Between the ages of fourteen and nineteen Leah received 3 kidney transplants, rejected two and endured countless hours of dialysis. These hardships made it impossible for her to attend regular high school or college because of the stress dialysis and disease put on her body. Leah’s latest transplant has fortunately remained stable, giving her a better life for the time being, although her struggles are far from over. Just in order for her to make it to age 70, she will likely need around 5 more transplants (Leah). Though this may seem surprising to most, it is a reality that many End Stage Renal Disease patients live with on a daily basis. Kidney failure, or ESRD is the ninth leading cause of death in the United States and takes the lives of about 4000 American citizens each year (“Kidney Transplants Facilitated…”). This struggle for transplants and terrible loss of life is caused by a huge shortage of kidneys available for transplantation. Along with this, the supply and demand gap for the organ is only growing, and as more Kidney patients need a transplant, less become available. This shortage of kidneys has led to other problems for the U.S., such as the massive amount of money being spent to pay for Dialysis treatments. In addition, the lack of donor organs has resulted in a dangerous Black Market for kidneys across the globe. With today’s current system, this issue cannot be solved, as there are simply not enough willing or deceased donors. As a result, Legalizing Kidney sale in the U.S. would have many benefits such as saving money, reducing the black market, and most importantly, saving lives. 

Though transplantation is now a reliable treatment for kidney disease, it was not always as effective. In the early stages of developing a transplant method, Doctors went through many unsuccessful trial and error experiments. Because in the early 1900s they did not yet understand the matching process, doctors would test how animal or random other people’s organs would work in a patient. Eventually they discovered that they did need to match kidney donors and recipients for antibodies, yet the organs were often still rejected. Until 1980 dialysis was essentially the only way to keep patients alive. Soon, however, scientists developed effective anti-rejection and immune-suppressant drugs to prevent the rejection of a transplanted kidney. Further improvements in the process were made until now, when transplantation is the best and safest method to treat ESRD, where about 1 in 3000 don’t survive from surgery (“Kidney Transplantation: Past…”) Though this it is easy to see how transplantation, in general, can save lives, but today there are not enough transplants available. 

Because the face of medicine was beginning to change, the U.S. Government decided it needed to create legislation to prevent potential harm. Congress soon passed the National Organ Transplant Act of 1984 which defined a human organ and made the sale of these organs illegal (“Intended…”). Though this law does protect in some ways, it harms in others. Because most organs in the human body are vital and cannot be transplanted without killing the donor, the sale of these does need to be banned. On the other hand, a person can live a perfectly healthy life with only one kidney and only about 1 in 10,000 kidney donors suffer serious injuries (“Kidney Disease and…”). Because of this law, however, a huge supply and demand gap for kidneys has been increasing in the United States. To elaborate, since the beginning of regular transplantation, the number of patients on the transplant waiting list has increased by five times the amount in 1990, while the actual transplants that have happened has stayed relatively the same. More so, in the span of 5 years from 2006 to 2013, the need increased by 30,000 people, while the available kidneys did not even grow by 2000 (Perry). The current system for procuring kidneys in the U.S. is failing terribly and cannot keep up with the unproportionate growth in demand. Because of this issue, it is necessary to consider how legalizing the sale of kidneys could solve the problem and be beneficial to the U.S., yet many oppose this idea.

Many who dispute the proposal of legalizing kidney sale argue that that there are other ways the solve the problem, that compensation invalidates consent and that it violates the Hippocratic oath. Firstly, they say that the problem could instead be solved by initiating a presumed consent system where people found brain dead would be presumed to consent to donating their organs unless they have a card that specifically forbids it. This would only solve a small fraction of the issue by not providing enough organs and would take away any consent from the dead individual (Goodwin). Along with this, in Spain, where it is implemented, families are not even informed before the harvesting, leading to a reduction in consent (Goodwin). In addition, this system has not made even close to a substantial impact on producing enough kidneys (Clark).   

