Writing for the left-leaning media outlet Vox, Dylan Matthews makes the moral case for paying kidney donors.
Matthews, a kidney donor who has written for the Washington Post, the New Republic, The American Prospect, and Slate, is a senior correspondent and lead writer for Future Perfect, “Vox’s section that tells stories about people and institutions trying to do the most good for the world they can.”
A few months ago, Matthews wrote an article for Vox regarding the End Kidney Deaths Act, “a bill put together by a group of kidney policy experts and living donors.” The End Kidney Deaths Act “is a ten year pilot program to provide a refundable tax credit of $10,000 each year for five years ($50,000 total) to living kidney donors who donate a kidney to a stranger, which will go to those who have been waiting longest on the kidney waitlist.”
For the record:
- For the last 15 years, more than 50 percent of those on the waitlist die before they can receive a kidney transplant.
- 800,000 Americans currently suffer from kidney failure.
- Regarding deceased kidney donations, fewer than 1 percent of deaths occur in a manner (in a hospital on a ventilator) that enables the organs to be recovered and transplanted.
- For the past two decades, only around 300 to 400 nondirected donors each year have donated kidneys to strangers.
- Kidney donation is safer than either childbirth and appendectomies.
Not getting a kidney transplant is more expensive than getting one. This is because Medicare foots the bill for most patients with kidney failure, including dialysis, which cost U.S. taxpayers over $33 billion in 2021.
The problem is the National Organ Transplant Act of 1984, spearheaded by Sen. Al Gore, that outlawed the sale of organs and established the Organ Procurement and Transplantation Network — a public-private partnership under the Department of Health and Human Services — to oversee organ donation in the United States.
In his recent article, “The Moral Case for Paying Kidney Donors,” Matthews mentions that the End Kidney Deaths Act (H.R.9275) has now been introduced in the U.S. House of Representatives by two Democrats and two Republicans. He explains that “many people, including those running some kidney care advocacy groups, have expressed opposition to the idea of compensating kidney donors.” Matthews raises and answers three arguments in particular:
- Kidney donation is too dangerous to pay people to do.
- Kidney donation exploits or coerces the poor.
- We’ll get fewer kidney donations if donors are compensated because it will no longer feel altruistic.
He concludes that “there’s no other area of human life where we assume that monetary incentives are actively counterproductive.”
The reason there is a shortage of donated kidneys is that there is zero incentive to donate a kidney other than altruism toward a stranger, pride in oneself, love for a family member, intangible goodwill, or pity for a sufferer of kidney disease.
In addition to the End Kidney Deaths Act, I have seen two other proposals to alleviate the kidney shortage by using monetary incentives to encourage donation. Both of them involve the sale of organs after a person’s death. The late George Mason University law professor Lloyd Cohen “recommended that all of our body organs be considered to be parts of our estates in the same way that our homes and jewelry are parts of our estates.” One’s heirs would then decide whether to sell, give away, or do nothing with their deceased relative’s organs. The decedent could also put restrictions in his will concerning the disposition of his organs. Another plan calls for “allowing living people to sell rights to harvest their organs upon their deaths.”
Both of these proposals could be adopted without permitting people to sell their organs while they are still alive.
Ideally, though, every individual should have the freedom to sell one of more of his organs to the highest bidder — and make delivery while he is alive or after he is dead. After all, people can be compensated for donating blood and plasma, men can be paid to donate semen, and women can be paid to be a surrogate. It makes sense to extend the same monetary incentives to organ donation.
The problem with the End Kidney Deaths Act, although it is a great improvement over the situation now, is that it is the government that would be paying people to donate kidneys and the government that would still be facilitating kidney donations. Both should be handled by the private sector.
The National Organ Transplant Act should be repealed because (1) the Constitution nowhere gives the federal government the authority to have anything to do with organs, organ donations, or organ transplants; and (2) overseeing the procuring of kidneys is an illegitimate function of government that could be handled entirely and more efficiently by the free market.
If you own your own body, then you also own the organs in your body. And if you own the organs in your body, then you should have the right to do whatever you wish with those organs — while you are living or after you are dead.
As Judge Andrew Napolitano wrote in his book It Is Dangerous to Be Right When the Government Is Wrong: The Case for Personal Freedom (2011):
Because your body is your property, you should have the right to decide to live without one of your kidneys and be compensated accordingly (and conversely, to acquire a kidney through a voluntary trade). It is your body, your decision, your choice. Why does the government even care what you do with your organs, especially when that organ is saving the life of another human being?
But at least Vox gets it half right.
