ARTS & FARCES internet

In 1983, a Virginia doctor proposed buying kidneys from the indigent and selling them to those who could afford them. Al Gore (then a representative from Tennessee) introduced legislation to ban the sale of organs. Gore’s bill became law in 1984, the National Organ Transplant Act of 1984, which allows “reasonable payments associated with the removal, transportation, implantation, processing, preservation, quality control, and storage of a human organ.” Currently, several states offer a tax deduction of up to US$10,000 for expenses associated with donating an organ.

Now comes another doctor, Arthur Matas—a transplant surgeon from the University of Minnesota—with a plan disturbingly similar to the one proposed in 1983. Matas wants to see a regulated kidney market and “doesn’t rule out financial incentives for the families of deceased donors,” according to Laura Meckler’s report in today’s Wall Street Journal.

Francis Delmonico, a Harvard transplant surgeon who vigorously opposes his friend Matas, has helped determine a national transplant policy in the US. Until last June was the president of the United Network for Organ Sharing (UNOS). His greatest fear is that with an organ market, “altruistic donations might wither away,” according to Meckler. “Payments eventually result in the exploitation of the individual. It’s the poor person who sells.” [....]

At the January meeting of the American Society of Transplant Surgeons, the two doctors presented their opposing views. The audience was asked to vote with a show of hands, and Meckler reports the majority of assembled transplant surgeons supported “a trial to determine the viability of a US organ market.” Some medical ethicists, including Arthur Caplan, agree.

Matas’s plan calls for the government to set a price for kidneys, for which the recipient’s insurance would pay. Organs would go to the first person on the waiting list.

“It’s a concept that takes a little while to sink in,” Mattas tells Meckler. “When you first hear about it, it doesn’t sound right. It doesn’t sound right because it’s wrong—morally, ethically, in every way possible—simply wrong. This is evidenced by Mattas approach to putting economics before ethics. Meckler writes, “his [Matas] first step was to ask whether kidney sales would be financially viable. if not, he felt, the ethics were irrelevant.”

In Iran, the only country with a legitimate market for organs, sellers are often exploited. “Much of the fees go to unscrupulous brokers, for instance, and there is little screening to ensure donors are healthy enough to withstand surgery,” according to Meckler.