To the Editor:
Re “We Should Be Allowed to Sell Our Kidneys,” by Dylan Walsh (Opinion guest essay, April 4):
I’ve seen firsthand how kidney transplants can transform the lives of patients living with debilitating renal disease who are often forced to spend hours each week in painful and exhausting dialysis treatments. Mr. Walsh is correct that we need to greatly boost the number of living organ donors. But before we consider paying people for their kidneys, we need to ensure that every potential donor has an equitable chance to also receive a lifesaving organ transplant.
Even though undocumented people can and do donate organs, far too many of the undocumented, Black and low-income clients we serve with severe renal disease are unable to receive treatment at transplant centers run by private hospitals, despite many of them being excellent medical candidates for a successful transplant.
It would be grossly unethical for our government to encourage them to sell their organs when they receive far less than an equitable share of needed organs.
There are many steps the federal and state governments can take to gather data on transplant equity and require tax-exempt health systems to provide fair and equitable access to transplant care, regardless of immigration or insurance status, income or race. We must create a fair system before we consider a market for organs.
Karina Albistegui Adler
New York
The writer is co-director of health justice for New York Lawyers for the Public Interest.
To the Editor:
As president of the American Society of Transplantation, I know there is an extreme need for additional organs to support lifesaving organ transplantation. Dylan Walsh aptly describes the challenge.
We at the A.S.T. support the author’s intent to increase living donation. However, A.S.T. policy opposes direct remuneration for organs, as it would encourage donations for financial rather than altruistic reasons, thereby propagating disparities. Instead, we aim to remove disincentives that prevent living donors from providing a lifesaving gift.
The A.S.T. is advancing effective solutions. The Living Donor Protection Act, which ensures that life, disability and long-term care insurers cannot discriminate against living donors, has bipartisan support. Other legislation provides a one-time tax credit for living donors that would offset donors’ expenses without providing perverse incentives. The A.S.T. also encourages companies to offer paid leave for living donors through our Circle of Excellence initiative.
Living donors alone cannot meet demand. The A.S.T. is engaged in ongoing work with the Health Resources and Services Administration, patients and other stakeholders to optimize the existing system for deceased donor transplantation, maximize the use of all available organs and minimize non-use.
These activities, along with research on the best strategies to remove disincentives, will result in meaningful progress. Selling organs is not the answer we need now.
Josh Levitsky
Chicago
The writer is a professor of medicine, surgery and medical education at Northwestern University Feinberg School of Medicine.
To the Editor:
Five years ago I donated my left kidney to a stranger after seeing his flyer posted in Starbucks. I was not paid money for my efforts. Yet it was one of the most rewarding endeavors in my life. Throughout the process, I learned many of the lessons that Dylan Walsh discusses.
Even though it’s too late for me to benefit financially, I strongly support the idea of paying future donors. The criticism that rich, powerful people will take advantage of the poor or vulnerable is based on the incorrect assumption that it’s not a rational decision to incur personal risks for financial and other benefits.
It is legal for women to act as paid surrogates carrying a pregnancy that poses at least as many potential medical risks as the nephrectomy. Paying people for kidneys is no different.
As a social worker who has worked with vulnerable people for decades, I believe it’s possible to create safety protocols to ensure that no one is making a decision that is coerced or lacking proper informed consent. There is no better reward than the good feeling of saving a life. Paying someone to do it is just icing on the cake.
Catherine Pearlman
Laguna Niguel, Calif.
To the Editor:
Nineteen years ago, I donated a kidney to my younger sister with the hope she would live another 10 good years. She had 12 good years, two not so good, and died at the age of 63. I am now 72 and have no regrets, but I remain strongly opposed to the concept of selling kidneys.
The organ transplant community tells only half the story, which is that donors should expect to live well with just one kidney. The other half of the story is what might be involved in recuperating from major surgery. To those involved in physical labor, I would tell them to be prepared to lose your livelihood for up to a year. Sure, there will be anecdotes like “I was mowing my lawn a week later!” But for me, even months later, my children told me that I walked funny.
With a Ph.D. in ethics, I am well aware of the ongoing debate of autonomy versus paternalism on all kinds of subjects. It’s too simplistic to say, “People should be allowed the personal freedom to sell a kidney.” We live in a society that limits our choices in all kinds of ways and for good reason.
In this case, I don’t see the transplant community ever being fully transparent about all the consequences of making this choice, just as they weren’t with me.
Thomas P. Roberts
Hillsborough, N.C.
To the Editor:
Dylan Walsh’s essay struck a chord. I have failing kidneys, brought on by being one of the millions of Americans with diabetes. Now 75, I long ago made major changes relating to diet, weight and exercise. Unfortunately, my progressive chronic kidney disease refused to get better.
So many of those thousands of Americans who are on waiting lists are young people deserving of so much more life to live. With so few donor kidneys available even for them, at my age I’ve made the decision not to seek a donor kidney, not to add my name to the waiting list. It would not be fair for those who have yet to experience a full life to miss out because I was next in line.
Would I like more time to enjoy life, love, family, etc.? Of course. If Mr. Walsh’s piece gains traction, and one day there are donor kidneys aplenty, I look forward to changing my mind.
Esteban S.
Corona, Calif.
The writer’s full name is not being used to protect his medical privacy.
To the Editor:
The essay by Dylan Walsh highlights the travesty of our kidney transplant program. We are allowed to sell our blood, serum, sperm or ova but not kidneys, which are in short supply.
In addition to Mr. Walsh’s suggestion I would add another: Trade a kidney to stay out of jail. If select first offenders were given the opportunity to avoid a prison sentence by donating a kidney, they would benefit immediately by avoiding incarceration.
Society would benefit from obtaining a young healthy kidney while avoiding the cost of prison sentences. The offender/donor would avoid the many negative aspects of imprisonment. The kidney donation will save the life of someone who might otherwise die of kidney failure.
The experience of saving a life might also contribute to the rehabilitation of a first offender.
Robert W. Morgan
Vero Beach, Fla.
The writer is an epidemiologist.