June 10, 2006
Healthcare Department
Cash For Kidneys, Part 1
Virginia Postrel, who recently donated a kidney to a friend, has an op-ed in the Los Angeles Times about the disincentives of becoming a donor:
My parents were appalled. My doctor told me, "You know you can change your mind." Many people couldn't understand why I didn't at least wait until my friend had been on dialysis for a while.
This pervasive attitude not only pressures donors to back out, it shapes policies that deter them. Some transplant centers require intrusive, demeaning psychological probes that scare people off. Some bioethicists suspect that donors suffer from a mental disorder, as opposed to being motivated by benevolence or religious conviction.
[...]
The most obvious way to increase the supply of any scarce commodity—paying more for it—is illegal. Federal law blocks transplant centers, patients and insurers from compensating donors in an above-board process, with full legal and medical protections. The growing and inevitable "transplant tourism" industry, and even shadier organ brokers, are the kidney equivalents of back-alley abortionists.
Speaking of back-alley abortionists, it's easy in today's world to think that physicians who secretly performed abortions were progressive-minded guys who believed in woman having control over their bodies. And maybe some of them were, but a lot of them were just plain criminals. They would routinely fake pregnancy tests, telling every woman she was pregnant and needed an abortion. And just like any other black-market product, there was organized crime involvement. I'm sure the same thing is happening with organ donations.
But even talking about incentives is taboo to some self-styled patient advocates. On Monday, the American Enterprise Institute will hold a conference in Washington on incentive-based transplant reforms. (It's organized by my kidney recipient, a physician and health-policy scholar at the institute.) When the National Kidney Foundation heard about the conference, its chief executive, John Davis, complained to the institute's president, "We don't see how an AEI forum would contribute substantively to debate on this issue."
Davis' group adamantly opposes donor compensation, lobbying against even experimental programs and small tax credits. It's as though the National Parkinson Foundation opposed stem cell research, or thought researchers should work for free.
That's the thing that gets me. Everyone else, from the doctors and nurses who do the work to the staff at the transplant center, gets paid. Only the person providing the kidney is expected to work for free.
[Part 2 is now up.]
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Which is even more ironic, considering that the donor is also the only one making any kind of lasting sacrifice or taking on any unusual degree of risk. For everybody else involved, it's just another day's work (for which they are, of course, entitled to be compensated themselves, but still...).