Would You Sell One of Your Kidneys?

My brother and I received transplants on the same day. It wasn't supposed to be like that. In April of 1998 he was going to get my dad's transplant. Twenty-four hours before the surgery, the transplant team performed its final blood panel and found a tissue incompatibility that had been missed. My brother was put on the list so that he could wait for someone who had died and had foresight to be a donor after they died. Next in line was my father. The date was set after we matched. On August 22, my parents received a call. There had been an accident. There was a person who could provide a transplant. My brother and I followed each other.

The operation went well. It was my time six days later. I remember visiting the doctor shortly before the transplant, feeling a pinprick and stinging flush of local anesthesia, then a blunted tugging, the nauseating and strange sensation of a Dialysis catheter withdrawn from below my collarbone. I remember the mist of midazolam as I was taken to the hospital.

I woke from a deep sleep after surgery under bright lights. I remember lying naked under blankets in the intensive care unit and watching a movie about a plane crash in the Alaskan wilderness with Anthony Hopkins and Alec Baldwin. Friends visited me on the recovery floor and it hurt to laugh.

I can see how much I forgot after 24 years. I don't remember the days before my transplant when I was in a hospital with machines draining and recycling my blood three times a week. A low-potassium, low-phosphorus, low-salt diet is plain. The foreign organ in my lower abdomen is kept alive by a few pills in the morning and a few in the evening. While other Americans wait for the same gift that I have been given, I have lost sight of it. Four percent of people will die every year still waiting, and another four percent will be too sick to have surgery. I forget this grace here.

Five years ago, my brother's kidneys began to fail, and all of the buried memories came back. His blood tests came back with high levels of variability. The necrotic tissue was webbed throughout like a colony of ants. He sent an email to his family and friends in May of last year, telling them how he had fallen in love with a woman and started a family. All of these details were offered with a kind of lightheartedness, but they ended up being awkward. He was 37 years old and was looking for a new organ.

The first successful organ transplant took place in Boston in 1954. Richard died of a heart attack eight years after his transplant. There were many attempts before that. A 60-year-old man with type B blood who had been dead for six hours was given a transplant into a woman with type O blood. Considering the technology, circumstances, and general knowledge at the time, it's amazing that the recipient survived for two more days. A person who received a transplant in Chicago in 1950 had a few months of extra function. There was a lot of experimentation in Paris in the 50s. The Herricks followed.

The central biological puzzle of transplantation was left unanswered by their story. B and T cells are sent to kill foreign tissue by our bodies. The Herricks sidestepped this problem because they were identical twins. Doctors would need to find a solution to our innate immune response in order to perform a transplant. Patients were subjected to blasts of X-ray radiation at very high levels. The aim was to destroy the immune system and allow it to rebuild with a new organ. There was an injection of bone marrow. Organ rejection was the most common cause of patient deaths. The field of transplant surgery was desperately needed. The basic precepts of avoiding unnecessary harm were vilified by the more conservative medical practitioners. One detractor wondered when colleagues would stop experimenting on human beings. When will they realize that dying can be a blessing?

The state of the field was discussed at a meeting in 1963. They weren't in a lot of numbers and weren't happy. According to one account, only 10% of patients survive more than six months after an operation. In the words of the procedure's most ardent proponents, the procedure remained a highly experimental one. The prevailing gloom was lifted when two surgeons from Denver presented the results of their work. The outcomes were 10 percent failure and 90 percent success. The crowd was shocked, which gave way to skepticism. The results were studied and confirmed.

The leukemia drug azathioprine was mixed with the steroid prednisone in order to make it work. Combining these two drugs and starting a regimen a few weeks prior to surgery made patients more willing to accept a transplant. Rejection was treated with a lot of drugs. A doctor wrote that the genie appeared to be out of the bottle. The number of medical centers that offer organ transplants grew after Starzl and Marchioro discovered. Demand was far greater than supply from the beginning. Only 300 people received a transplant in 1967, according to a study.

It took a long time for someone to step into the gap. In 1977 H. Barry Jacobs lost his license to practice medicine because he tried to cheat Medicare. After spending 10 months in jail, he turned his attention to organ brokering. Most of us are born with two kidneys, but can function with one, and that's the basis of his company. If one of the two kidneys is removed, the other will grow larger and work harder to cover the other's blood supply. Jacobs had a simple business model. He would connect people who wanted to sell one of their organs with people who needed one. Jacobs charged a fee to the recipients.

The National Organ Transplant Act was developed by Al Gore when he was a member of the US House of Representative. The question of compensation was taken up by Gore after hearing of Jacobs' plan. The Subcommittee on Health and the Environment was chaired by Jacobs. He talked about a doctor who had testified before him and failed to address the issue of organ shortages. He asked his questioners questions. The testimony highlighted the likely abuses in an unregulated market.