Another argument opposers use is that compensation makes consent impossible and would be exploitative to the poor (Adair). One source even went as far as to say that “financial gradients are inherently exploitative” (Adair). This argument is not valid or consistent because financial incentives do not cancel the consent of a person, but only add another factor to be considered. If this were true it would mean that each time anyone did anything for money, (such as work a job) they would be unable to consent. Furthermore, certain bodily products, such as blood, semen and eggs are frequently and legally sold. Impoverished individuals, additionally, are permitted and even encouraged to work extremely high risk jobs for compensation, such as enlisting in the military or coal mining. 

Finally, the opposing argument that it goes against the Hippocratic oath, or “Do no harm”, can be refuted by the fact that donating an organ is an very safe procedure and the donor can live a normal full life (McAndrews). Again, only 1 in 10000 suffer injuries after surgery (“Kidney Disease and…”). In addition to this fact it is not only legal, but supported for people to donate their kidneys in today’s society, so the harming is not the problem but the money. In a study by the New England Journal of Medicine, results even showed that donors did as well as people who had not donated, and, astonishingly, that the possibility of kidney failure was even lower in donors, long term (“Top Ten Questions”). Most importantly, giving a kidney saves the life of another individual suffering from organ failure preventing them from harm and suffering. Along with all of these arguments, there are a few specific benefits that should cause kidney sale to be considered.

Legalizing kidney sale would save a huge amount of money for American citizens and the U.S. government. To begin with, the ever growing shortage of kidneys paired with the growing number of people who need a transplant has resulted in the government paying a huge amount for supportive care. By means of Medicare, the federal government has been forfeiting a massive sum to sustain numerous patients on dialysis, which is an ongoing and expensive procedure. The cost of paying for only 3 years of dialysis, equals that of a transplant and the anti-rejection drugs for a patient’s whole life (“Paying to Live”) To compare transplants with dialysis more specifically, it costs about $8,550 annually to sustain a transplant patient while it is around $50,938 annually to support a dialysis patient. This is $42,500 difference per year. Overall, the shortage of kidneys has had a large impact on Medicare spending as shown in 1972 when only $200 million was spent for dialysis and then in 2010 when it had increased to more than $22 billion (“Kidney Transplants Facilitated…”). A large sum of money could be saved if more transplants were available and dialysis was no longer needed. Though these facts are very significant alone, the government would save money in even more ways.

When totaling the difference in transplant and dialysis costs, and the money saved from disability payments and lost taxes, the savings per patient are massive. Again, the difference in cost of a transplant patient per year from a dialysis patient is $42,500. Along with this, only 10% dialysis patients are employed, while 85% of transplant patients resume work about a month after the operation (“Paying to live”). Because most of dialysis patients are unemployed, they receive an average disability payment of $13,000 per year from the government and do not give a yearly income tax of $5,500 on average. When adding these up, about $60,888 could be saved per year, per patient. Going further, if the transplant lasts a minimum of 5 years, $304,440 could be saved for each transplant a patient receives compared to dialysis (“Kidney Transplants Facilitated…”) Legalizing kidney sale would also lead to better matches, if more were available, which would lengthen transplants and reduce the cost for post-operative drugs. This data, again, is staggering and shows a fraction of what could happen if the waiting list was cleared for the over 400,000 Americans on the list.

To look at the cost benefits of legalizing kidney sale from a different perspective, individuals in America will save as well. Kidney failure patients would save a large amount from the lost wages while on dialysis. To reiterate, the government pays an average disability payment of $13,000 annually to the 90% of dialysis patients who are unemployed. This does not even come close, however, to the median income of $46,326 annually. When these two values are subtracted, a patient who does not work because of dialysis does not make about $33,326 of what they would have if they could work (“Kidney Transplants Facilitated…”). In addition to this, the money Medicare pays for dialysis per year, per patient is actually about 80% of the full cost. This means that the other $12,734, or 20%, is left to the patient (“How Dialysis is Paid For”). When compared to their disability payment, it is easy to see how many ESRD, or End Stage Renal Disease, patients are pushed towards bankruptcy, even with insurance. To solve this issue, if more kidneys were available from legalizing kidney sale, there would be a huge decrease in dialysis and less subsequent surgeries because live donor kidneys last longer.

