Kwok 1

Jolin Kwok
SOCS-S210
Christi Smith
July 6, 2010
Reflection Paper 1:
Much Ado About Kidneys

A Two-Page Introduction

Ideally, people come to life and pass away with two—preferably functioning—kidneys.

However, not everyone has that privilege. One or both kidneys may malfunction at some point in

life and cause various medical health issues which may make life difficult. The socially

acceptable contemporary solutions so far are either the acceptance of dialysis or a donated

kidney (usually from a cadaver). However, as of May 2001, nearly 49,000 patients are waiting

for a kidney in the U.S., making the kidney “the organ in greatest demand”, followed by the

heart. An interview with nephrologist Michael Friedlaender of Hadassah University Hospital at

Jerusalem aptly summarizes the situation of legal organ donation:

Between 1990 and 1999, despite numerous marketing efforts trying to persuade people to

sign donor cards, the U.S. organ waiting lists grew five times as fast as the number of

organs donated. By the end of this decade, it is estimated that the average wait for a

kidney will exceed 10 years. (Finkel)

On the brighter side, as of 2005, according to statistics collected by Gary S. Becker and Julio

Jorge Elias, the waiting list for legal kidney donation lasts for about 5 years. Either way, many

people are dying in consequence and as Friedlaender puts it, “the current system of organ

donation without remuneration…is a failure”.

Ironically, while it is difficult to procure legally donated organs, transplant operations

have become safer and easier. Furthermore, according to Finkel, “the kidney is the only major
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organ that can be wholly harvested from a living person, leaving the donor essentially

unharmed”. Hence, it makes economical sense to some people to purchase kidneys from live

donors. To compare the quality between the kidney of cadaver and one of a live donor, one has

to understand that the match of the organs of the donor and the recipient as well as the timing of

the transplant surgery are very important in determining the “long-term outcome of [the] medical

transplantation”. As kidney donations from cadavers have to be transferred within 2-3 days, this

places a barrier in ensuring ideal matches between donors and recipients (Becker and Elias 22-3).

Moreover, as kidney buyer Avriham says,

Why should I wait years just to have a kidney from someone who was in a car accident,

pinned in his car for hours, then in miserable condition in the I.C.U. for days, and only

then, after all that trauma, have part of him put inside me? That organ is not going to be

any good! Or, worse, I could get the organ of an elderly person, a person who died of

stroke or an aneurvsm—that kidney is all used up! It’s better to take a kidney from a

healthy young man who can also benefit from the money.

Friedlaender further supports the use of kidney transplants from live donor after he compared

“his illegally transplanted patients with those transplanted in his own hospital…[and] found that

the percentage of illegal transplants still functioning after one year was, in fact, slightly higher

than his own hospital’s success rate—and that of many U.S. hospitals”. He attributes the positive

difference to “the benefits of transplanting kidneys from living donors” (Finkel).

Yet, kidney transplants from live donors are illegal. The National Organ Transplant Act

of 1984 charges anyone convicted—of buying or selling human organs—a $50,000 fine on top

of five years in prison. So far, the ethical issues regarding the succession of illegal kidney

transplants generally center on the commodification of human body parts essentially “reduces
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[them] to bags of spare parts”, as well as the lack of transparency in both medical and business

procedures, which in turn potentially turns someone’s poverty into another person’s gold mine,

so to speak (Finkel). This issue is also reflected in Swedberg’s observation that a “market-

centered economy (involves) the exploitation of certain groups” (66). In order to address these

concerns, I shall refer to the legal standards of other human body-related commodifications—

such as blood donation, as well as ovum and sperm donation—and the main problem when

looking at monetization. By the end of the discourse, I shall also introduce diverse ways to

approach the issue of selling human kidneys.

Buying Kidney is Bad, Selfish, Inhuman

Commodification is to make something a commodity. In the eyes of many, to make the

human body—any part of it—a commodity is an unforgivable act. Opinion leaders in the

medical field describe the commodification of the human kidney with sentiments like “…morally

and ethically irresponsible” and “inhumane and unacceptable”. Pope John Paul II says the

commercialization of human organs violates “the dignity of the human person” (Finkel).

Emerson would certainly also disapprove of the purchase of someone else’s kidney. For him,

“we cannot be bought or sold”, for those economic acts are not of warm giving but of cold

insincerity. As people who buy kidneys from live donors usually are more concerned about how

the kidneys would be of service to themselves—as opposed to be concerned about the gift giver

too—Emerson thinks they should be ashamed to “see that [they] love his commodity and not

him”. Commodification complies with the notion of Homo Economicus—perpetuated by 18th

century thinkers like Adam Smith and David Ricardo—whereby human beings are presumed to

be of rational nature and will always try to maximize their utility, usually from monetary

interests. This shapes the market logic that people who get remunerated or paid for their donated
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organs are simply being utilitarians, void of sincere, selfless care-giving which Rene Almeling

calls “altruistic rhetoric” (323).

