Body parts for sale

There are about 20 million spare kidneys in Australia - one for each man, woman and child: and a kidney given for financial gain works just as well as one donated benevolently. That’s why it is obscene that there are thousands of Australians who spend years on dialysis, waiting for a life-saving kidney that often never comes.

Netherlands based TV program Big Donor should be commended for highlighting the dispiriting plight endured by people with kidney failure. In the show, a terminally ill woman with the assistance of viewers was to select one of three candidates to receive one of her kidneys.

The show turned out to be cleverly crafted hoax, designed to draw attention to the shortage of donor kidneys. The donor was in fact an actress rather than a terminally ill cancer sufferer.

Prior to being announced as a stunt the show attracted world-wide international condemnation. Dutch legislator Joop Atsma blasted the show because it allowed the audience to play “referee on what could be a matter of life and death”.

To the contrary, the program should be praised for illustrating the highly questionable choices that we as a community condone regarding cardinal moral issues.

Doctors and hospital make decisions regarding life and death daily. Life saving body parts are in scarce supply, as are expensive drugs and certain forms of medical treatment. Who should live and who should die is the most fundamental moral issue of our time - and indeed at any time in history.

Decisions of this nature involve highly controversial and contestable judgments regarding the worth of human life. The line that all human life is intrinsically important doesn’t cut it when there is one life-saving kidney but 100 needy patients. In such circumstances it is necessary to decide which life is most valuable.

Momentous decisions of this nature are acutely difficult, but that is all the more reason that they must be made within a transparent framework, which engages the preferences and wisdom of the entire community, as opposed to the whims of well- intentioned, yet sometimes ethically barren medicos.

When we are confronted with difficult ethical choices, in my view the morally correct decision is the one that will maximise net human flourishing, where each person’s interests count equally. In the donor situation, this means preferring the potential recipient who needs it most (i.e., is closest to death) and who, on the basis of age and talent, is likely to contribute most to the community.

Many people will disagree with this framework. And it is exactly for this reason that we need wide-ranging community debate on the issue. Big Donor will no doubt fuel this discussion.

Moreover, the show will highlight the incalculable and unnecessary suffering that our medical system inflicts on sick patients.

In Australia about 9,000 people are alive on dialysis and only about 5 per cent of patients are offered a kidney transplant in any year. The average waiting time for a transplant is four years. About one patient a week dies waiting for a kidney. The cost of dialysis is over $500 million per year.

The reason that so many people are undergoing dialysis and dying due to kidney failure is simply because people lack the incentive to give up their spare kidney.

As with most disconnects between need and supply, there is a ready solution: money. The current ban on being paid for kidney donations is misguided and indecently paternalistic.

The government should set a minimum price that will be paid by the health system for a kidney. This should reflect the pain and suffering involved in donating the organ and the increased risk to the donor’s future health. Once this threshold, say $50,000, is set hospitals should be able to purchase kidneys at sums not below this amount. The purchase price should increase until equilibrium emerges between demand and supply of kidneys.

But won’t this lead to the exploitation of the poor who will be coerced into selling their kidneys? No.

While there is no doubt that the poor will disproportionately sell their kidneys, this no more amounts to exploitation than the fact that it is the same people who spend their lives selling their labour cheaply to the wealthy, in the form of cleaning toilets and working in (legal) brothels.

While some kidney donors might blow the $50,000 plus, many will use it wisely as a springboard for financial security by, for example, using it as a home deposit. Poor people are financially challenged. But they are not dumb. They are capable of making informed, self-regarding autonomous choices.

Our bodies are no less an asset than our time and resourcefulness. In fact this is the one asset that is possessed equally by the rich and the poor. There is no principled basis for not allowing the poor to recoup this asset.

The fallacy of the argument that benevolence should be the only motivation driving organ transplants is highlighted by the fact surgeons and hospital make thousands of dollars transplanting organs, as do drug companies who provide follow up medication. The only person who misses out on the cash is the one that gave the most - the donor. Rarely is paternalism so vulgar.

Of course, some kidney donors down the track will themselves require a kidney transplant if their only kidney fails. But this won’t be problem, because under the proposed scheme there will always be a ready supply of donors at any point in time.

Critics will object that this proposal will lead us down the slippery slope of (suicidal) people wanting to sell hearts and other non-spare parts organs. They are wrong. A clear distinction can be made between essential and non-essential organs and body parts - such as kidneys and bone marrow.

Law-makers need to take of heed of this - it is a matter of life and death.