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World Kidney Day, to be held Thursday, is part of a global health campaign meant
to alert us to the impact of kidney disease. Sadly, there is little to
According to the International Society of Nephrology, kidney disease affects
more than 500 million people worldwide, or 10 per cent of the adult population.
With more people developing high blood pressure and diabetes (key risks for
kidney disease), the picture will only worsen.
There are nearly two million new cases of the most serious form of kidney
disease–renal failure–each year. Unless patients with renal failure receive a
kidney transplant or undergo dialysis–an expensive, lifelong procedure that
cleanses the blood of toxins–death is guaranteed within a few weeks.
Last year, Australian nephrologist Gavin Carney held a press conference in
Canberra to urge that people be allowed to sell their kidneys. “The current
system isn’t working,” The Sydney Morning Herald quoted him as saying. “We’ve
tried everything to drum up support” for organ donation, but “people just don’t
seem willing to give their organs away for free.”
Dr. Carney wants to keep patients from purchasing kidneys on the black market
and in overseas organ bazaars. As an American recipient of a kidney who was once
desperate enough to consider doing that myself (fortunately, a friend ended up
donating to me), I agree wholeheartedly that we should offer well-informed
individuals a reward if they are willing to save a stranger’s life.
If not, we will continue to face a dual tragedy: on one side, the thousands
of patients who die each year for want of a kidney; on the other, a human-rights
disaster in which corrupt brokers deceive indigent donors about the nature of
surgery, cheat them out of payment and ignore their postsurgical needs.
The World Health Organization estimates that 5 per cent to 10 per cent of all
transplants performed annually–perhaps 63,000 in all–take place in the
clinical netherworlds of China, Pakistan, Egypt, Colombia and Eastern
Unfortunately, much of the world transplant establishment–including the WHO,
the international Transplantation Society, and the World Medical
Association–advocates only a partial remedy. They focus on ending organ
trafficking but ignore the time-tested truth that trying to stamp out illicit
markets either drives them further underground or causes corruption to reappear
For example, after China, India and Pakistan began cracking down on illicit
organ markets, many patients turned to the Philippines. Last spring, after the
Philippines banned the sale of kidneys to foreigners, a headline in The
Jerusalem Post read: “Kidney transplant candidates in limbo after Philippines
closes gates.” (Israel has one of the lowest donation rates in the world, so the
government pays for transplant surgery performed outside the country.)
Similarly, patients from Qatar who travelled to Manila are “looking for
alternative solutions,” according to the Qatari daily The Peninsula.
True, more countries must develop efficient systems for posthumous donation,
a very important source of organs. But even in Spain, which is famously
successful at retrieving organs from the newly deceased, people die while
waiting for a kidney.
The truth is that trafficking will stop only when the need for organs
Opponents allege that a legal system of exchange will inevitably replicate
the sins of the black market. This is utterly backward. The remedy to this
corrupt and unregulated system of exchange is a regulated and transparent regime
devoted to donor protection.
My colleagues and I suggest a system in which compensation is provided by a
third party (government, a charity or insurance) with public oversight. Because
bidding and private buying would not be permitted, available organs would be
distributed to the next in line–not just to the wealthy. Donors would be
carefully screened for physical and psychological problems, as is currently done
for all volunteer living kidney donors. Moreover, they would be guaranteed
follow-up care for any complications.
Many people are uneasy about offering lump-sum cash payments. A solution is
to provide in-kind rewards–such as a down payment on a house, a contribution to
a retirement fund, or lifetime health insurance–so the program would not be
attractive to people who might otherwise rush to donate on the promise of a
large sum of instant cash.
The only way to stop illicit markets is to create legal ones. Indeed, there
is no better justification for testing legal modes of exchange than the very
depredations of the underground market.
Momentum is growing. In the British Medical Journal, a leading British
transplant surgeon called for a controlled donor compensation program for
unrelated live donors. Within the past year, the Israeli, Saudi and Indian
governments have decided to offer incentives ranging from lifelong health
insurance for the donor to a cash benefit. In the United States, the American
Medical Association has endorsed a draft bill that would make it easier for
states to offer non-cash incentives for donation.
Until countries create legal means of rewarding donors, the fates of Third
World donors and the patients who need their organs to survive will remain
morbidly entwined. What better way to mark World Kidney Day than for global
health leaders to take a bold step and urge countries to experiment with donor
Sally Satel, M.D., is a resident scholar at AEI. She is the editor of When Altruism Isn’t Enough: The Case for Compensating Kidney Donors (AEI Press, 2009).
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