Gore said that he had heard about going to South America and Africa, to third-world countries, and paying poor people overseas to have a kidneys removed for use in the US. That is part of your plan.

It is one of the proposals.

Gore said in the past that the payment would be different for each individual.

Jacobs said it was up to the people to make the decision.

Some potential donors probably wouldn't ask a lot because they would get to see America, Gore said.

It's up to them.

If you want to see the Statue of Liberty or the Capitol, they might be willing to give you a discounted price.

What their motivation is unimportant.

According to Gore, the company would sometimes charge a commission to recipients for their lives, even if they were poor. The sale or barter of organs used in transplant is against the law.

Since transplantation first became possible, the debate has been unfolding in the dimmer theater of academia. The organ-market question was taken up by a UCLA law professor. He referred to a 1968 classified ad in Los Angeles in which a man said he would sell any part of his body for money. Proponents of an organ market have historically used the crisp, cold-blooded logic of utilitarianism. They suggested that a properly designed market would give an economic surplus to both the organ donor and the recipient. Dissents from the gossamer realm of ethics are what opponents of a market usually craft. What do you think about the temple of our body being auctioned off for parts? Is it okay to live in a society where the poor are forced to sell their organs in exchange for necessities of life?

The two camps have been at odds for a long time. There hasn't been much progress in addressing the shortage of kidneys. The prohibition against the sale of organs is still in place almost forty years later.

Thirty-nine thousand people were added to the list of people waiting for a transplant in the US when my brother made his appeal. There were thousands of transplants from living donors. Almost 15,000 came from dead donors. The total number of transplants is over twenty thousand. 21,000 is not worth mentioning. Many of the people who received a deceased-donor organ had been waiting for a long time and were living in a world of little hope.

When I read my brother's message, I wondered how soon my dad's transplant would end. How long would it take? How many years? I wondered if a market could work in the US given that so many people are waiting for a transplant and so many are dying.

Nobody in the US supports a private exchange for a kidneys, one in which negotiations happen between two people with no oversight. Sally Satel of the libertarian American Enterprise Institute, Arthur Matas, a professor of surgery at the University of Minnesota, and a law professor at the University of California, Irvine are some of the people who have advocated for a kidneys market. Economists, ethicists, lawyers and doctors have all put forth proposals, and they all converge on a few key points The market would be monopsonistic, meaning there would be only one buyer for the organ. Your family would be rewarded if you were to donate a kidneys after you die. Living donors would be paid.

People are debating what kind of compensation should be given to donors. There is a lump sum of cash. It is1-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-6556 A college fund, student loan forgiveness, retirement fund, or free health insurance for life are possibilities. Maybe it's a combination of these things or something else. Proponents agree that it should be managed by the federal government. Both donors and recipients would not negotiate. A local organ procurement organization overseen by the United Network for Organ Sharing would go about its business of finding the most suitable match and the surgeries would unfold behind it.

Since 1972, when President Nixon signed the Social Security Amendments, the federal government has been involved in organ transplants. Hundreds of thousands of lives have been saved since the launch of the end-stagerenal disease program. Patients with end-stagerenal disease account for 7 percent of Medicare spending and 1 percent of the entire federal budget, even though they make up less than 1 percent of Medicare users. The majority of this group is on the transplant table.

This expense is highlighted by those who favor a federal market. It's much cheaper to have a transplant than it is to have a Dialysis is less expensive than it is to have a transplant. The quality of life of transplant patients is improved, as well as their productivity in the labor market. The number of transplants would go up and the federal government would save a lot of money if Medicare paid people to donate a kidneys. The economics are easy to understand.

There are many counterpoints to the idea of a kidneys market. Iran is the only country in the world that has a partially regulated market for kidneys. The Iranian government fixes the price for donated organs, but the actual payment is made between two people. Many donors hire brokers to get more money out of the exchange.

Those who oppose a market worry about exploitation. The epitome of inequality is organ sales. The US Public Health Service has a poor track record with medical experiments that are exploitative. Markets can still be exploitative even though they have been declared illegal. Up to 10 percent of transplant organs can be found on the black market. Afghanistan was described as a portal to new misery for the country's most vulnerable by the New York Times. Markets like this, which exist around the world, are supported by transplant tourists who travel to other countries to buy a transplant. The global black market wouldn't be stamped out by legal compensation in the US.

The belief that our body should remain above the market's grubby reach is a more fundamental aversion to the commodification of organs. Henry Waxman said that human organs should not be treated like junk in junkyards. Three years later, a report from the Department of Health and Human Services reinforced the idea. The point is compelling.

