We badly need more donated kidneys. Let’s start paying for them

The need for living kidney donors is dire. Last year more than 4,000 Americans died while waiting for a kidney transplant, and many more people will die if they do not get the proper care in time.

A few months ago, I donated a kidney to a stranger who desperately needed one. I decided I could not morally justify living luxuriously with a back-up kidney when someone else would die without my help. I felt compelled, both by my religion and by my conscience, to sacrifice whatever I could to save another life. The procedure worked, and I am no worse for wear.
I was not financially compensated for my deed (nor would I want to be). But the truth is that a well-regulated market where financial incentives could be offered could save the lives of countless people. Since kidney sales are illegal, they often occur underground, which drives the price up substantially per unit. The inherent unregulated and unsupervised nature of the market makes it difficult to pay such a price unless wealth or connections are in place. It causes terrible harm to the world’s most vulnerable people. Bringing kidney sales out from the shadows could solve both of these problems by increasing the supply of kidneys at a reasonable price and safeguarding the easily exploitable poor.
The impoverished people who sell kidneys are rarely informed of the risks, and lack health insurance or adequate compensation. They are sometimes not paid at all because the transaction was initially illegal and seeking police recourse would be futile. The World Health Organisation estimates that broker-purchased kidneys go for about $5,000, and are in turn sold to wealthy recipients for an estimated $150,000.

There is no doubt that the current unregulated, illegal network is abusive. Organ brokers make false promises – some tell donors that kidneys will grow back after being harvested – and subsequently earn enormous profits over their illegal transaction. The Nepalese village of Hokse, near Kathmandu, is a heart-rending example. It is known as the “Kidney Village”, due to organ brokers persuading so many villagers to go to southern India, where each has sold a kidney to a foreigner to raise funds to pay debts or to support their families. Geeta, 37, mother of four, sold one of her kidneys for the measly sum of $2,000; she used the funds to buy a small house for her family. Her pain was for nought: in April 2015, the earthquake that struck Nepal levelled her modest home. Her family now lives in a structure made of corrugated iron and clear plastic wrap.
In this worst of all possible worlds, only black-market incentives are offered. Since underground organ sales are happening en masse, we must look deep inside and ask vital questions: how can we re-channel this exploitative industry to one that ensures the health of the donor? How can these people be adequately protected in the procedure in such a way that non-coercive consent is ensured? How can exorbitant profit opportunities for organ brokers be eliminated? How do we ensure a level playing field to ensure fair distribution of donated organs? Those who support the prohibition of offering incentives think it will prevent the enormous ills of this abusive black market. But like the prohibition of sex work, it has failed. Miserably.
Though it would be nice if everyone would donate a kidney altruistically, we don’t live in a utopia. And why should society require pure motives from one willing to take a health risk to save another’s life? We don’t expect altruism when paying firemen and policemen. We pay soldiers to fight wars, doctors to treat ill patients and researchers to work in labs handling the Ebola virus. So why should we be troubled by a penurious person being paid for a small medical risk that will save a life, especially considering the mortality rate for kidney donation is less than that of non-essential plastic surgery?
As a rabbi – as a human being who believes in the infinite dignity of the other – I believe saving human life is of utmost consequence. If most people will not donate altruistically, then incentivising people by offering them compensation and benefits should be our ideal. It is vital that we correct today’s exploitative status quo of underground donation trafficking. This will bring sanity to a system that needs it. We can save countless lives. This not a mere apothegm: it is something worth striving for.