Allowing Kidney Sales, Preserving Patient Autonomy

(Op- Ed)

When it comes to kidney donation, the United States harvests a huge problem–lacking legalization of selling kidneys. Even if every citizen opted to be a donor, we would still be facing the severe organ shortage we are now. The wait list of patients in need is constantly being restricted to a smaller range of age groups because of availability. Compensation for kidneys would not only have the potential to alleviate the shortage, but would also keep many people eligible to receive an organ who may have been moved down or off the list because of age or medical status. With compensation, this would no longer be an issue.


Each person is born with two kidneys. Research has proven that the removal of one kidney has not contributed to an onset of kidney disease nor significantly affected the health or life span of the kidney donor if the surgery was performed (legally and) correctly with proper therapy and follow-up. In other words, life can be lived, and lived well with just one kidney[1]. If monetary compensation were awarded to individuals for a kidney, the black market for kidney sales would be totally eradicated in the US. It would set the conditions to make the surgical process entirely safe for both the donor and recipient, and would not risk the life or lifestyle of the donor.


An important threshold to bear in mind is one of patient autonomy. Legalizing compensation does not jeopardize the autonomy of the patient giving a kidney nor the patient receiving a kidney. If legalized, physicians would ensure each patient (donor and receiver) was made aware of the risk of surgery, and get their conscious consent before operating. In the current black market system, coercion and corruption overpower autonomy of both donor and receiver. Both are frequently cheated out of money and health. Legalizing organ sales would restore each person’s autonomy and provide a safe environment for surgery as well as pre and postoperative healthcare.


The position that the legalization of compensation would only afford the rich access to receive organ transplantation simply does not hold. Not every case would be one requiring monetary value, as donors frequently come from family members, or cadavers. Live donors would most likely request monetary compensation, however, those who could afford to pay a donor for a kidney would quickly be removed from the waiting list. This removal would grant more likelihood of receiving a kidney to the men and women still on the list from fresh cadavers. Compensation would only facilitate the current wait list system to run more efficiently by getting more people taken off at a fast rate; in other words, payment does not hinder those who cannot afford to pay a live donor, rather it would increase their chances of receiving transplantation in a timely matter.


What if the US also made donorship for US citizens something to opt out of rather than opt into? Millions of citizens would be expected to become donors, while maintaining the autonomous choice of being one or not. Furthermore, with the current investment of researching methods for creating synthetic organs, patients in need of kidney transplantation with proper health insurance will have access to this option in the future.


Theoretically, the practice of selling one’s physical matter is already legal. There is no dispute as to the ethics of compensating egg donors or sperm donors for receiving payment for their body parts. What is the difference with kidneys? Surely the surgery, recovery period and pre/post operative treatment will be much more invasive, but the compensation prices would obviously parallel the process. With the current technology and survival rate of transplantation surgery, one’s lifestyle and health will not be jeopardized.


In matters of life and death, people are going to find a way of achieving the end they are looking for through legal means or not. Dialysis is not a viable option anymore when transplantation has such a higher success rate for longevity and lifestyle. Transplantation is a treatment; Dialysis is a means of surviving. By legalizing compensation of kidneys, the US would be providing the safest way for patients to receive proper care and treatment options. The US kidney shortage would essentially dissolve, as would the length of the wait list. What’s more, the questionable and saddening standards of age and movement of patients on the list for factors of status would not face ethical disputation. Most importantly, the process would maintain and assure the autonomy of all individuals involved.


[1] To be clear, I am not suggesting that compensation should be awarded for live donation of life-dependent organs such as hearts and lungs.


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