Legalize Kidneys, Too

In December of last year, the Institute for Justice won a case challenging the National Organ Transplant Act (NOTA), which since 1985 has made compensation for bone marrow cell transplants punishable by five years in prison. Based on the Ninth U.S. Circuit Court of Appeals ruling, “any form of compensation for marrow donors would be legal within the boundaries of the Ninth Circuit, which includes California, Alaska, Arizona, Hawaii, Idaho, Montana, Nevada, Oregon, Washington and various other U.S. territories.”

Compensation for organ donations such as kidney and actual marrow will remain illegal, but there’s good reason to consider rolling back NOTA on these types of transplants, as well. Today, The Atlantic published an article bemoaning Bangladesh’s exploitative black market for kidneys:

During his fieldwork, [Michigan State anthropologist Monir Moniruzzaman] interviewed 33 poor Bangladeshis who decided to sell their kidneys, many of whom initially didn’t even know what a kidney was. Burdened by debt and with mouths to feed, these sellers were lured in by newspaper classifieds which imply a bounty to those willing to donate. In his research, Moniruzzaman collected more than 1,000 classifieds in popular newspapers…asking for organs and making impossible offers such as citizenship in a foreign country.

Obviously, the mention of citizenship disappears when the potential seller meets with the broker, and in its place is compensation of “around $1,150.” This figure drops after fees for transportation and “other logistics.” The seller usually travels to India to have the operation. Upon arrival, his passport is confiscated to mitigate the effects of a change of heart. In the end, according to the article, the broker makes around $5,000 and the seller goes home with a twenty-inch scar on his torso and a few hundred dollars. Cultural and religious taboos add to the post-op complications:

All but one of the sellers Moniruzzaman interviewed were Muslim, and in Islam there is a strict taboo against body mutilation. After the surgery, feelings of remorse and shame would set in. “They wanted to get rid of their poverty so they got entrapped in that system,” [Moniruzzaman] says, “but then they realized that they sold God’s gift and when they go back in the afterlife, God would ask them ‘Where are your body parts, where are the missing body parts?’ And that creates a state where they are living with shame and disgrace.”

Moniruzzaman doesn’t think a legal, regulated market for organ selling is a solution to the problem of exploitation, but why not? There are parallels in the markets for other controversial goods and services that suggest the opposite. This report by the Cato Institute found that seven years after drug decriminalization in Portugal, many of the negative effects typically associated with drug usage had subsided:

None of the parade of horrors that decriminalization opponents in Portugal predicted, and that decriminalization opponents around the world typically invoke, has come to pass. In many cases, precisely the opposite has happened, as usage has declined in many key categories and drug-related social ills have been far more contained in a decriminalized regime.

In the United States, our own ban on kidney selling not only disproportionately affects low-income Americans in need of kidneys, it also contributes to the problems in countries like Bangladesh, as mentioned in this New York Times op-ed:

When wealthy white people find their way onto the kidney waiting list, they are much more likely to get off it early by finding a donor among their friends and family (or, as Steve Jobs did for a liver transplant in 2009, by traveling to a region with a shorter list). Worst of all, the ban encourages an international black market, where desperate people do end up selling their organs, without protection, fair compensation or proper medical care.

Here’s hoping the Institute for Justice’s success with bone marrow transplants and taboo-breaking initiatives like that in Portugal encourage the creation of safe environments for sellers like those from Bangladesh. Legalization might not alter the social stigma on organ transplants, but it will at least make room for fair compensation to the people willing to sell.

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