When looking at the benefits of legalizing kidney sale from a financial standpoint, the data shows how much of an impact it would have. To reiterate, the reduction and possible elimination in the need for dialysis would save an incalculable amount of money for the Federal Government, through Medicare. This data comes from the cheaper cost of a transplant and the reduction of unemployed dialysis patients. Possibly even more significant, is the fact that it would save money for ESRD patients who are already suffering so much. Because, most could return to work in a short period of time and be at full strength, they could earn a regular salary. Additionally, they would not be left with such high medical bills while they are not even working. To conclude the importance of how much money would be saved cannot be overlooked, but what are some other ways that legalizing kidney sale could benefit the U.S.? 

In the past 40 years, since transplantable kidneys have become increasingly more scarce, a violent organ Black Market has grown as a result. To see how this is a huge issue, it is beneficial to first look at times in the past when prohibition has yielded negative consequences. In all of these instances, organized crime bred unstoppable violence, unsuitable products were sold and people who had no other options were taken advantage of. Firstly, in the 1920s when the 18th amendment made the sale and consumption of alcohol illegal, these results were all visible. Though small scale crime, such as fighting as abuse diminished, large scale crime such as homicide erupted. Additionally, organized crime rings like the mafia rose up together and were nearly impossible to bring down by law enforcement. These gangs sold illegal moonshine, which was often found to kill civilians because it was improperly made and not being monitored for quality (“Prohibition”). Another instance where the illegalization of something has done severe harm is in the drug prohibition now. Again, waring cartels have produced a huge increase in violence and are seemingly unstoppable. Just in the span of 7 years, law Enforcement in Mexico released data that over 164,000 homicides took place because of the drug market (Gorner). Moreover, unsuitable drugs have resulted in the deaths of many, as in Chicago in 2015 when over 75 citizens died because of poorly laced heroin (Gorner). Finally, because these drugs are highly addictive a person who is hooked will pay huge prices and do anything to get more. To conclude, while these specific products should not be condoned, their prohibitions have mirrored the terrible effects of the kidney sale prohibition today.

Similar to drug and alcohol illegalization, the growing shortage of transplantable kidneys has led to a vicious black market where violence prospers, bad products are sold and desperate people have no other options.  To begin, the shortage for kidneys has created the perfect environment for this market to become prosperous. One nephrologist stated that he has “seen 300 of [his] patients go abroad and come back with new kidneys… it's a free-for-all” (Freidman) The World Health Organization has also declared that “The international trade in human organs is on the increase, fueled by growing demand as well as unscrupulous traffickers” and that about 20% of kidney transplants globally come from the Black Market (Goodwin). Though hard to see the effects in the U.S. because it happens overseas, these quotes show that the market is not just isolated incidents, but a growing organized ring. With the market on the rise, the first effect that is produced is the sale of unsuitable organs. Many doctors have recently shared concerns that these unmonitored kidneys could be infected with Hepatitis or HIV (O’Reilly) In the HBO documentary “Tales from the Organ Trade”, One desperate man in the Philippines sold one of his kidneys only to find out weeks later that he had had ESRD. Because he was not properly screened before vending, whoever received his organ is most likely now dead. Another harm from this market is that desperate individuals, who have no other option, turn to the market. Because there is such a severe shortage, dying patients are often forced to turn to the black market and pay extreme prices for a kidney, often up to $160,000 because they have no other option than to die. Additionally poor individuals in third world countries sell their kidneys for a small fraction of what the organ brokers receive, and have no chance to negotiate (Goodwin). Finally, these organ rings often use violent methods to obtain the organs and in many instances the brokers will kidnap, traffic and even murder men, women and children for their organs, taking away the consent of countless individuals (O’Reilly). From these harmful effects it is easy to see why the Kidney market needs to be stopped  and that legalizing kidney sale could be beneficial.

The final, and possibly most impactful, benefit of legalizing kidney sale is the fact that it would save thousands of lives of those suffering from End Stage Renal Disease. There are currently 450,000 American patients on dialysis today. Dialysis is essentially an artificial kidney which pumps out a patient’s blood, filters it and pumps it back in for 4 hours a day, 3 times a week (Perry). Being on the transplant waiting list while on dialysis is a race against time to see if the patient receives the kidney before it is too late. The average wait time for a kidney is about four and a half years, and increasing, while the average time a person can survive on dialysis is about 5 years. In addition to the emotional stress that waiting puts on a person, any amount of Dialysis, especially before a transplant, can have severe consequences. First, It is proven to cause infection, anemia, heart disease, nerve damage, high blood pressure and bone disease in many patients (“The Benefits..”). Though treatable in healthy adults, these patient’s bodies are often too weak to fight off the illness. In addition to these negative consequences, dialysis does even more harm before a transplant even takes place.

