To the Editor:

The National Kidney Foundation stands by its firm opposition to the buying and selling of kidneys. Slates article today featuring the well known views of Sally Satel does not justify making a commodity out of human body parts. Our Board of Directors, many of whom are transplant recipients or family members of recipients, has unanimously voted to oppose any effort to sell kidneys through a commercial transaction.

Such a practice would not increase donation, in NKFs judgment. In fact, 10.8 percent of those polled in a recent national survey would be less likely to grant consent for the organs of a deceased family member to be used for transplant if they were offered a payment, while 68.2 percent said they would be neither more nor less likely to grant consent. Thus, there is little data to show that financial incentives would increase donation rates. More likely, "paying for organs" would lead people to view organs as commodities, having the opposite effect in diminishing the altruistic charitable act of organ donation. NKFs National Donor Family Council and transplant recipients council, transAction share and advocates this position. They honor the gift of an organ as a tribute to the selfless helping of others for no reason other than it is the right thing to do.

Organ donation must remain a gift. To put a price on it or offer money, indeed forming a market for organs, will result in fewer transplants. NKF supports many other programs that will increase transplantation; paired donation, pre-emptive transplants, living donation and extended criteria donors. But, NKF will continue to oppose all efforts to sell the Gift of Life.

John Davis

CEO of the National Kidney Foundation

John Davis:

To the Editor:Slate's article today featuring the well known views of Sally Satel does not justify making a commodity out of human body parts. Our Board of Directors, many of whom are transplant recipients or family members of recipients, has unanimously voted to oppose any effort to sell kidneys through a commercial transaction.

...there is little data to show that financial incentives would increase donation rates....To put a price on it or offer money, indeed forming a market for organs, will result in fewer transplants.

Dear Mr. Davis:

First of all and most importantly, let me express my sincere gratitude for the selfless work of the National Kidney Foundation. That said, I think your defense of the NKF's current position on this issue is seriously flawed.

(1) To incentivize a gift does not necessarily turn it a commodity, particularly when one is referring to dead donors. Rather, it simply provides a potentially persuassive source of motivation for individuals to consider an alternative to throwing the kidney away via burial or cremation. These still-viable organs are of immense value to potential recipients. Why can't this value also include some remuneration? You shouldn't limit this question to board members who have already received their donated organs but rather consider polling the thousands of folks currently on your transplant waiting list to see if they share these ideological concerns. If they don't, what would you do then?

(2) If there is little data to support Satel's argument, you similarly offered scant evidence to support the opposite position. Instead of speculating anecdotally, why not gather a sufficient amount of data to either support or refute this position? On the other hand, if the NKF would not support Satel's position no matter what supportive data emerges, then floating this particular line of argumentation appears disingenuous.

If NFK remains intransigently oppposed to financial incentives, then why not support "opt out" statues for organ donation instead? Either way, the perpetual shortage of donated organs is too important an issue to justify the current 'status quo' approach and simply hope that more publicity or education closes the current gap -- the numbers show that it's simply not working.

John Davis of the NKF ends with: "NKF will continue to oppose all efforts to sell the Gift of Life."

I assume that means the NKF will now oppose doctor's salaries and hospital charges. Surgeons must now give the gift of life without compensation, as must hospitals. But why stop there? Food is necessary for life, as is clothing, shelter, transportation...

Ahh, but those involve labor, you say! Of course we must allow those individuals to be compensated for their hard work. But what about oil out of the ground, then? The Saudis should, according to Mr. Davis's logic, allow our companies to remove their oil at no charge, since they, the Saudis, did nothing to create it or obtain it. It's a gift of Nature. Why soil the gift by putting a price on it?

Mr. Davis, economics tells us that we get more of something when we pay for it -- the supply increases along with the price. Forcing the price to be zero results in a low supply.

