President Trump signed an executive order yesterday that seeks to improve the diagnosis and treatment of kidney disease and increase the number of donated kidneys for transplantation.
I am aware of some of the behind-the-scenes conversations that went into this policy thrust, and I certainly support the goals and the methods the president has highlighted. But I think great care is required. In particular, I want to focus on the issue of living donations. From the order:
Supporting Living Organ Donors: Within 90 days of the date of this order, the Secretary shall propose a regulation to remove financial barriers to living organ donation. The regulation should expand the definition of allowable costs that can be reimbursed under the Reimbursement of Travel and Subsistence Expenses Incurred Toward Living Organ Donation program, raise the limit on the income of donors eligible for reimbursement under the program, allow reimbursement for lost-wage expenses, and provide for reimbursement of child-care and elder-care expenses.
This is well and good. It is against the law to compensate people for supplying an organ, but not illegal to reimburse a donor’s reasonable expenses. Unfortunately, under current practices, some of a donor’s actual out-of-pockets may not be covered, thus requiring some to pay for their own fleshly generosity, while potentially dissuading others who might be willing to donate except for those costs.
So, by all means, expand the category of recoupable expenses. But as the bureaucrats craft the rule, they need to be careful not to cross the line into creating a financial inducement for someone to give up a kidney.
There are many reasons for forbidding organ markets, including but not limited to the potential for exploiting the poor. After all, if kidneys can be sold, the poor are going to be the ones doing the selling–creating a whole new consequence from income inequality.
In this regard, it is also important to keep in mind that while living kidney donations usually work out fine, it is certainly not a risk-free proposition. Removing a kidney is serious surgery. Consider this:
- Three in ten thousand donors die.
- Morbidity is around ten percent.
- The potential for long-term health consequences have not been adequately studied.
I am certainly not trying to dissuade would-be altruistic kidney donors — as Fox News journalist Ed Henry is doing for his sister (liver). But people should not be induced by money or other benefits to risk their lives and health.
Or, to put it more simply. Making it easier for one to become an altruistic donor is fine. But inducing people to become organ vendors is not.