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.