Should human kidneys be bought and sold?
Should human kidneys be bought and sold?
Made with academic consultants at The Open University: Vicki Caldwell,Tutor in Social Work and Professor Derek Matravers, Professor of Philosophy VICKI CALDWELL, Organ Donation Campaigner & Lecturer, The Open University: There's some things money can't buy. STEVEN PINKER, Cognitive Psychologist: We don't like the idea of treating parts of the body as commodities. SALLY SATEL, Psychiatrist & Kidney Recipient: As beautiful a sentiment as altruism is, it just isn't enough. CAPTION: MADE IN PARTNERSHIP WITH THE OPEN UNIVERSITY FRANK DOR, Consultant Transplant Surgeon: People have two kidneys situated on the back, behind the ribcage, they look more or less like a bean. And kidneys are organs that filter waste material from the blood and process that into urine. They're extremely important, because if your kidneys are failing, you're collecting quite a bit of waste material which is detrimental for all other organ systems. CAPTION: PATIENTS WITH KIDNEY FAILURE CAN BE KEPT ALIVE WITH DIALYSIS. THIS PROCESS CLEANS THE BODY, EITHER BY DRAINING WASTE PRODUCTS WITH A CATHETER OR BY FILTERING THE BLOOD THROUGH A MACHINE. FRANK DOR: A typical dialysis patient has a poorer life expectancy than many cancers. After decades of experimenting, in 1954 was the first successful human transplant, which revolutionised the field. CAPTION: TODAY, KIDNEY TRANSPLANTS ARE COMMONPLACE, WITH AN EXCELLENT SUCCESS RATE. MOST OF THE KIDNEYS USED COME FROM DECEASED DONORS. VICKI CALDWELL: My daughter was involved in a car accident. It was clear that her injuries weren't survivable. But Fi had let us know that, if anything had happened, she would want to give her organs. So when we arrived at the hospital and were given that devastating news, this felt like something that we could all get behind and for something positive to come out of such a sad time. I mean what an incredible legacy. Fi saved four people's lives on that day. CAPTION: DEMAND FOR KIDNEYS GREATLY OUTSTRIPS AVAILABILITY. OF THE MORE THAN 3,500 PATIENTS CURRENTLY ON THE UK WAITING LIST, 30% HAVE BEEN WAITING MORE THAN TWO YEARS... AND AS MANY AS 1 IN 10 DIE BEFORE THEY GET THE TRANSPLANT THEY NEED. IN THE US, ANOTHER NAME IS ADDED TO THE TRANSPLANT LIST EVERY 9 MINUTES. SALLY SATEL: In 2006 I went for a regular check-up and I felt fine, but the blood work that I got showed that my kidneys were in very, very bad shape. I had to either go on dialysis, hooked up to a machine for three to four hours a day, about three times a week, or I would have to try to find a donor. CAPTION: THE WAITING LIST FOR A KIDNEY FROM DECEASED DONATION IS SO LONG THAT THE BEST SOLUTION FOR PATIENTS IS OFTEN TO TRY TO FIND A LIVING DONOR. FRANK DOR: Lots of people still don't know that many people could actually donate a kidney. Removing one kidney should not affect someone's lifespan. And also should not affect someone's life quality. A kidney from a living donor in general will have a much better quality because it comes from a healthy and tested person. Kidneys are expected to survive up to twice as long on average in the recipient. CAPTION: BUT IN MOST COUNTRIES, INCLUDING THE UK AND THE US, THERE ARE STRICT RULES AROUND LIVING KIDNEY DONATION. KIDNEYS CAN COME FROM RELATIVES AND FRIENDS, OR FROM SELFLESS STRANGERS DONATING ANONYMOUSLY, BUT THE CHOICE MUST BE MADE OUT OF "ALTRUISM". SALLY SATEL: I was lucky, I had two people who were willing to sacrifice a body part to me. It leaves you speechless with gratitude, but it also leaves you speechless with sorrow and anger that there are so many people who don't have friends or relatives who can give them a kidney and who die waiting for one to become available. So that's how I became very interested in our organ transplant system and how we should change it. STEVEN PINKER: No-one needs two kidneys, and there are many desperate people who need one. If they were compensated their lives could be improved at little cost to their health, while saving the life of someone