The Hamilton Spectator

Let People Sell Their Kidneys. It Will Save Lives.

- Dylan Walsh is a freelance journalist who focuses on science and the criminal justice system.

I owe the past 25 years of my life to my father, who dozed under general anesthesia as a surgeon removed one of his kidneys, placed it on ice and sent it to a nearby operating room, where it was fitted into my abdomen. My brother had a kidney transplant the same week, six days before I did. His new kidney came from a man we never knew who had died in a car accident in the mountains. We were teenagers, afflicted with a congenital kidney disease. But we were lucky.

There are 100,000 people in the United States waiting for a kidney. More than half a million are on dialysis, which from my experience I know to be more of a means of survival than a form of living. About 4,000 people die each year while waiting for a kidney. Another 4,000 become too sick to undergo surgery — a gentler way of saying that they, too, die. The National Kidney Foundation estimates that without more investment in preventing diabetes and other ailments, more than one million Americans will be suffering from kidney failure by 2030, up from over 800,000 now.

Hundreds of millions of healthy people walk the streets quietly carrying two kidneys. They need only one. The puzzle is how to get kidneys from the people who have one to spare into the people who need one. There is a simple answer: Pay people for their kidneys. Creating a market for kidneys is not a new concept, but it has historical­ly been met with disgust.

To be fair, some of the ways to structure such a market would be irresponsi­ble, coercive and deserving of that disgust.

But others are more prudent. One is to make the government the sole purchaser of kidneys. Compensati­on would be fixed. After the kidney is acquired, the transplant process would unfold in the typical manner.

U.S. law presents the most significan­t hurdle. The 1984 National Organ Transplant Act, NOTA for short, makes it unlawful “to knowingly acquire, receive or otherwise transfer any human organ for valuable considerat­ion for use in human transplant­ation.”

Though markets exist for human tissue, bone, amniotic stem cells and blood plasma and for the use of a woman’s womb and her eggs, organs cannot legally be bought and sold.

For several decades, efforts to persuade people to become kidney donors have not increased the number of volunteers. There were roughly 6,000 living kidney donors in 2000; there were roughly 6,000 in 2023. One organizati­on, the Coalition to Modify NOTA, hopes to legalize compensati­on and then pass a federal law it has titled the End Kidney Deaths Act. As it is written, it would award living donors $50,000 over five years — $10,000 per year — through refundable tax credits. The coalition says it has held meetings with nearly 100 legislator­s from both parties and has been encouraged by the level of support for its idea. Other proposals abound.

Some people who are opposed to the idea of selling organs argue that we should instead improve the process of capturing organs from people who have died. But even a flawlessly functionin­g system that recovered and transplant­ed 100 percent of available organs would not meet demand.

One of the most consistent and vociferous objections to a kidney market centers on the fear of coercion or exploitati­on: If you pay people to do something, particular­ly if you pay them a lot, then you will drive those who are most desperate and socially precarious to take steps they later will regret.

Ned Brooks, a co-founder of the Coalition to Modify NOTA, told me there are ways to mitigate “the concern that someone is going to donate a kidney because they have a gambling debt or they are losing their house to foreclosur­e or you name it.” His organizati­on’s proposal, for example, would split the $50,000 payment into installmen­ts arriving only around tax season to weaken donation as a get-rich-quick scheme. Even now, donation requires a weeks- to monthslong process of physical and psychologi­cal evaluation.

Compensati­ng donors could also go a long way to reducing current inequities. Black patients are more than three times as likely to develop kidney failure as white patients. And under today’s system, white patients are about four times as likely as Black patients to receive a living kidney donation within two years of needing one. While there are many reasons for this imbalance, one critical factor is that white people generally possess social networks saturated with volunteers who are able to make the kinds of accommodat­ions needed for major surgery. Compensati­on would broaden the pool of available kidneys for those who lack these social networks.

A shift in attitudes among the public seems to be underway, making this moment particular­ly ripe for legislativ­e change. A 2019 study found that roughly 60 percent of Americans would favor compensati­on through a public agency — and this number, depending on the form of compensati­on, would increase to 70 percent to 80 percent if such a system eliminated kidney shortages. This is a rare nonpartisa­n idea at a highly polarized moment and could save the dozen people who die every day waiting for a kidney.

My kidney has been ticking along since August 1998, far longer than the average transplant­ation. It will give out sometime, maybe before my children graduate from high school. Still, I have lived 25 years I would not have had otherwise. I hope for a world in which others are given such an exquisite gift.


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