I used to find the commodification of kidneys objectionable. I am surprised to see myself defending the idea that markets can be used to solve morally messy problems. It's easy to endorse a policy that benefits you and your loved ones. Exposure to the world of medicine disabused me of the ideas I used to hold about the human body. The doctors are talking to you as if you are not there at all, the palpations, proddings and pokings, the intrusions, the needles and plastic sample cups, and alienating vocabulary are all part of the process. We're just finely wired machines that need to be fixed.

My mom had her blood drawn in a lab in California in December of last year. The sample was unpackaged and placed in an Illumina MiSeq next- generation sequencer. strands of DNA floated in the mixture after the blood spun through a number of cycles. We had suspected for a long time that my mom has the genetic signature of Alport syndrome, a condition in which one of her X chromosomes can fail. It's more severe in men because they have only one X chromosomes. If women show symptoms later in life, they should. My mother, my grandma, and her mother are carriers.

I felt mildly dizzy after reading the final report. My exon 7 of the COL4A5 gene is located on the long arm of the X chromosomes and is associated with the type of Alport I have. My mom, my brother, and I all have a GAT, which creates aspartic acid, which is different from a "GGT" in the DNA. In my case, a single misspelled genetic base and the COL4A5 gene causes faulty proteins that mass together with normal proteins to form. The eyes, cochlea, and kidneys are all affected by this in some way. There is a glitch in the software. My hearing is bad and my kidneys are doomed if I switch out a single letter.

It was a revelation to see my defect in the reflection of a microscope. It's a machine. If there was a way to replace the GAT with a GGT, I would pay for it. I'd pay a junkyard to fix my broken fender. We are just a bunch of parts.

There is a shortage of donor organs in other countries. Between 15 and 30 percent of patients die waiting for an organ transplant in Europe, according to a report. The search for solutions is not a US thing. There are more people in need of a transplant in Spain than in any other country. In recent years, the US has promoted "expanded criteria", meaning transplant centers now accept and use kidneys that were once considered too old or sick. The debate rages over the value of an opt-out system, in which consent is presumed, as opposed to the opt-in system, in which consent is required. People are dying even though policymakers are proposing small changes.

Iran does not stand together. The country's firstrenal transplant took place in 1967, but for years the program remained extremely small. The government tried to shorten the wait time for transplant patients by letting them go abroad. The Ministry of Health paid for travel and medical expenses for approved recipients who went to the UK for their operation. There was no solution at all. Due to the 1979 sanctions against Iran, it was difficult to procure dialysis machines, as well as the law that forbade the transplant of organs from dead people. The market for living donors was introduced in the late 80's.

An Iranian nonprofit is in charge of the whole process from matching donors with recipients to releasing the money after the operation. The fixed reward set by a government foundation is equivalent to less than two years of minimum wage, according to a study. If recipients can't pay, charities step in. The government pays for transplants at universities.

There is a system that isn't perfect. There are reports that brokers are hired to negotiate higher prices on the side. Students and parents with debt have been covered in newspapers by placing flyers near transplant centers. Poor people give more than rich people do. 78 percent of donors were from households earning less than the median. Only 6 percent of the people in the study had a college degree. Fifty percent of recipients were poor.

According to the Associated Press, 50 percent of transplants in Iran are from living donors. Most of them are unrelated to the person receiving them. The average lifespan of the kidneys from deceased donors is shorter than that of these. In most countries, it's much harder to find them. In the US, living donors were responsible for just under a third of transplants.

In May of last year, my brother requested a new organ. He had been tinkering with the letter for a long time and was checking in with his doctor to make sure the time was right. He had a kidneys that was only 20 percent the size of a healthy one. He was tired and bloated. There was a chance that it could happen again. His plea, sad and friendly, arrived in my inbox with a simple subject, "That e-mail about the kidneys."

Our lives are self-directed, that we have mapped out and are navigating every step of a lengthy narrative, that is what we believe. Don't backtrack, reach your goals. This comfortable misreading of the world happened when my brother and his family were fogged in with so much uncertainty. When will his transplant take place? Who will listen to his request? Who will get in touch with the transplant coordination? There may be a match. Will he be put on the list for a transplant? Is he going to survive?

His wife kept a record of who offered to donate and where they were. My brother tried not to think about how long it would take for the wheels to turn and how long he would have to wait before he started on the transplant. The reality of that with two young kids and a job was something he started thinking about. He spoke with an old friend from high school who is a father of two and an upstanding person who told him that he is too much of a coward to give a transplant. My brother was putting a lot of pressure on people. It felt like I was saying that I am so important to everyone that they should go ahead and have surgery for me.

