It was a strange experience reading Sally Satel’s essay, Desperately Seeking a Kidney in last Sunday’s New York Times. The writer, a resident scholar at the conservative think tank, American Enterprise Institute, needed a kidney transplant. She offers her personal narrative, and then some proposals for inducing the poor to sell their bodies in a free market.
Ms. Satel begins with her experience as a woman suddenly faced with a life-threatening illness…
Three days a week, for four debilitating hours at a time, I would be tethered to a blood-cleansing machine. Even simple things like traveling to see friends or to give talks would be limited. This would very likely continue for at least five years until my name crawled to the top of the national list of people waiting for kidneys from the newly deceased. On average, 12 names, the death toll from the ever-growing organ shortage, would be scratched off the list each day.
She is a psychiatrist, working in a methadone clinic, and she knew from her medical training what dialysis involves. She dreaded it so much that she chose not to wait on the transplant list, opting instead to search for a live donor. She writes honestly and unsparingly of her failed negotiations with two friends, then with a man she met online. Finally she received an offer from an acquaintance, Virginia Postrel, a fellow conservative writer, and the transplant was successful.
While Ms. Satel calls the gift she received, ‘altruism’ she has a different definition when applied to people outside her circle.
We must be bold and experiment with offering prospective donors other incentives for giving, not necessarily payment but material reward of some kind– perhaps something as simple as offering donors lifelong Medicare coverage. Or maybe Congress should grant waivers so that states can implement their own creative ways of giving something to donors: tax credits, tuition vouchers or a contribution to a giver’s retirement account.
This is the kinder, gentler version. She is not ignorant of how desperate things can get for the poor in this world…
I flirted with the idea of becoming a ‘transplant tourist’ in Turkey or the Philippines, where I could buy a kidney. Or going to China, where I would have to face the frightful knowledge that my kidney would probably come from an executed prisoner. Grim choices, but I was afraid I could die on dialysis if I didn’t do something to save myself.
In all of this long essay Ms. Satel never wonders what would have happened if she were poor and uninsured. She seems to live in a bubble where the only problem is a lack of donated organs. And she downplays, almost callously, the risk to the donor.
The operation is done by laparoscope, leaving only a modest three-inch scar. She would have been out of the hospital after two or three nights. Most important, the chance of death is tiny–2 in every 10,000 transplants– and the long-term health risks are generally negligible.
This kind of reasoning explains a lot about why conservatives can be persuaded that whatever works for them is just peachy. There is a reason nature gave us two kidneys, a woman with chronic renal failure should be able to figure that out. If you lose one, as did my aunt, to a tumor, or my friend, to a motorcycle accident, you have a spare. And I’m not so casual about the long-term health risks — we haven’t been doing these transplants for all that long. Not to mention the risk of post-surgical infection as antibiotic resistant germs increase. Myself, I would gladly take this risk for love, but god grant I never have to for money.
But back to the kinder, gentler. The mother who sells a kidney so her son can go to college ( no pressure, Sonny), or the eighteen year old who needs cash and feels invincible. Or the man who needs insurance and can’t get accepted on an affordable plan. David Holcberg, of the Ayn Rand Institute puts it a little more frankly. This was printed on the Journal’s editorial page —
A person may reasonably decide, after considering all the relevant facts (including the pain, risk and inconvenience of surgery), that selling an organ is actually in his own best interest. A father, for example, may decide that one of his kidneys is worth selling to pay for the best medical treatment available for his child…
Opponents of a free market in organs argue as well that it would benefit only those who could afford to pay–not necessarily those in most desperate need. This objection should also be rejected. Need does not give anyone the right to damage the lives of other people, by prohibiting a seller from getting the best price for his organ, or a buyer from purchasing an organ to further his life. Those who can afford to buy organs would benefit at no one’s expense but their own. Those unable to pay would still be able to rely on charity, as they do today. And a free market would enhance the ability of charitable organizations to procure organs for them.
Just think, all those deadbeats sitting in the waiting room at Hasbro with their sick kids, they could be persuaded to put out if they want ‘the best medical treatment for their sick child’.
But don’t consider giving free medical care to needy children, or scholarships to hardworking poor students. That would be immoral.
We are really on the edge of a class disparity that is not only about money but blood. We already pay lip service to ‘serving our country’ while dangling cash and scholarships in front of the kids at Central and Hope High. The recruiters know where to go.
No matter how well written, and no matter how much natural sympathy one feels for anyone who goes through a dangerous illness, Sally Satel’s essay is horrible. In countries where desperate people sell their kidneys, you can be sure there will be many who die prematurely when their remaining kidney gives out, and there will be no help for them. I wonder where in the Libertarian scheme of things you put the person who sold a kidney, and now needs one. Do you chalk it up to ‘bad choices’ ? We will be going down a very dark road if we give up the principle of taking care of our own, rich or poor, and instead let the rich use the poor for spare parts.
For another, less temperate, take on this, check out Daily Kos. And yes, I’ve signed a donor card, but they’re not getting them until I’m dead.