Kindness not enough to cut the queues


Cheers all round as the Human Tissues Authority announce that the number of people donating kidneys to strangers has increased by 50 per cent. The only problem, alas, is that the increase is from ten people to fifteen. And three of those have yet to undergo surgery. In a country where 7,000 people are in need of a kidney, an increase of two donors is hardly a cause for celebration. Fortunately there is a long-ignored solution: compensating organ donors.

The sacrifices made by the fifteen new altruistic donors should not to be ignored; they are committing the most noble of acts, and as a recipient of a kidney myself I cannot overstate my admiration for them. But altruism is not enough; nowhere in the world does it make serious leeway into the long queues of people in desperate need of transplants.

According to the International Society of Nephrology, kidney disease affects more than 500 million people worldwide, while in the USA the number of people dependent on dialysis tripled over the last two decades.

Also, bans on organ vending have created a terrifying global black market in organs which sees people in poor countries forced into perilous situations. Efforts have been made to clamp down on the illicit market in organs, but where demand exists, supply finds a way to meet it. Even when countries such as China, India, and the Philippines had some success in thwarting the trade, it simply switched to other areas like the Eastern Europe. Patients will go to extraordinary lengths to save their lives, turning to underground sources when legitimate avenues are banned by governments.

Due to the corrupt nature of the black market, donors get little or no protection. Deprived of the security of contract law, they often fail to receive the money they are promised, go without follow-up medical care and are forced away from the institutions designed to protect them. These appalling conditions are not a result of a marketplace, but a result of laws that drive it underground, away from where it can be a transparent regime devoted to donor protection.

Such a regime should include an impartial not-for-profit or state body matching donors to patients, with donors carefully screened for physical and psychological problems. The provision of follow-up care, potentially for the rest of the donor’s life, is mandatory. This system therefore rewards all patients, not favouring the rich. Donors, meanwhile, receive excellent levels of care.

The only way to stop illicit markets is to create legal ones. Indeed, there is no better justification for testing legal modes of exchange than the very depredations of the underground market.

Momentum is growing. In the British Medical Journal, a leading British transplant surgeon called for a controlled donor compensation program for unrelated live donors, while Israeli, Saudi and Indian governments have decided to offer incentives ranging from lifelong health insurance for the donor to a cash benefit.

I heartily applaud the donors in the UK who have given their kidneys to strangers, and know what a precious gift this is. But we need thousands more. There is currently no room for individuals who would welcome an opportunity to be rewarded for rescuing their fellow human beings. The system is gridlocked, while those on waiting lists lose their lives.

Sally Satel M.D. is a practicing psychiatrist and resident scholar at the American Enterprise Institute.