Dynamist Blog

Kidney Blogging, Cont'd

041807kidney.jpg_20070417_19_36_13_1663-Over the past few months, I've been correspnding with Tom Simon, an FBI agent in Chicago who decided he wanted to give someone a kidney. He now has a blog with a great explanation of how he came to make the decision and why he decided to choose a specific person, Brenda Lagrimas, through MatchingDonors.com, rather than simply donate to the next person on his local transplant center's list. The transplant surgeries are tomorrow, April 19.

Tom is well known to the local press from his FBI work, and his donation has gotten coverage in the Sun Times, the Tribune, and the local Fox affiliate. The articles do a good job of capturing his basic thought process and his important point that donating a kidney is not an especially risky procedure or unthinkable sacrifice. That doesn't mean everyone should run out and give someone a kidney--any more than everyone should take a job in law enforcement. But we need to start thinking of kidney donors as normal people taking reasonable risks for great benefits, not as crazy or heroic.

That giving up a kidney is an inconceivable sacrifice is one of several false assumptions behind Will Saletan's recent article on organ markets in Slate and the WaPost Outlook section. Consider his lead:

If you lose your job, you can sell your home. If you lose your home, you can sell your possessions. If you lose your possessions, you can prostitute yourself. And if you lose everything else, you can sell one more thing: your organs.

I guess that makes Tom Simon and me kidney sluts, since we didn't even charge. Having gone through the process, I can in fact imagine that selling a kidney would be for many people, especially the young and healthy, a far more desirable option than, say, giving up a home and certainly better than becoming a hooker. Within the U.S. transplant system, where laparoscopic surgery is the norm and malpractice and financial protections are in place, paying for organs would not mean exploitation of donors--any more than paying firefighters means exploitation of desperate men with a taste for danger and doing good.

Saletan is right that "transplant tourism" is a growing problem, but not because there's something inherently wrong with paying people money for their organs. The problem is that--thanks to gray or black markets--kidney vendors receive only a fraction of the market value of their organs and have few, if any, legal or financial protections. And that's not to mention the dubious sources of the cadaver organs China is offering.

But Saletan is wrong that paying for organs discourages donation. Nephrologist Ben Hippen, who has a forthcoming piece in Transplantation on the subject, notes in an email that the claim is "empirically false in the only country (Iran) where commercialization is legal. From 2000 - 2005, deceased organ donation increased from < 1% of all transplants to 10% of all transplants. The obstacle, it turns out (a la Kieran Healy) was that no procurement organizations for deceased donors were up and running until about 5 years ago." (Ben has also written a letter to the editor of the Post.)

The worst part of Saletan's article is the well-meaning but dangerously ignorant conclusion: "The surest way to stop him from selling his kidney is to make it worthless, by flooding the market with free organs. If you haven't filled out a donor card, do it now. Because if the dying can't get organs from the dead, they'll buy them from the living."

As advice, this is fine. Sign your donor card. Maybe it will do some good. As policy analysis, it is complete b.s. It might make a little more sense if Saletan added, "Then make sure you do a lot of helmetless motorcycle riding in the rain around lots of drunk drivers." Signing a card is not enough, even if your family honors your wishes. You have to die in just the right circumstances, usually from some head trauma that preserves the blood supply to your organs. Cadaver organs are great, and certainly essential for people who need, say, hearts. But not enough people die in the right circumstances to supply the need for kidneys. Any serious policy must focus on living donors.

Just to rehearse the statistics once again: As of this moment, there are 71,181 Americans on the waiting list for kidneys--a number that is bigger every time I look at the statistics. In January alone, 319 people died waiting for kidneys and 138 became too sick for transplantation. [Note: This has been corrected. The post previously attributed the numbers to the year so far.] Every year about 4,000 people die on the list, more than the number of U.S. military personnel who have been killed since the beginning of the Iraq war. On or off the list, living with kidney disease requires devoting your life to dialysis treatments--the kidney equivalent of the iron lung. It's a debilitating and disruptive way to live. As Bill "Epoman" Halcomb, the founder of I Hate Dialysis.com, wrote:

I understand HATE is a strong word, and I understand some people will be turned off from this site just because this site is named I Hate Dialysis.com, but I ask those of you who are reading this to have an open mind and realize that living with kidney failure is a terrible thing and it takes its toll on a person's physical and emotional well-being. There is a saying that goes around, "A person will NOT die from kidney failure, however, he or she will die from complications of kidney failure.

He died last month at the age of 34.

UPDATE: Northwestern Memorial Hospital, where Tom Simon and Brenda Lagrimas are having their transplant surgeries, has a terrific video on its living donation program.

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