The other day, I was reading about a new procedure in which a kidney was extracted for transplant through the donor's vagina . And it got me thinking: If kidney donors deserve special surgical benefits—which is what doctors argued in this case—then what other benefits should they be offered? How about free medical care? How about cash?
The Johns Hopkins doctors who performed last week's vaginal kidney delivery describe several special benefits. "An organ donor, in particular, is most deserving of a scar-free, minimally invasive and pain-free procedure," says one Hopkins surgeon. The natural-orifice procedure supplies these benefits. According to Dr. Robert Montgomery, head of the Hopkins transplant division, "Removing the kidney through a natural opening should hasten the patient's recovery and provide a better cosmetic result."
The doctors see these benefits not just as a special reward but as an inducement. "This approach could have a tremendous impact on people's willingness to donate," argues Montgomery. The shorter recovery time "greatly reduces the inconvenience of donating and we're hoping that will encourage more people to donate."
I've written before about the horrors of the international black market in organs from living donors. Federal law goes further, banning the provision of any " valuable consideration " in exchange for an organ. But the law adds that this term doesn't apply to "the expenses of travel, housing, and lost wages incurred by the donor."
So it's OK to compensate donors for lost income opportunities. And it's OK to make sure that they, of all people, get the most pain-free procedure with the best "cosmetic result." What else?
Sally Satel, a friend of mine and a frequent Slate contributor, points out that other countries have taken further steps. In When Altruism Isn't Enough: The Case for Compensating Kidney Donors , she reports that last year, "the Dutch health minister directed health insurers to reduce annual fees by 10 percent for registered organ donors."
Sounds good, right? If you do a good deed for your fellows, don't you deserve a reward? You're supplying a medical benefit to the community. Doesn't the community owe you, at a minimum, a discount on your health insurance?
And why stop at 10 percent? Satel notes that Saudi Arabia's Cabinet recently "passed a law to compensate unrelated living donors with lifelong medical care."
Still onboard? Let's keep going. Satel proposes to amend the definition of "valuable consideration" in U.S. law so that states can offer "incentives" for organs. The incentives, she explains,
could take many forms, perhaps as simple as an offer of lifelong Medicare coverage or a credit on the federal income tax. States could, perhaps, implement their own creative incentive ideas, such as the utilization of tuition vouchers, state income tax credit, loan forgiveness, or contributions to retirement accounts.
After all, lifelong medical care, which we've already agreed is appropriate, is a quantifiable benefit. What if the reward you really need isn't medical? What if you need a college education or a professional degree? What if you're struggling with your student loans or your mortgage? Can't we do something for you?
Don't worry. We're not talking about cash. Under most of the proposals outlined by various authors in Satel's book, benefits would be "in-kind," with "a months-long cooling-off period prior to surgery" so that nobody rushes to donate out of financial desperation. The value of the incentives might range from $15,000 to $40,000. And according to surgeon David Cronin and economist Julio Elias, there would be one further payoff:
A smoothly functioning pilot period of in-kind rewards might, however, allow the public to adjust to the very idea of compensation so that actual payment became more socially acceptable over time ...
That's a good bet. Satel opposes cash payments, and a bill awaiting introduction in Congress, the Organ Donor Clarification and Anti-Trafficking Law of 2009, would reassert the ban on cash transactions (in fact, it would increase penalties for them) even as it legalized state-provided in-kind incentives. The question is whether such legal distinctions would hold firm in the face of the increasing social acceptability of compensation.
So here's the dilemma: If we maintain the ban on "valuable consideration," Americans with sufficient wealth will keep going abroad to buy organs from living donors on the black market. Those without sufficient wealth will wait for freely donated organs, and some will die waiting. On the other hand, if we relax the ban, we might get used to the idea of compensation and end up buying and selling organs legally.
Which is worse?