alive while they wait for a new kidney. The sessions are time-consuming and extremely fatiguing. As such, many patients draw Social Security Disability benefits instead of working. All told, the average kidney transplant pays for itself in about two years.
Dr. Satel lays out the case for compensating donors succinctly: “If we keep thinking of organs solely as gifts, there will never be enough of them. Deaths will mount, needless suffering will continue, and the global black market in organs will continue to flourish.”
At some point down the line, artificial kidneys will render dialysis and transplants obsolete. The desperation of 100,000 kidney patients will be but a tragic chapter in the annals of medicine. Until then, we should get our story straight: Is organ donation a scourge from which people need special protection? Or is it — as everyone I know has been assuring me — a wonderful, even life-affirming undertaking?
Obviously, I hope and expect it’s the latter. I suppose I’ll know soon enough.
Michael Cummins is a Madison-based business analyst.