else. SALLY SATEL: The idea is to offer people an in-kind benefit, not cash, but maybe loan forgiveness, or a tuition voucher, or a contribution to their retirement account in exchange for a kidney. STEVEN PINKER: If I were a patient with failing kidneys, and I faced a short and miserable life, and I had the opportunity to buy a kidney, and was assured that the donor was being properly compensated, you bet I'd take that option. CAPTION: THE IDEA OF CREATING A MARKET FOR KIDNEYS REMAINS HIGHLY CONTROVERSIAL, HOWEVER. FRANK DOR: Currently it's not allowed to donate a kidney under any form of payment. We rely on the goodwill of people to help others. VICKI CALDWELL: It's not the wealthy who would be wanting to sell their organs, it's people who are on the poverty line, in very desperate situations. And those people are also the most vulnerable people in terms of poor health in later life. CAPTION: THE NEED FOR KIDNEYS HAS ALREADY SEEN EXPLOITATION AROUND THE WORLD. PUT OFF BY WAITING TIMES, "TRANSPLANT TOURISTS" TRAVEL TO COUNTRIES SUCH AS THE PHILIPPINES AND PAKISTAN TO PAY FOR OFTEN ILLICIT KIDNEYS. IN CHINA, KIDNEYS ARE ALLEGEDLY HARVESTED FROM PRISONERS - SYRIAN REFUGEES IN TURKEY HAVE ALSO REPORTEDLY BEEN TARGETED. SALLY SATEL: Incentivising people to donate more is actually a way to starve black markets, it's not to recreate them, it's to undermine them. If you reward a person amply for the sacrifice they've made, something they go into with their eyes open and well informed, that's not exploitation. CAPTION: ONE COUNTRY ALREADY HAS AN INCENTIVISED SYSTEM IN PLACE: IRAN. THEIR KIDNEY TRANSPLANT WAITING LIST HAS BEEN NEARLY ELIMINATED, AFTER DONORS WERE ALLOWED TO BE COMPENSATED WITH A MONETARY "GIFT". MOST DONATED KIDNEYS COME FROM THE LOWEST 25% OF EARNERS, HOWEVER. FRANK DOR: No-one really knows what will happen if you start doing this. Because even though personally I'm not necessarily fully against it, if it would drive people to donate, but the effect could be that it all becomes a business transaction. And that the more obvious donors may not donate because they will tell the recipient, "Oh, you can go and buy a kidney, right?" It might actually reduce the number of people that want to donate, because they don't want to be involved in such a scheme. All of a sudden, transplantation becomes... a thing that you can organise as long as you can pay for it. CAPTION: IN THE FUTURE, SOURCING KIDNEYS MAY CEASE TO BE A PROBLEM. FRANK DOR: People are dreaming to build kidneys in the laboratory, bio-printed or 3D-printed organ structures, modified pig organs, so that's a revolution. CAPTION: BUT FUTURE SOLUTIONS WON'T HELP THE THOUSANDS OF PEOPLE ON WAITING LISTS TODAY, AND THE NUMBER OF PEOPLE WITH KIDNEY FAILURE IS SET TO GROW. DIABETES, ONE OF THE MAIN CAUSES, IS ON THE RISE... AND STUDIES SHOW INCREASING RATES OF HEAT-INDUCED KIDNEY FAILURE BECAUSE OF THE CLIMATE CRISIS. SO IS BUYING AND SELLING KIDNEYS AN ETHICAL SOLUTION? SALLY SATEL: This is the only way to solve the problem. It's so much needless death. VICKI CALDWELL: It feels like an incredible gift, and I don't know how that gift can be quantified. STEVEN PINKER: When we're considering this policy option, most of us don't weigh the pros and cons, but often we're offended at the very idea. WOMAN IN VINTAGE BROADCAST: Selling kidneys is so immoral I can only liken it to the woman who goes out on the street and sells sex. STEVEN PINKER: It's an example of a secular taboo. FRANK DOR: In my view, the full potential of living donation has not yet been achieved without using money. VICKI CALDWELL: Why are we not maximising deceased donation? We don't talk about our wishes. Research shows that most people would agree, after death, to organ donation. Yet we leave our loved ones wondering. SALLY SATEL: Ideally, we could change the law but I would advocate that anyone consider donating, no matter what, because, save dragging someone out of a burning building or pulling them out of a frozen lake, where else could you save someone's life so palpably as this?