You may be right that purely altruistic donations would decrease, but the number of compensated donations would more than offset that slight decrease. We pay families a death benefit if their loved ones die in combat or in the line of duty as police officers, and no one complains that we "trying to put a price on their loved one." Why should a monetary thank-you gift to accompany organ donation be any different?

hkyriazi:

You may be right that purely altruistic donations would decrease, but the number of compensated donations would more than offset that slight decrease. We pay families a death benefit if their loved ones die in combat or in the line of duty as police officers, and no one complains that we "trying to put a price on their loved one." Why should a monetary thank-you gift to accompany organ donation be any different?

These are excellent points, hky -- especially the idea of creating something akin to a death benefit for donors (their families, actually). In fact, this could easily become the default policy of organ procurement agencies like NKF with the option for this stipend to be given back to the NKF as a tax-deductible gift in honor of their deceased loven one. That way, it no longer comes off so much as a 'bribe,' if this is a primary moral objection.

In response to Mr. Davis' assertion that there is no evidence that incentives will increase the quantity supplied and that he believes it will be reduced: (1) essentially every economist who has written on the question disagrees--including myself (and Nobel Prize Winner Gary Becker); (2) There is ample evidence that cash has increased the supply of kidneys from strangers in a variety of countries including Iran, the Phillipines, etc.; (3) Surely there is less reluctance to surrender cadaveric organs than organs currently being used by the original posessor; (4) I challenge Mr. Davis to name a single other medical good or service whose provision would be increased by outlawing its sale? If he can not do so then what makes transplant organs (from the living or the dead) different; (5) the accepted notion that for essentially all other goods (medical and non-medical) remuneration to the providor increases the quantity supplied creates a presumption (albeit rebuttable) that the same principle applies for transplant organs. The burden is on Davids to rebut the presumption by something more than bald assertion.

If 10.8% of people would be less likely to donate, and 68.2% of people would be unaffected.... doesn't that mean 21% of people would be more likely to donate kidneys? If so, the evidence would suggest paying for kidneys would generate enough new donations to more than offset the number of donations that would be lost.

I can understand the metaphysical argument, though I'm not bothered by the commodification of body parts (isn't that what the exchange of labor is, after all?). But unless you got more numbers you failed to divulge, it seems like you should stick to the metaphysics... because the math isn't doing you many favors.

Freditor_G:

If 10.8% of people would be less likely to donate, and 68.2% of people would be unaffected.... doesn't that mean 21% of people would be more likely to donate kidneys? If so, the evidence would suggest paying for kidneys would generate enough new donations to more than offset the number of donations that would be lost.

I can understand the metaphysical argument, though I'm not bothered by the commodification of body parts (isn't that what the exchange of labor is, after all?). But unless you got more numbers you failed to divulge, it seems like you should stick to the metaphysics... because the math isn't doing you many favors.

Thank you for pointing out the obvious problem with the survey quoted by John Davis. This completely removes any semblance of a serious counter to Dr. Satel's essay. He simply restates their position, which is hardly an argument.

There is a simple solution to the issue that poor people may sell a kidney due to economics, thus creating a situation in which there is a widening between the haves and have-nots. Why not limit the ability of a living person to give away organs for money? If someone is willing to give away a kidney while alive, usually it is due to the fact that they are giving the organ to a family member or friend for free. These types of donation will likely be unaffected by other donors being paid.

i question the validity of the poll cited by the NKF. i doubt that 68.2 percent of people would not be influenced by the offer of some sort of assistance for the gift of an organ (yes, it would still be a "gift" because it would be precious and provided voluntarily). Who in the country would not be pleased to be offered assistance in helping to pay for burial expenses, or a contribution to the deceased's favorite charity? Or partial payment of tuition fees for the deceased's son or daughter?

How can the self-proclaimed leading advocate for those with kidney disease create policies that in fact harm those it is supposed to serve? How many of the Board's members have been on dialysis (a living death) for five or ten years? Are the board members worried that their donations and influence would decrease if the waiting list for kidney's dropped?