WOULD I pay for a kidney if I were dying, there were no donor kidneys available and there was a willing seller?
At this point in my life, I want to see my children grow up.
And I want to live this sweet life a little longer.
So my answer would be yes, with certain caveats.
First, the seller must be informed of the risks of the procedure and be educated on what it means to be a kidney donor.
He must undergo careful medical and psychological evaluation and receive follow-up care.
That said, the reality is still that such a course is illegal here.
But might we not examine the feasibility of a kidney market?
The way the Iranian government does it is to provide a fixed compensation to the seller of about $1,500 as well as limited health insurance coverage.
Second, he also receives separate remuneration either from the recipient or, if the recipient is poor, from a designated charitable organisation; this amount is usually between $3,000 and $6,000.
In Iran, there is no longer a queue for donor kidneys.
One idea, which has been mooted elsewhere, is to take the money spent to provide dialysis and use it to fund programmes aimed at helping lower-income people buy kidneys. The rich will be able to take care of themselves.
It was reported last December that Singapore's National Kidney Foundation had spent $17.5 million on dialysis and kidney failure prevention services for about 2,000 kidney patients in 18 months.
If this money were used to set up a kidney bank, which would buy kidneys, at $20,000 a kidney, 875patients every 18 months would be freed from the need for dialysis.
Over time, the numbers would get better, as kidney patients here wait an average of seven years before they get a donor kidney.
What about the risk of surgery to the donor?
Doctors I spoke to said that the most significant risks were those associated with anaesthesia and surgery which, at 0.03 per cent mortality, was comparable to any other operation.
Long-term risks are also low.
A 1997 study from Norway that followed 1,332 kidney donors for an average of 32 years found no difference in mortality rates between kidney donors and the general population.
A 25-year follow-up of 70donors conducted by the Cleveland Clinic found that the renal function is 'well-preserved' and that the overall incidence of hypertension was comparable to that of non-donors.
EXPLOITATION
But the potential for exploiting donors - especially low-income ones - is always there, for they will be the ones most likely to find monetary incentives attractive.
Protecting them is of utmost importance. That is why any plan for compensation should be regulated by the government.
Legal scholar Richard Epstein puts it in his own special way (The Wall Street Journal, May 2006): 'Only a bioethicist could prefer a world in which we have 1,000altruists per annum and over 6,500 excess deaths over one in which we have no altruists and no excess deaths.'
This story was first published in The New Paper on June 29, 2008.