A friend of my brother volunteered. She is a listed marrow donor, so her decision was not out of line. It wasn't an easy decision as the mother of two young children. I didn't know why she was doing it. She said she really felt for my brother, and that's why she did it. There may be hidden strands of obligation tied up in those three simple words, a sense that friends should do things for each other. I wonder if cowardice felt like an inadequate excuse. Were there deeper provocations connected to the fact that she had lost her father as a girl, and now had a chance to save someone else's father?

Her motivation was clear in a number of ways. She did a great job. I don't think the reason is relevant.

Major organizations that used to oppose incentives for donation have begun to warm to the idea. The American Society of Transplant Surgeons and the American Society of Transplantation support aarc of change that starts with removing disincentives to donations and moving toward pilot programs that give incentives to donate. Well-designed studies are supported by the American Medical Association. The Organ Donation Clarification Act would allow states to experiment with compensation free from criminal liability under the national organ transplant act. The National Kidney Foundation is one of the many who oppose the idea.

It's not clear who is being protected and how by preventing a regulated market for kidneys. People with little resources would be coerced into taking a risk they wouldn't take otherwise. The argument of this stripe ignores the fact that we pay people to get hurt. There is a group of people who live on the backs of other people. Line workers in the slaughter inspecting 140 chickens per minute, immigrant field hands, the employees of Amazon's fulfillment centers, miners of rare-earth minerals, the temp and gig workers who teeter daily over the abyss of poverty are just some of the people who work in this area. Many people are invisible.

Opponents do not speak with precision about the risks of removing a kidneys. The rate ofLoggers dying is much higher than the rate ofKidney Donors. The risk of death from donating a kidneys is slightly higher than the risk of death from giving birth in the U.S..

The most fundamental concerns of exploitation can be easily confronted. A waiting period of at least six months is needed to assure people don't sell their organ in haste. The demographic spread of donors could be affected by how compensation is played with, as it needn't be a one-time lump sum. He asked if compensation in the form of lifelong health insurance or student loan forgiveness would make people think twice about surgery. Is it pulling more evenly from the middle and upper classes? If a donor's remaining organ fails, they jump to the front of the queue for a new organ.

It is possible that the poor would be disproportionately represented among donors, but they would also benefit from it. Poverty and transplant numbers are tied to race. After being placed on the waiting list, white patients were about twice as likely as Asian and Hispanic patients and four times as likely as black patients to receive a living organ donation.

One of the reasons for the disparity is that white people are more able to snatch volunteers from a social network of those who can take a few weeks off of work, pay for travel and lodging, return home to recuperate, and then get back in the workforce. The friends and family who put the weight of their savings account on the pro side of the balance are the ones who decide whether or not to give. People who donate money are rewarded with money. Why aren't we willing to explicitly reward those without?

My brother didn't get hurt. He didn't need to sit at the end of the line. A good match was found when his friend underwent a number of tests. She went forward with the help of her husband, her mother, and her children, who were given books on how to use a scalpel. My brother and his donor were stuck in a precarious holding pattern after Covid-19 canceled all surgeries.

He felt like a different person after three years of failing health. He saw the borders of his life shrink. There was a lot of anger. Virginia Woolf wrote that when we are sick, we go down into the pit of death.

The surgery took place in July of 2020. My brother took two showers with antibiotic soap on the morning of the operation. His wife met him shortly after the second shower, and by 7:30 an orderly was carting him down a long series of corridors and elevators to pre-op, where he was given a glass of wine to calm his nerves. After taking her up on the offer, he felt lightheaded and was taken to the operating room. He made his way to the operating table. The doctor was in the corner working. There was a short period of waiting, men and women in scrubs and gowns busily at work, as the mundane miracle unfolded around him. Fentanyl ran up his arm until he was asleep after he was given it.

The donor did the same. She told me that she felt weird after waking up. Within a day she was home.

My brother and his wife gave her a small amount of money. This money was set aside to cover travel and hotel expenses. The framing gave the exchange a practical foundation, but the money signaled a deep level of gratitude.

My brother has more than one organ in his body because surgeons don't remove the old ones. He had two babies with him. Those aren't working anymore. A third belonged to a person who died in a car crash. The one that is limping is barely moving. My brother owned a boat. He is now carried farther down the current by his friend's boat. How long will it last?

While my grandparents watched my brother's two kids, he and his wife spent three days in the wilderness, hiking and camping to celebrate his 40th birthday and the return to a world uninflected by illness. They were back to normal in a way. He and I are both waiting on the generosity of friends and family and strangers. Its own time will be kept.

My bell will ring soon, I know, and I will join the crowd on the other side of the ledger, all of us applying friendly pressure to people we know and those we sort of know, assuming, each of us individually, because we must. It doesn't need to be a large number.

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