Your Body, Yourself, and Your Sellable Parts

There is a Libertarian argument that the body is a commodity and hey, why not sell a kidney? You do some good and can get access to things that poor people don’t normally deserve, like a college education for their kids.

No surgery, not even a tonsillectomy, is risk-free, as this tragic story shows…

(CNN) — When Manuel Reyna developed a deadly kidney disease, his sister, Florinda Gotcher, didn’t hesitate to give him one of her kidneys. When she found out they were a match, she cried.

“She was so happy,” remembers Gotcher’s daughter, Melinda Williams. “She was overwhelmed that she was able to save her brother’s life.”

Williams said her mother didn’t worry about the risks of surgery. Statistically, kidney donor surgery is considered to be very safe: in 2010, the year before Gotcher’s surgery, 6,276 people donated a kidney, and none of them died within 30 days of the surgery.

Her laparoscopic surgery went well, but about 30 minutes afterwards in the recovery room, she took a mysterious turn for the worse.

Someone raised a question that sent me on a search– what happens to the altruistic kidney donor if they find themselves uninsured and suffering ominous symptoms in the remaining kidney? The answer is disturbing.

There is a large support system for insured people with kidney disease who need a transplant. But for donors who fall out of the social safety net there’s not much out there. The system is set up for people in dire need of transplant or dialysis, but not for prevention of disease in people still healthy. Medicare disability is available for people with end-stage renal disease. The reason that this particular condition is covered is an intersection of science and politics going back a generation…

In the 1960s, in addition to dialysis, kidney transplantation was emerging as a treatment for chronic renal failure. The two therapies interacted in both complementary and competitive ways, each following its own developmental pathway. Though initially greeted with skepticism by many in the medical establishment, these therapies had demonstrated their clinical effectiveness by the mid-1960s.

Clyde Shields, the First Patient with Chronic Kidney Disease to Undergo Dialysis, University of Washington, 1960.

Both lifesaving treatments were costly — beyond the means of most individuals — and not covered by insurance. In Seattle, in response to financial limitations, access to dialysis was restricted through explicit rationing carried out by an anonymous lay committee — an approach that was laid bare for the American public in a Life magazine article in November 1962. Elsewhere, decisions limiting access to dialysis were tacitly incorporated into traditional medical decision making. Dialysis highlighted the tragic choices that had to be made when fundamental societal values encountered problems of scarcity.

Dialysis and transplantation have saved many lives. The lack of investment in prevention, however, has left a huge gap. Diabetes is epidemic, putting thousands on a downward slide to kidney failure. Diabetes can come on gradually, and do a lot of damage before it is diagnosed. The hard-working uninsured American, who is maxed-out on work and family responsibilities is the person who won’t get the inexpensive care to stay healthy. But when they reach end-stage renal failure– Medicare is there.

The funding supports a network of doctors and treatment centers. This is a huge benefit to their patients. Not all kidney disease is preventable, and saving lives is a public good. Universal health care would extend that good to people still healthy and reduce the need for expensive, high-tech treatments like dialysis and transplantation. Keeping a good blood sugar and your own kidneys in working order way beats a transplant.

You would think that a person who donated a kidney would be somehow recognized by a grateful society and not denied medical care. That seems like common decency. But that is not how the free market works. Not only is there no program that guarantees coverage for a donor, they may not even be able to buy insurance. If the Affordable Care Act is struck down by the Supreme Court, insurance companies will once again be able to deny coverage to people with ‘pre-existing conditions’, such having one kidney.

I don’t see a conspiracy here, I see unintended consequences. The system reimburses care for people with end-stage renal disease. These people are deserving, known to their doctors. Every life is precious.

But there are people out there in the community. Maybe they are sweeping the floor, or entering the bills, or caring for patients in the dialysis center. They are on the slide to being a patient there. This can be prevented. Do we have the moral imagination to see public health as a public good? I believe we do, and if the people lead on real health reform, nothing can stop us.

Lauren, at The Fat Lady Sings, has a funny and frightening post about the process of becoming a live kidney donor…

“I don’t even know if I’m a potential donor,” I answered. “I still have to do a kidney scan. If I’m not a donor, there’s no conversation to have. And anyway, I’m only trying to donate one.”

“Why are you being so stubborn about this?” asked Richard. “Most people wouldn’t even think about it.”

I pursed my lips. “Because River needs a kidney,” I said. “I sent the kids to Hebrew school for years so they could learn Torah. Saving a life is the most important mitzvah. What’s the point of talking about all this stuff if you don’t practice it?

“And I’m getting pissed off at hate-mongers and religious hypocrites. Giving somebody a kidney seems like a good way to tell them to go to hell. It makes our blogging community stronger.”

“I’d feel more comfortable with a gift of flowers,” answered Richard. “I understand your reasoning but you mean a lot to us, too. We don’t want anything to happen to you.”

Lauren’s post, incidentally, shows a lot of what is wrong with our health care ‘system’.

Someone close to me was contemplating being a live donor to a co-worker who was very sick. I am greatly relieved that he didn’t. Friends, sign that donor card on your driver’s license. You won’t need them in heaven.

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