In Defense Of Compensated Kidney Donation

Pay people for their work!

Photo by Robina Weermeijer on Unsplash

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?

1. Since dialysis occurs multiple times a week, many nurses form friendly relationships with their regular dialysis patients.