Yet, the contradiction lies behind the scenes of perceived acts of “altruistic rhetoric”.

While ovum donors are being painted the image related to the idealized care-giving motherhood,

they are being paid lucratively based on their donation experience and superficial qualities such

as physical appearances and ethnic background. Should they to take advantage of the system and

create a “career” of selling ova, they “provoke disgust among staff, in part because they violate

the altruistic framing of donation” (Almeling 334). Kieran Healy notes that even with the

presumed “purest”, ever-altruistic act of blood donation, it is the organizations that make the

contexts for giving (1633). On the other hand, upon realizing how the current legal system

regarding kidney transplants impedes his patients—and many other people—from getting

healthier, Friedlaender laments:

My patients don’t want my opinion on whether or not buying a kidney is moral—they

want to know if it’s safe. And I have to say that it is. It’s as safe as having a transplant at

a U.S. hospital. I realized that I had no right to actively stop my patients from going. I

realized that it may be harming them not to go (Finkel).

Ultimately, to those who are aware of the feasibility of utilizing the kidney from another live

person, when they are desperate to save lives—be it their own or others’—social mores may be

the last things on their minds.

It’s All About the Money

An argument against the selling of human organs is that medium used for this economic

transaction—money—is highly corruptive. This corresponds with the “separate spheres and

hostile worlds” idea Viviana Zelizer speaks of. According to Zelizer, money and intimacy (for
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the purpose of this paper, “intimacy” extends to the human body or organ) “represent

contradictory principles whose intersection generates conflict, confusion, and corruption” (27).

While we cannot deny the possibility that money can demoralize the efforts of a remunerative

kidney donation program, we can acknowledge that money does not have to depersonalize all

interactions. It is widely acknowledged that money is a universal medium of exchange in societal

markets, thus it only makes sense that amongst all forms of gifts one can offer another, money

can prove to be the most practical at times. For example, as per “connected lives”, not all

relationships rely on monetary relations to define themselves and close, trusted, “intimate”

relationships are usually marked by “intimate” rituals such as the use of a joint bank account

between a couple for sharing household expenses (Zelizer 33). Therefore, rather than a mere

commercial medium, the monetary compensation offered by an organ donation program under a

remunerative system can be established as a largely appreciative gesture towards the organ

donor, which value the paper shall discuss later on.

Nonetheless, it is unfortunate that the current monetary procedures relevant to kidney

transplants benefit the organ broker—the person who arranges the meetings of the organ donor,

medical practitioner(s), and organ recipient—the most, fiscally speaking. She or he subtracts a

large percentage from the economic transaction, in exchange for his or her legal risk. On the

other hand, the organ donor receives some amount of short-term monetary compensation (and

perhaps altruistic satisfaction too) while the organ receiver bears the total financial cost as

charged by the organ broker, on top of an organ that has no guarantee of quality control. But

despite the high risk of dealing with unwanted consequences from this illegal path, a growing

number of people—mostly very sick and some tired of the legal waiting list—think it is a risk

well-calculated (Finkel).
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Helping the Helpers and Everyone Else

This paper shall now discuss suggestions to improve the current kidney donation program

so to make a remunerative organ donation program more socially acceptable. From a

sociological perspective, the government can and should intervene to help, especially the

consumers of this market. Governments can propagate and enforce appropriate property rights,

such as contract laws that will protect the parties involved in the business transaction with legally

binding agreements. Generally, as Carruthers and Babb put it, “insecure property rights are cited

by economists as a factor contributing to economic underdevelopment [for] without reasonably

secure property rights, markets cannot function” (5, 8).

Essentially, with a properly enforced legal system, governments can promote a more

equitable, state-run medical system. Not only would this help to cease the current black-market

economic exploitations of those fiscally less privileged, this would make sure that there is equal

access to this health benefit. By legalizing remunerative kidney donations, the supply of kidney

donation will undoubtedly increase, thus offsetting the wait time for patients needing a kidney

transplant. Subsequently, this should decrease the need for a dialysis too, which increased

savings ideally result in the increase of demand for paid kidney transplants and ultimately

decreasing the overall cost of the kidney transplants; thus increasing the supply of kidney donors

(and decreasing mortality) at a much more preferable rate. Incorporating this new legal system

with the existing one, it is reasonable to expect that patients in need can then be paired off with a

suitable donor, dead or alive.

Similarly, Friedlaender and other Israeli and American lawyers and medical ethicists

support ideas for a specific legalization plan. A national regulatory board amongst several

regional centers would serve well as gatekeepers of the system, in order to promote the best
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interests of the patients and the donors. As part of a national health system, taxes collected

nationwide will be used to support the payment by the regulatory board to the kidney donor,

whether by a suggested sum of $25,000 or “via an indirect method, like a reduced income tax

rate or free health insurance”. In fact, a seemingly ideal model for such a market is found in Iraq.

