In Defense Of Compensated Kidney Donation
Pay people for their work!
Guess what percentage of the United States budget is spent on treatment for end-stage renal disease (the last stage of chronic kidney disease, also known as kidney failure)?
0.8%.
In 2021, the U.S. government spent $52 billion on end-stage renal disease, out of a $6.8 trillion dollar budget. This is about $155 per person in the United States.
You can look up federal agencies by budget here. End-stage renal disease costs more than USAID, the primary anti-global-poverty arm of the United States. It costs more than the National Science Foundation. It costs more than the National Endowment for the Humanities and the National Endowment for the Arts, combined. It costs only $16 billion less than the entire Department of Justice. It costs more than the SEC, or the FCC, or the EEOC. It costs more than fucking NASA.
People with end-stage renal disease need either a kidney transplant or dialysis to live. Dialysis uses a machine to filter waste products from your blood—essentially doing the job of the kidneys. In the United States, dialysis costs about $40,000 per patient per year. Uniquely, 85% of dialysis patients are covered by Medicare, because of a U.S. law which grants Medicare coverage to most people with end-stage renal disease.
And dialysis sucks for patients. Often, patients need to go to a dialysis clinic for four hours a day, three days a week. Dialysis can come with side effects, which depend on the kind of dialysis the patient uses: these can include nausea, dizziness, low blood pressure, hernias, and weight gain. And the life expectancy of a person on dialysis is only ten years; a donor kidney lasts twenty years, and you can get repeated kidney transplants.
And the cost of dialysis—both to the United States government and to individuals—is nearly entirely avoidable.
In the 1980s, Iran adopted a policy of compensating living kidney donors. By 1999, Iran’s waitlist for kidneys was completely eliminated.
Selling kidneys? Isn’t that exploitative?
I don’t think so. In fact, I think that the current system exploits kidney donors far more. Kidney donation requires a surgery and four to six weeks off work, and it has real risks. People who donate kidneys ought to be fairly compensated.
Let’s imagine that a dialysis company announces one day that it was no longer going to pay its nurses. It is concerned that the nurses might not really be consenting to work as dialysis nurses. They might just be nurses for the money, when actually nursing leaves them worse off. Therefore, from now on, all its nurses will be volunteers.
One of the nurses protests, “But if I don’t give my patients dialysis, they’ll die.”
The company spokesperson says, “We’re just saying we won’t pay you. It’s up to you whether you want their deaths on your conscience.”
First of all, this is obviously a terrible way to employ dialysis nurses and thousands of people will preventably die. Second of all, this is clearly exploitative of the nurses. They are being asked to work without pay, because otherwise people they care about1 will die.
We on the left recognize that unpaid internships are exploitative. We recognize that it’s exploitative to expect people to put in unpaid overtime for the sake of their patients or their students or ~*~the cause~*~. Similarly, we should recognize that refusing to compensate organ donors is exploitative. I am convinced that if you investigated the bioethicists who are against compensating kidney donations, you would discover they’re funded by dialysis companies who don’t want to suddenly be cut off from the beautiful gushing flow of cash.
To put it as clearly as possible: workers should be fairly compensated for their labor, whether they’re nurses, janitors, McDonalds employees, artists, or kidney donors. “I can’t pay you for your work, because how would I know you’re consenting to it?” is some fantastic backwards logic and evil megacorporations everywhere are taking notes.
A friend of mine who has donated a kidney says:
The surgeon who does a kidney transplant is compensated. The nurses are compensated. The janitor who makes sure the rooms are clean is compensated. The beds and scalpels and IV pumps are not compensated. I want the acknowledgement that my contribution is more like that of a nurse than like that of an IV pump.
To be sure, we could make numerous improvements to the kidney donation system short of full compensation. For example, we could stop rejecting potential kidney donors because they had OCD as children and therefore can’t consent, and then make them fly to New York City multiple times in order to get around your deeply held belief that mentally ill people can’t have bodily autonomy. In his previous term, Donald Trump signed an executive order ensuring that donors at least didn’t lose money because of donating a kidney.
But, ultimately, I think that the best solution is to compensate kidney donors fairly for their work and the risks they’re taking. It keeps donors from being exploited, it gives new freedom to people with kidney disease, and with the money saved the U.S. government can fund an entire Bonus NASA. Elon Musk, are you listening to me?
Since dialysis occurs multiple times a week, many nurses form friendly relationships with their regular dialysis patients.
I'm kinda in the process of donating my kidney (I have to decide between liver lobe and kidney donation since I can't do both. No one has done an analysis of this tradeoff, but conversations with the hospital make me lean towards kidney donation). I largely agree and even think we should extend this to all types of organ donations, but I don't agree with you when you say "I am convinced that if you investigated the bioethicists who are against compensating kidney donations, you would discover they’re funded by dialysis companies who don’t want to suddenly be cut off from the beautiful gushing flow of cash."
I've read some of those bioethicists and they strike me as genuinely concerned for the poor. One possible problem is that poor people are often forced to take deals that give them a bit of money now in exchange for having to pay a lot of money later (see e.g. the whole predatory lending landscape). I can easily see a similar dynamic happening here: the government gives a bit of money, but not enough to compensate the full recovery/long term effects, and poor people are forced to take that option because they need money now. This is especially dangerous in low-governance regions where I can see this leading to black organ markets (for a possible worst case scenario, see this story about "blood farms" in India: http://news.bbc.co.uk/2/hi/south_asia/7302649.stm)
Now I think that with very *very* careful law drafting we can craft a bill that minimizes these dangers while still saving those suffering from kidney failure, but I can't blame people for being skeptical about whether their lawmakers can pull that off.
talking specifically to people who have already donated their kidneys for free whether, holding that fact about them fixed, they would rather be paid seems to be missing the point. *of course* there is a straightforward sense in which *these* donors would be better off! more money, with the same number of kidneys—things are better for them by precisely the amount they have been compensated in this envisaged scenario. maybe there is a sufficiently broad minded sense in which they would be worse off for their being exploited, but i can see easily why someone would overlook that in favour of the obvious benefits of cold hard cash.
the people for whom kidney markets pose a risk are those who do *not* donate without a market but would sell their kidneys on the market. the introduction of kidney markets is, effectively, levying a certain tax in opportunity costs on those who do not commodify their organs, thus coercing potential donors into selling them. its similar reasoning to other incursions on "freedom of contract" on anti-exploitative grounds, like bans on working more than a certain number of hours per week. maybe you disagree with this analysis, i certainly have not given a full throated defence of the position here, but it should be obvious that the victims being envisioned *arent the ones who have already donated absent market pressure to do so*.
something similar happens in how people talk about sex work and its abolition. opponents of abolition will point out how certain sex workers under a nordic system, say, are worse off than they would be if the system switched to full decriminalisation. idk, maybe, but thats sort of missing the point: sex work abolitionists want to use sex work regulation to *abolish sex work* on the grounds would be sex workers are better off in a world where they are not economically induced to sell their bodies for use. the ones currently selling sex services in this envisioned nordic regime are the ones for whom the regime has *failed* to abolish sex work. the real question is not how decriminalisation would affect them, but how it would affect other potential sex workers who would sell their services under the new regime—both in terms of how many there would be and how their circumstances would be affected. again, you can disagree with this line of thinking, many do, but the relevant questions are about those who *would* sell sex under decriminalisation but *not* under the abolitionist/nordic system, not about those who would sell it under *both*.