UK Cash for Kidneys Debate Misses the Point

British researcher  Sue Rabbit Roff believes that students should be allowed to sell their kidneys to support themselves through college in the UK.  The British medical and government establishment have only in recent years embraced altruistic donation.  With fewer such donors than say the US or Canada the comments in the press have not reflected the wisdom and experience of actual living donors who gave to friends or strangers.

Instead the debate in comments and articles are about the ethics of of paying for living kidneys as opposed to non paid donations after death.  These two extremes in my view are not assisting what should be a more rounded approach to the problem of helping others through donation.

Nowhere do those opposing sale (and I am in this camp) appear aware that living organs are better for the recipient – that is one of the reasons altruistic donors donate.   So they advocate for after death donation.

Sue Rabbit Roff and her supporters on the other hand seem to think that donation is straight forward.  I came through my donation well and  my recipient is healthy but that does not mean there were not consequences even for me.  It took me a long time to get my strength back and in restrospect I could have used more information about the aftermath of the surgery.  When I told this later to the staff of the transplant unit where my surgery took place, they nodded to one another saying other donors had told them the same thing.

Each time I have seen a living donor  to a non family member interviewed I have found myself nodding as they said they were happy to have done what they did and would in hindsight have made the same choice.  BUT that they would never advocate for living donation. And they did not need to tell me the reason.  Kidney donors have to be very healthy to donate but  there can be unforseen longterm consequences to their wellbeing.   In 2006 the Canadian Council for Donation and Transplantation commissioned a study on the economic consequences of donation for living donors.  The costs of transport, childcare and paid assistance for daily tasks were all part of the “hidden” issues for donors before, during and after  surgery.  Preparing my support took a lot of organisation on my part and I had a fulltime job to manage as well. And speaking for jobs, the Canadian study reported that  some people were fired or resigned after the physical demands of recovery made it difficult for them to continue working resulting in a loss of income.

Potential living donors need to make an informed choice about donation but they do need some financial help.  In my view they should be compensated for travel and other normal expenses. My unit even paid for a hotel room for my husband and provided a shuttle for me to visit my recipient once I moved into the hotel after the operation. But that is where the consideration of money stops.  This is not due to ethics — ethical issues that worry me are more about children being conceived as donors for example.  Of course I am against cash for kidneys  because  those in financial need will have a higher proportion of single kidneys but using that argument alone is for those who have never donated. I have another objection.

Payment assumes that you can put a price on the donation.  There may be a market price for one’s kidney but what is the correct figure for loss of employment, of future health issues that may occur or of emotional upset for the loss of an organ (and losing an organ does involve emotion) if the procedure is unsuccessful?

Cash for a kidney would obscure the actual cost of the donation for the individual and  is therefore a form of deception.  The real donation can never have a pricetag and that is why is it such a precious gift.

 

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