According to Friedlaender:

This market…appears to offer kidney transplants performed by excellent surgeons, with

careful screening of sellers, extraordinary postsurgical care and a success rate that

evidently rivals even the finest U.S. hospitals. The program seems absent of false

promises and persistent rip-offs. The price is a bargain. Some people have even idealized

this program as a model of how a legalized system might one day function. (Finkel)

In addition, only a firm legal system can ensure the authenticity of the organ donor.

Oftentimes, the organ seller comes from a relatively impoverished position. Some people may

even pursue extreme means to obtain monetary compensation of a remunerative organ donation

program, by involving third parties in the sale of organs. As a preventive measure, in all fairness,

the relevant regulatory boards may execute extensive screening processes like the ones applied in

the recruitment of ovum donors, all in the name of the “altruistic rhetoric”. Respective kidney

donors and kidney recipients will also work with individual, regulatory board-approved medical

practitioners who will ensure the physiological and psychological eligibility of all parties

involved in the kidney transaction. In the effort of ensuring quality, it is important that the

medical and political authorities keep in mind that both the donor and the recipient are not mere

commodities in spite of the commoditative act of the kidney transaction.

Last but not least, while it is previously suggested that the kidney donor or seller be paid

a minimum of $25,000 as a form of monetary compensation, as that is taking a step in the future
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of potential legalized remunerative kidney transactions, we shall discuss why kidney donors

should be paid at all. Although under the disguise of the “altruistic rhetoric” which health

systems in general are well known for, medical practitioners are paid for their services. Why then

should the person giving up a limited, essentially invaluable part of themselves for free? It seems

only just to compensate them accordingly. After all, it is not as if organ donors are ignorant of

what they are consciously doing to their bodies. Moreover, to quell fears of malpractice and

abuse of trust, it is the duty of the regulatory boards to pressure all parties to “respect relevant

moral and legal codes” (Almeling). Should the regulatory boards take a leaf out of the books of

reproductive material donation regimes, they can also successfully encourage the social

acceptance of paid organ donations with the “altruistic rhetoric” of the donors’ selfless gift-

giving of their own kidneys, with the monetary compensation as a benefit secondary to altruistic

satisfaction. To further override concerns of participants of the kidney transaction with mostly

economic rational, Becker and Elias brings a comparison with “military volunteers” who “surged

after the terrorist attack on 9/11 because of patriotism” (27). If those volunteers are being paid

for volunteering their own bodies to defend their country, in effect they are also commodifiying

themselves. Then, it is only reasonable that kidney donors—assumed to be volunteers out of

altruism or out of need after procedural screenings—be paid too. 

Conclusion

However paradoxical the relationship between bodily commodification and altruistic

motivations or acts may seem to be, it clearly shows that they fundamentally cohabitate in the

societies we live in today. For those against bodily commodification, they often reason in terms

of “separate spheres and hostile worlds”. The body is sacred on moral and/or religious grounds

and to apply impersonal, utilitarian conditions on it is to render the world an eventual

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meaningless marketplace. Conversely, those for bodily commodification—in this case,

remunerative kidney transplants—see the transaction as a nothing-but economic benefit that

connects with the greater altruistic good in the present and the future. Just like what Zelizer says,

“[i]n order to arrive at clearer, more equitable, and more effective policies…we must get past the

simple opposition of sustaining intimacy and corrupting markets” (40). Therefore, using the

sociological imagination, it becomes easier to see why there is every reason to reward selfless

acts with the currency we use within a growingly globalized yet homogenized society, among

“connected lives”.
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Works Cited

Almeling, Rene. "Selling Genes, Selling Gender: Egg Agencies, Sperm Banks, and the Medical

Market in Genetic Material."

Becker, Gary S., and Julio J. Elias. "Introducing Incentives in the Market for Live and Cadaveric

Organ Donations."

Carruthers, Bruce G., and Sarah L. Babb. ECONOMY/SOCIETY: Markets, Meanings, and Social

Structure. Thousand Oaks, CA: Pine Forge Press, 2000. 5,8. Print.

Emerson, Ralph Waldo. "Gifts: An Essay by Ralph Waldo Emerson." About Ralph Waldo

Emerson. Cyber Studios Inc., 2010. Web. 24 Jun 2010.

<http://emerson.classicauthors.net/GiftsAnEssay/>.

Finkel, Michael. "Complications - NYTimes.com." The New York Times - Breaking News,

World News & Multimedia. 27 May 2001. Web. 03 July 2010.

Healy, Kieran. "Embedded Altruism: Blood Collection Regimes and the European Union's

Donor Population." The American Journal of Sociology 105.6 (2000): 1633-657.

Swedberg, Richard. "the market." Contexts. 6.4 (2007): 66. Print.

Zelizer, Viviana A. Rotman. "Encounters of Intimacy and Economy." The Purchase of Intimacy.

Princeton, N.J.: Princeton UP, 2005.