What's wrong with selling kidneys?

Personal view: Thinking the unthinkable: selling kidneys BMJ Volume 333, p 51

Doctors in this week's BMJ debate the issue of selling kidneys.

A personal view article, published earlier this month, asked what's wrong with a market in body parts?

Sue Rabbitt Roff of Dundee University Medical School argued that we already permit the sale of body parts and fluids, and we have also already determined "tariffs" for the value of certain body parts in compensation models for workers' accidents, criminal injury, or injury incurred during military service.

If we are not shy about reaching these values, why do we shrink from constructing a regulated exchange system for body parts that would undercut the existing illegal trade, which is so hazardous for the vendors, she asks?

The recommended value of a kidney is $40,000 (£22,000; €32,000), which is close to the annual average income in the UK and US, she adds. If such a sum were part of a package that involved the highest level of clinical care and follow-up, would it be any more reprehensible than the "vending" that is currently permitted for other body materials?

Responding to this article in a letter, doctors in India offer several points in favour of the regulated sale of kidneys.

Firstly, regulated sale will bridge the gap between demand and supply of kidneys for transplantation, they say. Secondly, it will reduce if not abolish the rampant illegal kidney trade.

Thirdly, monetary compensation of donors is well known and well accepted and, fourthly, a collateral benefit of the regulated kidney trade may be redistribution of some wealth in this seemingly unjust world, they write.

Dealing in human spare parts superficially seems to be indecent and immoral. But how can denying the sale of a part of a human body be denied in a world where body and soul are sold and resold daily? With proper and honest checks, they believe that this business has the potential of producing more benefit than harm.

But an e-letter from a heart specialist warns that a fixed compensation model with the price set by experts may increase the supply of organs but it is unlikely to preclude a (black) market from developing.

Alternatively, where the market price of kidneys is lower than the offered price, kidney brokers could operate, making a profit on the supply of the organ to a recipient where the price was higher, he writes.

The core argument for commodifying human kidneys for transplantation rests on the need to increase the supply of available organs. This is set against the likely result of a net flow of organs from the poor to the rich together with a debasement of the intrinsic societal value of altruistic organ donation, he concludes.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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