The Lucid Line

Over 100,000 people in the U.S. are currently in line for organs; 85,000 of them for kidneys. As things stand now, nearly 60,000 of them will die waiting for either rare, generous relatives; recently killed and decently matching donors; or thousands of Americans who somehow find it in their hearts to risk the complications and lost wages of undergoing a painful surgery to save the life of some stranger across the country, completely free of charge. 

The U.S. organ donor system, so reliant on altruism and luck, is in no shape to fill its kidney shortage. I'd like to say that's because organ shortages have no technologically viable solutions, but that's not true: There are solutions. We just don't want to adopt them.

But that's an attitude we need to adjust. For our large kidney-gap to be filled, stronger incentives – even financial – are required to convince potential donors to give up their organs while living, both to avoid the practical difficulties of collecting organs from the dead, and to create a system that relies less on luck and focuses more on human needs.

Only one government in the world – Iran's – currently offer to pay donors for kidneys. Iran has used this system since 1988, and it currently stands as the only country in the world with no kidney shortage. Singapore is preparing to adopt a similar system. Israel recently implemented a system that rewards those citizens who sign up to donate organs upon death by offering them favorable chances of receiving a donated organs should they ever be in need. Some claim this policy will be a replicable panacea.

The U.S., in contrast, seems incapable of considering any such changes. Sure, we've developed fancy registries; a multitude of private, non-profit funds; and donor "chains." But even these ingenious chains will at most provide 1,500 more kidney donations per year, a number nowhere near the number needed. The implementation of financial incentives for organ donors would be an easier and more effective solution, one that could, as it turns out, be quite easily self-financed.

For just a fraction of the $100,000 per kidney failure patient dialysis costs currently shelled out by Medicare (including many people in line for kidneys), we could persuade a lot of folks to provide much-needed kidneys, saving the money spent on dialysis for those patients currently in line for kidneys and enrolled in Medicare. Whatever was leftover could finance limited insurance for donors, who many fear will end up being overrepresented by the poor, the uneducated, and the uninformed, and could likely get "screwed" into a raw deal.

Iran's example has shown that such financial incentives can work for kidneys. But while Americans tend to be sympathetic to non-financial incentives for organ donations (as used in Israel's system), they hate the idea of buying and selling kidneys. Why?

Since the evidence supports financial incentives over the current, insufficient U.S. system, we can only assume this opposition stems from some sort of moral posturing, though to which moral system the opposition clings I cannot say. Its adherents demand nearly superhuman levels of generosity from merely human donors, seemingly so they can get some sort of cheap thrill hearing about "miracles" on "Larry King Live" and "The O'Reilly Factor." They sit in their moralistic armchairs philosophizing about the questionable ethics of organ markets while arguing vehemently in favor of a status quo in which thousands of people die every year. They consume life-giving products like food, water and shelter daily, but wag their fingers at kidney patients trying to do the same thing, confining them instead to 25 percent chances of survival in a system based on luck of the draw and (cough) human charity.

This is no moral system to be proud of. We can and must deal away with the kidney shortage, but we need to adjust our attitudes on organs first. We need to acknowledge that compensation for the gift of an organ is no vice, and necessary to offset humanity's inherent selfishness. We need to realize that the words "organ" and "market" need not provoke disgust when used in the same sentence, especially if kidney markets (or incentives) could save lives. Most importantly, we need to admit to ourselves that failing to act on the problem of kidney shortages – one that could so sensibly be fixed – for the vicarious satisfaction of our own corrupt consciences is a tragedy of the worst kind; a tragedy we can, and should, avert.