Consider the following. A young boy aged 10 has had kidney failure for quite some time. Dialysis is now no longer sufficient to keep him alive. He is now in desperate need of a kidney transplant. That will not only save his life, it will give him a normal and healthy life with a normal lifespan.
He is on the UNOS list. This is an organization that seeks donor organs for those in need of lifesaving transplants. They have an official and ethical protocol as to who gets them first. The problem is that a donor has not been found for this child. The kidneys that are available are incompatible and cannot be transplanted. His only hope is that of a private donor. Appeals to the public have thus far been unsuccessful.
The ratio of those in need far exceeds the available donors. It is probably relatively rare for people to donate kidneys to others. I know of only two people who have done so voluntarily. One was a daughter who donated a kidney to her mother. And the other is a truly altruistic young man who donated one of his kidneys to a recipient he didn’t even know.
Back to the story. This bright and upbeat 10 year old is well behaved with the kind of Midos that we all hope our own children develop. He is loved by his parents, extended family, teachers, and friends. He never gave anyone a moment’s trouble or anything other than pure Nahcas! And now he is about to die unless he finds a donor. But there is no donor. Doctors have given him at best 48 hours to live without one.
Across town there is a fellow is about to be evicted from his home. He has lost his job and is behind over a year in his mortgage payments. In this bad economy he cannot find another job. He has no income and no savings. He is desperate for the $25,000 the bank requires by the end of the month in order for him not to be evicted! He has a family. They need a roof over their head. He is desperate.
Along comes Levy Izhak Rosenbaum who happens to know both the dying young boy in need of a kidney and the poor fellow who is desperate for funds. So he makes a ‘Shiddach’. He suggests to this fellow that to save his family from being evicted into the streets - he sell one of his kidneys to the family whose son needs one in order to survive. It turns out the kidney is compatible with that child. They agree on a price of $40,000. Mr. Rosenbaum takes a 10% fee. The result is that the young boy’s life is saved. The fellow who was about to be evicted pays off his debt to the bank, keeps his home and has a few dollars to spare.
Is this a win/win for everyone? Is there anything wrong with this picture? Here is the other side of the coin.
Trafficking in human organs it would seem is one of the most reprehensible crimes one can commit. Profiteering by getting people to sell their organs conjures up all kind of nefarious motives on the part of black market brokers who do it. It conjures up unsanitary ‘back-alley’ operations to remove and transplant the kidney. It is in fact illegal. Organs cannot be bought and sold. The very idea of convincing someone to sell one of his easily elicits a reaction of disgust. Most people are revolted by it.
But let us analyze this as dispassionately as we can. As I see it - the problems with doing this are as follows. Surgery is required to remove a kidney. Surgery always involves a level of risk. Post operative complications like infection can ultimately kill you. Even though the risk is very small (I believe that only one in 4000 people have died as a result of it) the risk is still there. What if you are that one in 4000? No one requires that you save the life of another at risk of losing your own.
Secondly there is the fact that by donating one kidney you run the risk of your own kidney failure without ‘the spare’. True, one can live a perfectly normal and healthy life with just one kidney… should anything ever go wrong, you no longer have the spare kidney that God has given you to rely on.
There is also the circumstance of illegal operations taking place under the less than ideal conditions of a hospital.
And then there is the rich man- poor man aspect to this. If kidneys are bought and sold on the open market, it can easily end up being the case that only the rich will have access to these kidneys. In a free market where the demand is so great and the supply of kidneys so low, I can easily see the price of a kidney being out of reach for the average man.
And finally there is the mercenary aspect of it. Profiteering by trafficking in human organs just seems to be plain disgusting.
Given the above reasons it is quite understandable why it is illegal to buy and sell organs from living donors.
I have agonized about this for a while now and I’m simply not sure what the most ethical approach to this problem is. The above mentioned Mr. Rosenbaum has recently admitted in court that he brokered three illegal kidney transplants. When this news first broke during another unrelated scandal, I was appalled by the fact that anyone would do something like this.
But I have taken another look at it and now wonder if the three people who had those transplants would still be alive today if not for Mr. Rosenbaum. The three donors are very likely still alive too and I'm sure function quite well on one kidney. Their health will very likely be unaffected by what they did. Is it fair to look down at them for selling one of their kidneys? Leaving legal issues aside - is it fair to condemn Mr. Rosenbaum for making some money while saving three lives?
Is it unethical? What if it were me or you or a loved one who needed a kidney to live? Would we not do whatever it takes to live – if it did not harm others? Would money be an object when it comes to saving our own lives or those of our loved ones? I know what my answer would be. I would buy the kidney!
That begs the question, should we change the law about trafficking in kidneys? If so how do we prevent abuse or excessive profiteering? How do we make this ethical?
I think it can be done. It can be regulated by an ethics committee consisting of medical and religious leaders who can prevent or at least limit abuse. It will certainly take it away from the current black market and the back-alley operations.
I know it sounds a bit untoward to be buying and selling organs from living donors. It still troubles me just thinking about creating such a market. But when lives are at stake… maybe it should be considered.
