Kash for Kidneys

Apparently, if you need a new kidney, Iran is the place to be. There’s no waiting list, because donors are at the ready.

In Iran, donors get paid about a third of the average national annual salary to donate.

Iran says:

1. In the chain of people helping to get a kidney from donor to patient, why should donors be the only ones NOT getting paid for their time and effort?

2. It’s a flat sum for every donor, paid by a charity (not the recipient), so there’s no bargaining with the dying person, or buying an organ on the black market.

3. There are strict rules in place to stop “transplant tourism.” Donors or recipients from other countries aren’t welcome.

Is this ok?

At first glance, I don’t see what’s wrong with it. In the U.S., thoughtless, ignorant, or otherwise inconsiderate people feed their perfectly usable organs to worms and bacteria when they die. And the living are understandably unlikely to donate to people they don’t know. So about 18 people a DAY die waiting for a transplant. Most of those people need a kidney.

Why shouldn’t people be paid for donating?

As usual, there are some pretty good reasons on the other side of the debate.

The most compelling reason is that for donations to be safe, the donor needs to be completely open and honest about his own (and his family’s) health and history. If the donor is poor and expecting money for the deal, that honesty is compromised in a way that it probably isn’t most of the time in the U.S.

Before we condemn Iran’s policy, though, someone needs to study what actually happens when donors are paid. We shouldn’t just say that it’s dangerous without actually finding out. Are the transplants working as well as expected long-term or not? If they are, then maybe the worry about lying donors is overblown.

A less convincing argument against paid organ donation is that it adds up to coercing poor people to compromise their health. Of course, we don’t mind paying miners, football players, or even firemen for risking their lives. I bet that most people in those professions also come from lower income homes.

And again, we need to study what happens to those donors after the donation. Iran does give them medical care, but are they suffering 10 years down the line? If not, then why the bother? Isn’t it possible that their lives are better after getting the money? We need to find out before deciding.

The least convincing argument in the article is that once you open a kidney market, you can’t stop people from paying under-the-table prices, which becomes the repugnant practice of donors selling their kidneys to the highest bidder.

For the sake of argument, let’s start by assuming that it’s wrong to bargain for organs (whether that’s true or not is a different discussion). As long as there are safeguards in place to keep donors from knowing the recipients beforehand, then why would anyone assume that the market is open?

How does their being paid make it any more likely that they’ll be able to negotiate an illegal overcharge? It doesn’t make sense. Having money in the legitimate part of the deal doesn’t change whether there’s an illegitimate deal. If Iran’s system makes it easy to overcharge, then that part of the system should be fixed. It has nothing to do with being paid in the first place.

I’m interested to see how this plays out over the next couple of decades. If the U.S. doesn’t destroy Iran in a war, we may get to see whether our system is based on an irrational distaste, or serious medical and social concerns.

Link to article.