Even if a patient received a transplant kidney before they ran out of time, their long time spent on dialysis would have a detrimental impact on the new organ. Scientists and doctors at Beth Israel Deaconess Medical Center have affirmed that “patients who wait for a transplant on dialysis for 2 years are three times more likely to lose their transplant kidney than those patients who wait less than 6 months on dialysis”. This is because the dialysis results in shorter lasting transplant lives over all, often causing rejection. On the other hand, preemptive transplants, which are surgeries that take place before dialysis ever happens, on average last for 10-15 years more (“The Benefits…”). Despite these facts, in the current kidney distribution system preemptive transplants are extremely unlikely. This is because when a patient is entered on the transplant list by UNOS, they go to the back of the list. Because of all this, dialysis is essentially a never ending cycle until death for patients who barely receive a kidney in time, have their kidney fail because of prolonged dialysis and then need a new kidney once again. Legalizing kidney sale would solve these issues, however, by allowing preemptive transplants and stopping the emotional and physical harms of dialysis.

In addition to these reasons, kidney sale could help save lives in a few more ways. Because more kidneys would be available, there would be a better possibility of longer lasting, better matched transplants. In the U.S. today there is almost no chance of receiving a perfectly, 6 antigen matched kidney (“Kidney Transplants Facilitated…”).  As a result, there is always a possible chance of rejection in the new organ, even with the lifelong anti-rejection drugs. If more kidneys were available, however, there would be greater a chance of getting better matched and even perfectly matched kidneys. These create amazing benefits, such as a reduced need for immune-suppressant drugs and an extra 8 years to the life of a transplanted kidney. In addition to better matches, any kidney obtained from a live donor lasts about double the time of a deceased donor kidney, resulting in the need for less subsequent transplants (“Kidney Transplants Facilitated…”). Overall the current system has failed in producing enough kidneys to meet the need of those battling kidney failure. As a result, legalizing kidney sale would provide more kidneys and solve the problem by reducing the need for dialysis and increasing the life of many transplants. 

When looking these advantages of legalizing kidney sale, the benefits are astounding, but would system work? In a 2012 poll given out to individuals across the country, results stated that 41% would consider selling their kidney for a negotiated price. Though more may be from lower income brackets, they would not be exploited as in the black market because the bottom 10% in the U.S. lives better than any third world countries (Hensley). In addition, the poor in the black market are targeted, preyed on and never given a chance to negotiate a fair price and if a market did arise in the U.S. vendors and recipients would agree upon a fair price before the surgery. They would also be paired for socio-economic status as well to ensure a better match. To show that kidney sale has worked to solve the kidney shortage, in Iran where it was legalized, the entire transplant waiting list was cleared (Hipen). This is an amazing success that if implemented in the United states, would save the lives of thousands of individuals each year.

In conclusion, America today is facing a massive and growing shortage of transplantable kidneys resulting in wasted money, violence and death each year. The current system has severely failed in providing for this shortage and the gap in supply and demand is only getting bigger. As a result of this, the Federal government has been paying to provide supportive care, through dialysis, for the over 450,000 patients who are waiting for a transplant today. Additionally, patients who are already suffering through this painful process, are left to pay for the additional costs. Globally, this shortage has led to another horrible effect. Organized crime rings of organ harvesters and sellers have sprung up in nearly every impoverished country. Because they are nearly impossible to track and stop, their profits have grown as they use almost any means necessary to take advantage of kidney patients who have no other options in the U.S. Finally, Kidney failure, and the lack of available kidneys has led to the deaths of about 4000 men, women and children each year. For those who are lucky enough to receive a transplant, it will not last long as lengthy dialysis has led to a shortened transplant life. Because nothing else has even come close to solving these monstrous problems, Kidney sale may be the best option to aid the U.S. 
