The kidney is a strange organ. From a physiological point of view, the kidney is a bean-shaped collection of tissues that serves as an integral part of the excretory system. The average individual has around a gallon and a half of blood circulating through his or her body. Our two kidneys filter the blood around 400 times daily. This is made possible through the millions of microscopic nephrons — the functional unit of a kidney — that utilize a finely calibrated system of osmotic gradients that hormones such as vasopressin and aldosteronecan further modulate. All of these factors speak to the complexity of kidneys in normal physiological function. However, the current debate involving the kidney may be even more complicated than the organ itself.
For instance, the National Organ Transplant Act of 1984 made it illegal to compensate organ donors and prohibited the selling and buying of any organ, even technically expendable organs like kidneys (a human only needs one to live). While the hearts of the lawmakers who passed the act may have been in the right place, the law has been nothing less than heartbreaking for patients and their loved ones. Thousands of patients have died waiting for kidneys over the past three decades. According to the U.S. Department of Health and Human Services, in 2012 alone, 4,100 registered candidates died waiting for a kidney, and another 2,700 candidates were removed from the transplant list because they became too sick to undergo the operation. One of the most promising solutions to the current kidney shortage may be a government-regulated kidney market.
One of the more vocal arguments against the case for kidney markets is that they would demean the sanctity of the human body. However, if we take a look at the medical system in cases of organ and non-organ transplants, as it exists, the human body is already highly commoditized. There are many perfectly legal tissue banks in the U.S. that harvest a range of tissues from donors, including but not limited to bones, cord blood, skin, heart valves, tendons, ligaments and blood vessels. After inspection and processing, these tissues are delivered to hospitals with thousand-dollar price tags, namely because of “processing fees.” These costs, however, pale in comparison to the procedures themselves. According to the National Foundation for Transplants, a kidney transplant costs $260,000. The organ donors seems to be the only party left out of this highly profitable market.
Furthermore, the implementation of a kidney market would decrease the activity of organ black markets, which would protect patients’ health as well as potentially lower the number of unregulated black market organ harvests, usually from vulnerable individuals from other countries. According to a 2012 Bloomberg article, a kidney trafficker was convicted of buying kidneys in Israel for $25,000 and selling them to patients in the U.S. for $120,000 or more. Although the defendant’s lawyers claimed that the surgeries occurred in prestigious U.S. hospitals and the organ sellers were fully aware of their actions, an anthropologist testified that sellers were usually poor immigrants from Eastern Europe. A regulated, legal market to ensure that all tissue is obtained legally and ethically and decrease the demand for illegal organs of questionable quality and origin.
Eleven people will die today because they did not receive a kidney transplant. Everyone but the donor profits from today’s lucrative organ transplant system. Black markets continue to thrive in extreme situations without a legal alternative. As it stands, the belief in the sanctity of a human life has allowed us to believe that it is better to let people die than offend our sensibilities. On the other hand, a regulated kidney market would increase the supply of organs and benefit the givers by creating a legal arena to protect sellers, who would accept payment for a product that enables the consumer’s survival.
The column has been revised to reflect the following correction:
Correction appended: March 26, 2014
The column, initially published online, incorrectly listed "vasopressin and ADH" as example hormones. The column has been updated to reflect the change.
