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The case for a regulated system of living kidney sales

Nature Clinical Practice Nephrology volume 2, pages 600–601 (2006)Cite this article

Let me establish where I stand on this complex issue by first answering a few questions. Am I in favor of justifying or encouraging immoral practices? Of unfettered buying and selling of kidneys for transplantation? Of undermining altruistic donation of cadaveric organs? Of commodification of the human body? Of exploitation of the poor by the rich? Of erosion of important societal values? The answer is 'no' in all cases. There is, however, another equally important set of questions related to what is happening in the real world. Am I in favor of encouraging black markets? Of exploitation of kidney donors by unscrupulous middlemen? Of endangering the lives of donors undergoing nephrectomy in poor, unregulated conditions? Of transplant tourism? Of ignoring evidence of the unrelenting increase in commercial transplantation and the failure of legislation—for example, in India—to eliminate this practice? Again, the answer to all these questions is 'no'. Our current approach, however, of expressing revulsion at the sale of organs while ignoring the realities, condones all these eventualities.

Transplantation is a victim of its own success. The shortage of organs and the number of patients awaiting transplants is growing. In the US, 90,000 patients are on the waiting list, of whom 6,000 die every year; in cities, there is a 5–7-year wait for a cadaveric organ, and some patients take matters into their own hands by advertizing for a donor on highway billboards, by consulting websites, by making personal pleas in the media, by listing themselves in multiple registries and by relocating. As a result, monetary incentives have been seriously considered. In 2002, the American Medical Association voted to endorse pilot projects to give families financial rewards for donation of deceased relatives' organs and some states do now offer such tax incentives. Recipients can legally reimburse living donors for medical bills and other expenses, blurring the line between this and “payment” for organs, which is forbidden by the 1984 National Organ Transplant Act as “valuable consideration”. Even the issue of revulsion is turned on its head by 'freakonomists' advocating a market approach.1 It is not surprising that there is talk of organ sales from living donors taking place on the quiet in the US.2,3 All this happens in a wealthy country where dialysis is funded by the federal government.

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Authors and Affiliations

  1. AS Daar is Professor of Public Health Sciences and Surgery, Director of Ethics and Policy for the McLaughlin Centre for Molecular Medicine, and Co-director of the Canadian Program on Genomics and Global Health at the University of Toronto, Toronto, ON, Canada

    Abdallah S Daar

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Correspondence to Abdallah S Daar.

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Daar, A. The case for a regulated system of living kidney sales. Nat Rev Nephrol 2, 600–601 (2006). https://doi.org/10.1038/ncpneph0320

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