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Psychiatrist Sally Satel, of the American Enterprise Institute, has written about being diagnosed with eventual renal failure and her efforts to jump ahead of the organ waiting list (before going on dialysis) by finding someone to give her a kidney. (Her efforts failed until the author Virgina Postrel heard of Satel’s illness and gave her one of hers—an act of utter selflessness since the two women did not know each other at the time.) Ever since her illness, Satel has been pushing for the creation of an organ market in which people would be able to sell a kidney, a slice of liver, etc. From her latest piece pushing the idea in the Wall Street Journal:

My colleagues and I suggest a system in which a donor can accept a reward for saving the life of a stranger. A third party (the government, a charity or insurer) would provide the benefit and newly available organs would be distributed to the next in line—not just to the wealthy. Donors would be carefully screened for physical and emotional impediments to safe donation, as is currently done for all volunteer living kidney donors. Moreover, they would be guaranteed follow-up medical care for any complications.

Many people are uneasy about offering lump-sum cash payments. A solution is to provide in-kind rewards, such as a down payment on a house, a contribution to a retirement fund or lifetime health insurance, so the program would not be attractive to people who might otherwise rush to donate on the promise of a large sum of instant cash.

Not only will more lives be saved through legal means of donor rewards, but fewer people will haunt the black-market organ bazaars of places like China, Pakistan, Egypt, Colombia and Eastern Europe. The World Health Organization estimates that 5% to 10% of all transplants performed annually — perhaps 63,000 in all — take place in these clinical netherworlds.
These rationalizations do not change the fact that it would be the poor who would be selling—not well off people like Satel. Also, note that she uses the term “safe donations,” and potential “health complications” as if the two were not partially mutually canceling.

It is true that most living donors recover fully. But not all. I know one living donor who had a very hard time for awhile post surgically. On the other hand, a good friend’s son donated a kidney without any problems. But some people have died giving their kidneys or had other serious complications. Finally, people willing to go to the black market for organs do so because they don’t want to wait in line—and may not care if people are being killed to save them, as has happened in China. So opening up an organ market would not stop the biological colonialism that is a scourge in the developing world.

Organ buying would transform vital body parts into a commodity and add to the growing threat of human instrumentalization. Utilitarianism can be appealing. People who need organs are understandably desperate to increase the organ supply, which is a very worthy goal. But the lives and well being of the healthy matter as much as those of the sick. Organ markets are a bad idea that would open the door to a terrible potential for exploitation.

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