TCS Daily

Markets in Everything: What About Kidneys?

By Val MacQueen - November 22, 2005 12:00 AM

Britain is going to introduce a sobering bill in April that will finesse the issue of ownership of a newly deceased corpse. According to The Times, doctors are to be given the right to keep organs artificially alive after death without getting consent from the next of kin. This involves cooling and preserving fluids being pumped into the corpse. These preserve the organs for up to four hours, while surgeons seek consent from -- read "put pressure on" -- the newly bereaved in the holy name of transplants. In this instance, they are hoping to clear a backlist of more than 5,000 people on the kidney transplant list -- assuming that they can wear down most of the grieving families within the four-hour time limit.

Thus one more light goes out. The ancient universal respect for the dead and horror at desecration of the corpse gets one more accretion of hardening calcium over ancient tenderness and respect in the service of official "need". Your body belongs not to your family, but the state, and we are en route to nationalization of the recently deceased.  

Singapore, the most authoritarian democracy in the world, was the first to take the pragmatic approach, with its Human Organ Transplant Act of 1987. This stipulates that on death, organs of citizens and permanent residents between the ages of 21 to 60 may be removed for the purposes of transplant unless they specifically opt out. If they do so, they will be placed on a lower priority should they ever need a transplant themselves. Muslims as donors are excused. However, they can opt in, if they wish.  

Given the evidence of other countries that have draconian opt-out laws, it doesn't work particularly well. People are not that careless and do opt out in vast numbers. Three years after the approval of the Belgium Transplant law, which implemented presumed consent, kidney donations doubled from only 20 kidneys per million population (PMP) to 40 kidneys PMP in 1989.  

Medical science is able to keep people with critical illnesses alive for ever-longer interim pre-transplant periods. So the need for organs has reached the stage where ghoulish measures, such as the one proposed in Britain, are being tiptoed in. How much favor they will find with the public isn't known, but the sanctity previously accorded the dead is being eroded by a powerful and aggressive transplant lobby.  

Most countries with presumed consent exclude Muslims from enforced organ donation after death. In most of Islam, any mutilation of the body after death including, in some instances, the cutting of hair, is forbidden. Although it is a specialized and complex subject, I believe it is safe to say that the taking of organs from a human corpse is not only disallowed in most sects, but Islam doesn't even like post mortems to determine cause of death. (The exception is Iran. It appears that Ayatollah Khomeini issued a fatwah approving of transplants and Iran, which has a population of 60 million, now performs 24 renal transplants per 1 million of the population per year.)  

Many Muslims living in other Islamic countries, however, are less dainty when it comes to accepting organs from the dead, and this means those in search of a new liver or kidneys, or a new heart for themselves have to get on waiting lists abroad.  

Some say they don't always have to wait very long. The internet is awash with anecdotal accounts of Saudis and citizens of other oil-rich countries paying hundreds of thousands of dollars over the odds to jump queues in the West, but I was only able to find real evidence of one such instance. When St Vincent's in Los Angeles discovered in September 2003 that some of its staff had falsified records on numerous occasions and that a check had been received for a liver transplant from the Saudi Arabian embassy for $339,000 (25 to 30 percent higher than the normal fee), it immediately closed down its transplant program pending an investigation. The two surgeons who performed the transplant are no longer affiliated with the hospital. So the hospital apparently behaved with rectitude and there is no evidence that wealthy Muslims (or wealthy anyone else) are able to buy their way to the head of the line.  

Given the transplant industry's ever more aggressive lobbying of governments to enact opt-out laws which, as mentioned above, are not substantially effective as people do indeed opt-out, and given technological and pharmaceutical advances that make transplanted organs ever more viable, I cannot see any reason not to trade human organs on the open market. Pragmatically speaking, both the buyer and the seller benefit.  

Just now, India does not allow trade in human organs, but they do allow family or close friends with compatible organs to donate one kidney. This makes for some very unlikely friendships, with a Dravidian peasant in the far south of India suddenly finding himself the lifelong and cherished friend of a rich Hindu businessman's wife in bustling Hyderabad. His kidney will be paid for through a broker. This is not ideal because the gap in social status and resources puts the seller at a disadvantage and in situations that include one poor and ignorant party, is there such a thing as an honest broker?  

I propose that it would be far better to have a trade in kidneys regulated so the more powerful buyer cannot take advantage of the poor, who often sell an organ to pay off debts. And there is no conceivable reason such trade should be limited to developing countries. Once there was an open market in the West, kidneys for transplant would become freely available.  

Such legalization and regulation would benefit the entire kidney transplant industry, in that the person who receives the purchased kidney frees up a space in the dialysis queue for the next in line. And the individual who sold the kidney has the money he needs or wants.  

Considering the number of patients who could have their lives prolonged by receiving a transplant, and that there are not enough freely donated organs, and given that the pressure put on newly bereaved families will only increase, is there a rational or humanitarian reason not to allow trade in organs on the open market? America already sanctions the selling of blood. Why not other bodily constituents?  

Val MacQueen is a TCS contributing writer. Further reading: for dozens of other references, Google "trade in organs for transplant".

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