Almost three years ago a doctor told me my kidneys had failed. Like Laura Johnson in Nicholas Kristof’s New York Times editorial today, I’m hooked to a dialysis machine a couple times a week. Have been for almost three years. Like Laura Johnson’s experience, patients die at the dialysis center I use too. This year we’re averaging about one per month. Since there’s only 16 dialysis chairs in my center, the odds are officially Not Good. But unlike Mrs. Johnson, five years from now I’ll still be waiting for a kidney because of my slightly odd blood type. Still waiting that is, unless I remove my name from the transplant list.
Kristof’s editorial calls for the sale of organs on the open market, noting that 17 people die every day waiting for a transplant because of a 1984 Congressional ban on selling organs. Kristof goes on to argue that policy is responsible for 6,000 American deaths each year and that “by the time the policy is overturned—as it will be—it’ll have killed more Americans than the entire Vietnam War.”
Kristof’s argument is as misguided as it is misinformed. The 2 October 2002 issue of the Journal of the American Medical Association (JAMA) includes a report concerning the consequences of selling kidneys in India. Even though it’s illegal to sell organs in that country, it’s widely accepted and practiced. The JAMA report indicates that the average price paid for a kidney was about US$1,000. Impoverished Indian citizens who sold a kidney—and it was, of course, only impoverished Indian citizens who sold a kidney—remained poor years after the sale. Most of the Indian kidney doners said they did it to pay off debt, but an alarming 75% remained in debt after selling the kidney. The number of individuals living in poverty actually rose from 54% to 71% after they sold a kidney and average family income fell by 33%. Worse, the vast majority of them (86%) experienced health problems. Kristof’s New York Times colleague Eric Nagourney reported on the JAMA findings just over a month ago.
Clearly the sale of organs can lead to exploitation. If organs are sold, the most desperate will be the most easily exploited. The rich will simply buy the spare parts they need at rock bottom prices. Would you sell your kidney for US$1,000? Of course not. But the experience of those Indians that sold a kidney was a lot closer to the worldwide norm than yours. How long do you think it would take to drive the cost of organs close to the cost of a garment sewn by a sweatshop laborer?
Kristof tries to make all of this palatable by pointing out that none of the organizations that support selling organs (the American Medical Association, the American Society of Transplant Surgeons, and the United Network for Organ Sharing) are talking about selling organs from live donors, only dead ones. Nevermind that the American College of Surgeons and the National Kidney Foundation are both adamantly opposed to selling organs. According to Kristof, one proposal in the United States calls for a street price of about US$2,000 that would be used to defray “the funeral costs of anyone who has contributed organs.” Does that mean that American kidneys are worth twice as much as Indian kidneys or that a dead American has to give up both kidneys to get the two grand?
Where Kristof really shows his ignorance is when he attempts to explain why organ sales would be an especially good thing. “One of the biggest problems with the existing system is that the shortage means that many live people end up donating spare kidneys to needy relatives,” Kristof writes. “At least two live donors died in the last three years because of the surgery, and a third was left in ‘a vegetative state,’” he concludes. There are so many things wrong with this statement, it’s easiest to simply deconstruct it clause by clause.
Live people donate kidneys to relatives because a living-related donor, if a match, is by far the best transplant option in terms of long-term viability. I won’t even bother to address the “needy” description Kristof uses to characterize a kidney patient. Organ donors are screened extensively—physically and psychologically—before they’re even considered as a donor. Last year alone, 20.593 successful transplants took place. That three people died and one came out as fodder for the vegematic as a result of surgery over the past three years isn’t news. Last year, three men died after elective knee surgery in Minnesota alone, for chrissakes.
Kristof goes on to explain that “paying for organs would be cost-effective, because dialysis costs much more than the transplant operation itself.” That’s true enough, but it’s only part of the story. The part that Kristof conveniently leaves on the operating room floor is that a kidney transplant is not a cure for permanent kidney failure; it’s only a treatment, just like dialysis. Only about half of cadaver kidney transplants are still working after five years. Additionally, a transplant patient has to take anti-rejection drugs for the rest of his or her life—to the tune of thousands of dollars per month. And while dialysis is covered by Medicare, the anti-rejection drugs are covered for only three years.
Even though I’m on the transplant waiting list, I probably won’t accept a kidney if I’m called. I managed to piss off a few friends and my sister when I told them I wouldn’t accept a kidney from them either. The reasons are personal, and complicated, but boil down to my feeling that it’s unethical.
Unethical for me, that is, not necessarily for anyone else. If you need a transplant to remain alive or significantly improve your quality of life, by all means go for it. Don’t let anything I write here dissuade you. It’s your business and no one else’s. Just make sure you’ve researched and thought it through. All the way through.
My own situation informs my sense that organs should go to younger recipients, mostly because transplantation is a relatively new development and improvements are necessary. Hell, 30 years ago, dialysis wasn’t even widely available. Until permanent kidney failure (the medical diagnosis is end-stage renal disease) became covered by Medicare in 1972, hospitals actually had death committees that would decide which patients would get dialysis and which would be given morphine to ease the convulsions as they died.
Other people have a greater need for a kidney than me. I’m relatively healthy—aside from the kidney failure—and still work full time (when I can find assignments, that is; I’m currently experiencing the longest dry spell in my 20+ year professional life—hire me). I’d much rather have sustainable work right now than a functioning kidney.
I thought I’d get over my transplant reluctance; figured it was part of the disease. But my mind was pretty much made up the day I had to dialyze next to a 16-year old young woman who has no hope for a transplant. She’s ordinarily a home dialysis patient in one of the Twin Cities suburbs, but there had been a flood and she had to come into the dialysis center I use for treatment. She was having an especially bad day—hell I average an especially bad day at least once a week, and I’m 48 years old—I can’t imagine having permanent kidney failure at so young an age. Her tears are indelibly etched in my mind’s eye.
All that said, consider becoming an organ donor. Do it because it’s altruistic, meaningful, and has nothing to do with market economics.
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