On Wednesday night, Natalie Cole announced on Larry King Live that both of her kidneys were failing following a decades-long battle with Hepatitis C; without a kidney transplant, she lamented, she'd be looking at a life of dialysis.
Within minutes of her sharing her illness with the world, dozens of Cole's fans had emailed the show with offers of their organs. "There are some great human beings out there," Cole said of the outpouring. It's a heartwarming story, but it also underscores a major problem in America: the giant gulf between those in need of an organ and those willing to donate one. When patients waiting in an endless line for a kidney transplant are relegated to making on-air pleas for help, something’s seriously wrong with the system.
We need to pay people because, although one can live without two kidneys, the process of extracting one is hell.
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As Americans everywhere wait to see how Barack Obama will handle medical care, allow me to suggest to the new president a solution: an open, regulated, and legal cash-for-kidneys market in the United States.
It's a subject very near to my abdomen. Last summer, I traveled to Riyadh, Saudi Arabia, to donate a kidney to my ailing father, who lives and works there. By the time I arrived, his kidneys were functioning at 5 percent of their capacity and he was going to four hours of dialysis, three times a week. After the sessions, I would watch him struggle up the stairs, his weary body shaking, belying my childhood memories of riding on his broad, solid shoulders. Giving him my left kidney was an honor, and I'd do it again—even if there weren't thousands of dollars in it for me the next time.
See, like many in the creative underclass of New York, I was gainfully employed, yet still without health insurance. When my father's illness got gradually worse, I eagerly volunteered to donate. But because kidney donation in America is a nonprofit enterprise, the myriad expenses associated with the operation and the years of aftercare fell beyond my ability to pay. Before I could even broach this dilemma with my dad, he wired me thousands of dollars to pay for insurance and initial testing. Would I have gone through with the donation without the money? Probably—only because he was my father. The point is that the offer of money made me absolutely certain I wanted to donate.
To make such a sacrifice for a stranger, I’d almost definitely require some similar monetary encouragement. And with 83,000 Americans desperately waiting at least five years for a donated kidney—thousands of whom will die before they get it—the U.S. government has a responsibility to provide that encouragement.
Because although one can live without two kidneys, the process of extracting one is hell. Before the operation, when I wasn't in the hospital giving blood or getting weighed, I was at home, collecting my urine in big plastic bottle for testing. After the surgery, I would sleep half the day away, partly because I was on heavy medication and partly because it hurt to be awake. Sneezing and laughing were agony; simple things like rolling over in bed required yoga training. Even six months later, my surgeon told me not jog or play tennis. I'm completely fine now, but the fact remains that unless you're Natalie Cole, it would probably be next to impossible to get a stranger to make such a sacrifice for nothing more than good karma.
Were the U.S. to create a cash-for-kidneys market, we wouldn’t be the first. Currently the only nation in the world that allows the buying and selling of living donors' organs is Iran, which adopted the practice in 1988 when it could no longer ignore the rate at which patients with end-stage renal disease were outpacing willing kidney donors. Whatever you might think of Iran’s politics, the results have been noteworthy. According to an article published in the Clinical Journal of the American Society of Nephrology in 2006, in the years since Iran started the nationally regulated and funded program, the wait for a renal transplants has vanished. In Iran, the kidney waits for you.
Outside of Iran, the only place to easily obtain a kidney is on the thriving black market, an option my father says he also considered, and one that's just a Google search away. The World Health Organization estimates that around 14,000 kidney transplants per year—some of them performed right here in America—are done with illegally obtained organs, kidneys purchased from living Indians, Pakistanis, Brazilians, often for about $5,000.
I asked my dad if his thoughts of purchasing an organ from the third world were ever accompanied by pangs of guilt. "Absolutely none!" he said. "The arrogance of those who decide that they know what is best for me, you, the poor, and the sick is just staggering."
Countries less offensive to Americans than Iran are also considering legalization. Last week, Singapore's parliament legalized monetary reimbursement for living organ donors. It's now completely aboveboard—and probably expected—for a kidney recipient in Singapore to pay for his donor's travel expenses, lodging, or time off from work. The hope is that the legislation will lead to a larger, government-run version of America's National Transplant Assistance Fund, a nonprofit that provides some assistance for some uninsured organ donors' medical expenses (though it’s far too small to help everyone in need, and doesn’t offer any cash “reward” on top of expenses as incentive for potential donors).
The chief argument against a cash-for-kidneys system is that it will summon an outright organ market, one in which the rich procure second chances at life from the poor. Nancy Scheper-Hughes, a professor of anthropology at Berkeley and one of America's most vocal critics of the organ trade, criticizes kidney sales for two main reasons. What she most takes issue with is that organ sellers are often impoverished laborers who return from their surgeries unable to work and without the proper aftercare. Soon, their fee is spent on things other than their health, and they're drinking unclean water and eating bad food, neglecting a body that needs time to recover. The professor's second point is less tangible: She believes it's dangerous to commodify the human body. "It's the sense that body and soul are connected," she once told the Christian Science Monitor, "and selling your body is chipping away at what gives you existence."
Her first argument doesn’t hold water. Every reputable proponent of legalized organ sales (which, by the way, includes both Dr. Arthur Matas, former president of the American Society of Transplant Surgeons, and Dr. Benjamin Hippen, transplant nephrologist at the Carolinas Medical Center) says they envision a market that's strictly regulated by government bodies, preventing donors from getting hustled and left to fall ill. As it stands now, the criminality of the organ trade is what’s dangerous. My father recalled asking his surgeons if buying a kidney in the black market was safe. "They couldn't give me an answer because there are no records kept in the black market," he said. "But what they could do was tell me about all the people they saw who were now sick and dying because the black market is unregulated."
Dr. Michael Friedlaender, head of the kidney-transplant follow-up unit at Hadassah University Hospital in Jerusalem, has likened the black-market organ trade to abortions in years past: "Though I hate to compare it, because this saves lives, it's like abortions, where the illegal state of abortion caused terrible things to happen to young women,” he says. “[With organs], we have no control over standards, over payments, over follow-up health care. You can make standards only for things that are legal."
As for Scheper-Hughes' point about commodifying the body, since when is that new? There are a countless instances in which America allows the poor to do dangerous things with their bodies for money. Working-class people shoulder the burden of war; they risk their lungs and limbs in mine shafts, factories, slaughterhouses, and fishing boats. And it remains perfectly legal for a surrogate mother to sell her womb—also no small physical burden. What makes a kidney so special?
I think it’s similar to America's failure to consider legalizing marijuana. Both are supported by many medical professionals, but the political will to change the law exists for neither. Yet every day, 17 Americans die while waiting for a kidney. It’s an organ most of us could give to them easily, if only there were a system in place to compensate us for our trouble. My father was lucky to have my support and the resources to go elsewhere if he didn't. But with such a definite source of life constantly operating just out of the reach, it's a shame that luck comes into the equation at all.
Cord Jefferson is a writer living in Brooklyn. He is the managing editor of Jossip Initiatives and his work has appeared in Filter, The A.V. Club and National Geographic . You can read more about his kidney operation here.
