I was as upset as anyone by the allegations of organ selling that are associated with a New Jersey corruption scandal resulting in more than 40 arrests last week. But a Wall Street Journal column this week calling for more incentives for folks to donate organs makes the issue seem more complex than at first blush. "More than 80,000 Americans now wait for a kidney . . . thirteen of them die daily; the rest languish for years on dialysis," writes Sally Satel. She says she would have gladly considered paying an organ broker to get a kidney several years back when she needed one and there was no donor. That is, if it hadn't been illegal. (She eventually received a kidney from a friend.)
While most of us find it revolting to pay for an organ, we readily accept allowing women to sell their eggs to an infertile couple. In fact, just a few weeks ago, New York State became the first in the nation to allow federally funded researchers to pay women for their eggs for embryonic stem cell research. While men typically donate their sperm free of charge, women expect to get paid for their eggs because of the hassle and risk of injecting themselves with hormones to ripen multiple eggs at once and of having those eggs surgically extracted. The reality is, few donors would go through that if there were no financial incentive. While it's not illegal for women in the United States to get payments for egg donations (it is in Europe), the American Society for Reproductive Medicine has established ethical guidelines for egg donor compensation—a cap of $10,000 per cycle—which most fertility clinics follow.
So taking this one step further, why shouldn't willing donors be allowed to charge reasonable rates for their organs?
"I'm on the fence, I have to say. I'm really torn about this," says Jonathan Moreno, a professor of bioethics at the University of Pennsylvania. "People are understandably uncomfortable and uncertain about selling kidneys, but there really is a shortage." He says if there were a nonexploitative way of doing this, he'd like to see it tried within the framework of a research study. (Most shocking were allegations that poor donors were forced to give up their kidneys for $10,000, while the middlemen received $150,000.)
Trouble is, Moreno admits, it's hard to say whether setting up an ethical and legal system reduces exploitation or increases it. He still sees advertisements at Penn offering students $40,000 for their Ivy League eggs and notes that the legalization of prostitution in Amsterdam's red-light district has led to a spike in criminal activity like money laundering just outside the district. Donating a kidney is also a riskier procedure than egg donation because it involves more-invasive surgery and long-term risks of having a malfunction in the one remaining kidney.
But some, like Satel, argue that living kidney donors need to be given more incentives. She favors a bill being put forth by Democratic Sen. Arlen Specter of Pennsylvania that would enable state governments to provide donor benefits while also raising penalties for brokering. Donors could get health and life insurance, tax credits, or a generous contribution to the charity of their choice. I've written before about those who altruistically donate their kidneys to strangers, but those folks are, unfortunately, few and far between.