Here’s a succinct, beautifully-argued piece from Matt Welch.
Every day, eighteen people die in the United States while waiting in vain for a kidney transplant, according to the National Kidney Foundation. The Department of Health & Human Services reports that nearly 92,000 patients were on the kidney waiting list as of April 6 (up from 66,000 six years ago), but that only 16,812 transplants were made in 2011. That deadly math is part of the reason that, according to the National Institutes of Health, more than 380,000 Americans are on dialysis, a punitively expensive and physically grueling death-postponement procedure. The imbalance cannot be meaningfully addressed via cadaver-harvesting alone . . .
So we know that maintaining prohibition—letting the law be guided by our moral revulsion toward placing price tags on human organs—will certainly increase the body count. We know that boosting the number of kidney donations from the living is the only real way to whittle the waiting list down. And we also know, from such procedures as egg donation, that legalizing monetary rewards is a guaranteed method for expanding the pool of living donors. Your morality may vary, but mine says that sentencing more than 6,000 people a year to an avoidable death falls well short of the Golden Rule.
A few additional thoughts:
With kidneys, and also with vital organs, you could also envision markets that, for example, would pay a smaller sum while you’re still alive if you sign to donate your organs when you die. Another plan might give larger sums to your family once you’re dead, should you die in a manner in which your vital organs remain viable. It also isn’t difficult to imagine “organ brokers” finding that there’s a market advantage to protecting their donors—for example, by including clauses in donor contracts stipulating that any kidney donor who later encounters health problems requiring a transplant would receive a free kidney, a paid-for transplant, and move to the top of the donor list—not because organ brokers would necessarily be kind and benevolent, but because if I were donating a kidney, I’m thinking that would be one of my primary concerns, and I’d probably chose a company or system or non-profit that could give me that peace of mind.
The most common argument against organ markets is that they’ll exploit the poor. That’s basically an appeal to equality. There’s nothing wrong with putting a high value on equality. But if your vision of equality includes letting thousands of people die so we can be confident the poor aren’t being exploited by entering into voluntary transactions in which they’re paid for one of their kidneys, I’d argue that you’re putting far too much emphasis on equality. It’s true that we’re all equal when we’re dead. That doesn’t mean it’s a desirable outcome. The argument is also fairly paternalistic, in that assumes that poor people aren’t capable of making these decisions on their own, so the rest of us should impose the correct decision upon them.
We already let people donate kidneys. We considered them heroes. And with good reason. They’re saving a life. But if the same person accepts compensation for the organ, a large chunk of the population suddenly considers the whole exchange somewhere between tacky and hideous. It doesn’t seem to matter to most people that legalizing the process would result in more lives saved, the very reason why we find donors heroic in the first place.
But the fact that money exchanges hands doesn’t change the end result. Someone still gets a shot at at life that they wouldn’t have otherwise had. I’d submit that if you’re ready to use the force of law to condemn people to die years, possibly decades, earlier than they otherwise would, all so you aren’t burdened with icky feelings about living in a country where organ donors are compensated, it might be time to reassess your principles.