For those in need of a kidney transplant, it can be a difficult journey to find a willing donor. Circumstances have become so desperate for those waiting for a posthumous kidney that they sometimes resort to advertising their need on billboards and websites. Even worse, some may turn to the black market.

On August 24, 2009, the American Enterprise Institute discussed these issues with Dr. Sally Satel, a resident scholar at AEI and beneficiary of a kidney transplant. Satel argued that the best way to procure more organ donations is to compensate donors.

“I’m far from alone in my interest in this [issue]. Ever since, frankly, the [19]70′s people have been talking about the fact that there are not going to be enough organs [because] every year the list gets longer and longer,” she said.

Her position is not without controversy. In 1984, Congress passed The National Organ Transplant Act, making it illegal to receive money or anything of value in exchange for an organ.

Satel argued that such policies are “not enough” because they focus on the “one prong strategy” of altruism. While she referred to herself as the “poster girl” for someone who benefitted from altruism, Satel cautioned that even altruistic situations can have an element of coercion. One example proffered by Satel is the pressure family members may be under to donate an organ to a fellow family member in need.

“This is a dark side of altruism that no one talks about. In fact, a system that imposes an altruist narrative and policy … is complicit in a lot of emotional coercion,” she said.

Without a healthy kidney, patients must undergo dialysis treatments to remain alive. Each session of dialysis lasts about 4 hours. Many patients say that this undertaking inhibits their quality of life.

Some patients wait on transplant lists for years. Satel says patients living in major cities have to wait between five to eight years in order to obtain a transplant.

“You wait in line to take your turn to die,” she said.

Satel expressed her concerns about what she calls the “symptoms of a dire, dire organ shortage.” She argues that these circumstances lead people to take desperate measures such as turning to the black market.

“People are desperate. When they get desperate to save their own lives it’s really hard to fault them,” she argued.

Satel relayed the story of Levy Izhak Rosenbaum, a man from Brooklyn who would broker kidney sales to needy Americans by matching them up with donors from Israel. Both the donor and the patient would arrive at the transplant center and falsely claim to be friends in order to obtain a transplant.

Satel said that she might have considered a similar option in order to save her life. “What a position to be in…where I would be involved in a transaction where [the broker] would charge $160,000. The donor allegedly gets $10,000. Who knows if the donor even gets paid? That’s the kind of financial asymmetry that you see in a black market because there are so many costs to the broker,” Satel said.

Instead, Satel argued for a “regulated market” to take third-party brokers out of the picture. According to Satel, replacing private contracts for “in kind” benefits such as tax credits, tuition vouchers, or contributions to one’s 401K would deter those from selling an organ because they are desperate for cash.

Another angle in this debate would be to consider compensating the estates of deceased persons who choose to donate their organs. The altruistic aspect would still play a part, because the beneficiaries of the estate would be compensated instead of the donor.

Still, for many there is a concern that selling organs puts a price tag on the human body. Satel called this concern a “strawman” and points out that “we don’t commodify our health by paying physicians.” She added that the main concern of “dignity and respect” for the individual donor can be achieved through treating donors as “autonomous being[s]” who can “make a decision about [their] own fate” by considering their “own best interests.”

“This isn’t an exercise in altruism,” Satel argued. “This is an exercise in more organs so more people can live and needless suffering can be reduced.”

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