TIME: Almanac 1990/1990 Time Magazine Compact Almanac, The (1991)(Time).iso/time/031389/03138900.015

Text File | 1990-09-22 | 6KB | 111 lines

ESSAY, Page 88

Take My Kidney, Please

By  Michael Kinsley


    Even Margaret Thatcher's devotion to the free market has some
limits, it seems. Reacting to newspaper reports that poor Turkish
peasants are being paid to go to London and give up a kidney for
transplant, the British Prime Minister said that "the sale of
kidneys or any organs of the body is utterly repugnant." Emergency
legislation is now being prepared for swift approval by Parliament
to make sure that capitalism does not perform its celebrated magic
in the market for human organs.

    Commercial trade in human kidneys does seem grotesque. But it's
a bit hard to say why. After all, the moral logic of capitalism
does not stop at the epidermis. That logic holds, in a nutshell,
that if an exchange is voluntary, it leaves both parties better
off. In one case, a Turk sold a kidney for (pounds)2,500 ($4,400)
because he needed money for an operation for his daughter.
Capitalism in action: one person had $4,400 and wanted a kidney,
another person had a spare kidney and wanted $4,400, so they did
a deal. What's more, it seems like an advantageous deal all around.
The buyer avoided a lifetime of dialysis. The seller provided
crucial help to his child, at minimum risk to himself. (According
to the Economist, the chance of a kidney donor's dying as a result
of the loss is 1 in 5,000.)

    Nevertheless, the conclusion that such trade is abhorrent is
not even controversial. Almost everyone agrees. Is almost everyone
right? This question of how far we are willing to push the logic
of capitalism will be thrust in our faces increasingly in coming
years. Medical advances are making it possible to buy things that
were previously unobtainable at any price. (The Baby M. "womb
renting" case is another example.) Meanwhile, the communications
and transportation revolutions are breaking down international
borders, making new commercial relations possible between the
comfortably rich and the desperately poor. On what basis do we say
to a would-be kidney seller, "Sorry, this is one deal you just
can't make?"

    One widely accepted category of forbidden deals involves health
and safety regulations: automobile standards, bans on food
additives, etc. Although we quarrel about particular instances,
only libertarian cranks reject in principle the idea that
government sometimes should protect people from themselves. But it
is no more dangerous to sell one of your kidneys than it is to give
one away to a close relative -- a transaction we not only allow but
admire. On health grounds alone, you can't ban the sale without
banning the gift as well. Furthermore, the sale of a kidney is not
necessarily a foolish decision that society ought to protect you
from. To pay for a daughter's operation, it seems the opposite.

    But maybe there are some things money just shouldn't be allowed
to buy, sensibly or otherwise. Socialist philosopher Michael Walzer
added flesh to this ancient skeleton of sentiment in his 1983 book,
Spheres of Justice. Walzer argued that a just society is not
necessarily one with complete financial equality -- a hopeless and
even destructive goal -- but one in which the influence of money
is not allowed to dominate all aspects of life. By outlawing organ
sales, you are indeed keeping the insidious influence of money from
leaching into a new sphere and are thereby reducing the power of
the rich. Trouble is, you are also reducing opportunity for the
poor.

    The grim trade in living people's kidneys would not be
necessary if more people would voluntarily offer their kidneys (and
other organs) when they die. Another socialist philosopher, Richard
Titmuss, wrote a famous book two decades ago called The Gift
Relationship, extolling the virtues of donated blood over purchased
blood and, by extension, the superiority of sharing over commerce.
Whatever you may think of Titmuss's larger point, the appeal of the
blood-donor system as a small testament to our shared humanity is
undeniable. Perhaps we should do more to encourage organ donation
at death for the same reason. On the other hand, however cozy and
egalitarian it might seem, a system that supplied all the kidneys
we need through voluntary donation would be no special favor to our
Turkish friend, who would be left with no sale and no $4,400. Why
not at least let his heirs sell his kidneys when he dies? A
commercial market in cadaver organs would wipe out the sale of live
people's parts a lot more expeditiously than trying to encourage
donations.

    The logic of capitalism assumes knowledgeable, reasonably
intelligent people on both sides of the transaction. Is this where
the kidney trade falls short? At $4,400, the poor Turk was probably
underpaid for his kidney. But in an open, legal market with
protections against exploitation, he might have got more. At some
price, the deal would make sense for almost anyone. I have no
sentimental attachment to my kidneys. Out of prudence, I'd like to
hang on to one of them, but the other is available. My price is $2
million.

    Of course, I make this offer safe in the knowledge that there
will always be some poor Turk ready to undercut me. So maybe,
because of who the sellers inevitably will be, the sale of kidneys
is by its very nature exploitation. A father shouldn't have to
sacrifice a kidney to get a necessary operation for his daughter.
Unfortunately, banning the kidney sale won't solve the problem of
paying for the operation. Nor can the world yet afford expensive
operations for everyone who needs one. And leaving aside the
melodrama of the daughter's operation, we don't stop people from
doing things to support their families -- working in coal mines,
for example -- that reduce their life expectancies more than would
the loss of a kidney. In fact, there are places in the Third World
where even $4,400 can do more for a person's own life expectancy
than a spare kidney.

    The horror of kidney sales, in short, is a sentimental reaction
to the injustice of life -- injustice that the transaction
highlights but does not increase. This is not a complaint. In fact,
it may even be the best reason for a ban on such transactions. That
kind of sentiment ought to be encouraged.