A few months ago, I wrote about a proposal End Kidney Death Actwhich wants to ensure that each one More than 135,000 Americans People who develop kidney failure every year have access to a kidney transplant.
Its approach is simple: A federal tax credit worth $10,000 a year for five years is awarded to anyone who donates a kidney to a stranger. When I donated a kidney in 2016 it was something that helped a lot. Elaine Perlman, a fellow kidney donor who leads Coalition to amend NOTAwhich is advocating for the legislation, estimates that the measure will save 60,000 lives in the first decade. With polling showing that such measures have overwhelming public support At least 64 percent of Americans support a system Where a government agency compensates donors.
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Since we last covered it, the law has made some major strides. It is introduced by two Republicans (with representatives) in the House of Representatives. Nicole Maliotakis New York and Don Bacon Nebraska) and two Democrats (Rep. Josh Harder California and Joe Negus of Colorado) in support of. Dozens of supporters went to the Hill for a lobby day last week, meeting with the staff of more than 50 other senators and representatives.
But it’s also starting to generate some real opposition. This is expected. Over half a century or more, organ donation has become a safe and reliable procedure, with many people including some running kidney care advocacy groups. Expressed opposition to the idea of compensating kidney donors for our work. Compensation has been banned since the National Organ Transplant Act of 1984, legislation Perlman’s coalition seeks to amend. We’ve made mistakes for 40 years hard to admit and count. every year, About 47,000 people die prematurely Due to kidney deficiency. Over the course of 40 years, the death toll ran into the millions. Failure to pay donors killed many people.
Surveying the entire landscape of anti-reparations arguments could fill an entire book (and have!), so I will only address a few here. But none of them are persuasive, and members of Congress weighing a bill to fairly pay donors for the work we do to prevent death from kidney failure should reject these arguments.
3 Bad Arguments Against Paying Kidney Donors
1) Paying people to donate kidneys is very dangerous: This would be a very good argument against charity if it were true – but it is extremely false. Although kidney donation carries risks, they are quite small. A Newly published study It found that the risk of donor death in actual surgery, which was already very low, has dropped by two-thirds over the past decade. For the decade 2013 to 2022, which includes my donation in 2016, there were 58,656 living kidney donors in the United States. Five died within 90 days of the operation. That’s a risk of death of 0.9 per 10,000.
For comparison, in 2022, it ended there For every 100,000 working loggers in the United States, 100 die from work injuriesThe death rate per year is about 10 times greater than the one-time risk of kidney donation. Roofers, fishermen, and truck drivers each have an annual death rate at least twice the risk of death from kidney donation. Certainly, these workers deserve better protection, just as five deaths among donors is five too many. But no one would argue convincingly to ban the practice of roofing because it is so dangerous. Why should that logic work for the kidneys?
2) Kidney donation exploits or forces the poor: This argument takes several forms, but it is based on the insight that paying for donations disproportionally pushes poor people to be donors, and that this constitutes exploitation because they would not donate without compensation and thus are donating in part because of them. Self financial deprivation.
Oxford philosopher Janet Radcliffe Richards notes that this argument, like the one above, proves too much. “This applies to almost all paid jobs,” he wrote The ethics of substitution“Unless you do your work without pay … anyone who hires you or buys what you offer for sale exploits you.” Although the assumption is that all wage labor is exploitative Hardly newIt is foolish to conclude that wage labor should be banned and workers should not be paid wages.
A similar but distinct argument is that such payments are coercive rather than exploitative: the lure of cash actively forces people to donate, as a blackmailer or extortionist does. This is not what the word “coercion” means. Coercion means using threats or force to limit a person’s options so that they do what you want. Paying for kidney donation expands rather than limits options.
The late philosopher Alan Wertheimer, who literally Wrote books on coercionIt puts it plainly: “Genuine offers are not coercive. Period.” An offer of money to donors of the End Kidney Deaths Act is a genuine offer. It cannot be coercive.
I should note that the Kidney Death Act could be changed to avoid this concern. It could be written so that only wealthy people (perhaps those making $400,000 or more) are eligible for the tax credit, so we can be sure they aren’t being exploited. Is that good? Or does it disproportionately exclude poor people from valuable benefits? I think the latter.
3) If donors are compensated we will receive fewer kidney donations because it will no longer feel altruistic: This is known as the “crowding out” hypothesis, and has long been an argument of compensation critics Alexander Capron reports to NPR And in their writing on the Kidney Deaths Act: “When something becomes something people buy, donors stop giving.” The problem is that there is no evidence for Capron. (I emailed him asking something and never heard back.)
When it comes to donating blood, A recent meta-analysis On the subject, most of the estimates show that cash or cash-like incentives increase it, not decrease it. in case blood plasmaWhile more time-consuming and physically draining than whole blood, financial incentives have proven dramatically more effective than altruistic ones. The United States and Germany compensate plasma donors, while Canada, the United Kingdom, and Australia do not.
Certainly, the latter three countries import the bulk of the blood plasma they use where donors are paid. In a shocking twist, paying people for their work is getting more done.
The same may be true of the kidneys. A recent survey conducted by the National Kidney Donation Organization (which represents living kidney donors) of its 288 members, shared privately with Vox, found that 97.9 percent said they would be likely or even willing to donate if they were taxed. Credit
If you believe in kidney donors, incentives work. D Iran has the shortest kidney waiting list in the worldWhich, not coincidentally, is the only country that currently allows compensation.
More to the point, the whole theory that paying people to donate blood or kidneys would make them less likely to do so is sufficiently outlandish that it’s hard to see how it could theoretically be true, perhaps. Very low level of compensation.
There is no other area of human life where we assume that monetary incentives are actively counterproductive. We are not concerned that paying doctors and nurses will “crowd” their philanthropic reasons for working in health care, or allowing firefighters to accept wages because of their natural desire to save the “crowd” from burning buildings.
The correct response to “People give more blood when they’re paid to donate blood” is “Well, duh.” And the correct expectation of paying people to donate kidneys is that they will donate more kidneys.
Enough thought tests, it’s time for the real test
I studied philosophy in college, and I enjoy dissecting the meaning of concepts like “exploitation” and “coercion” and “commodification” as much as the next dork. But I have to admit that I find some philosophers tend to use the kidney as a kind of playground to test ideas about how market constraints can be offensive.
Their arguments are not merely theoretical. They borrow principle statements from practitioners like jaw-droppingly naive Istanbul DeclarationA joint statement by several transplant doctors and nephrologists organizations said that compensating donors “helplessly leads to inequity and injustice.”
The document provides exactly zero empirical evidence for this statement because there is none. “There is no argument, only smoke and mirrors,” Radcliffe Richards rightly points out. “For a major international statement, widely supported, it’s appalling.”
it is is Horrible, and it has contributed to a situation where about 25,500 kidney transplants are performed in the U.S. each year but more than 135,000 new end-stage kidney disease diagnoses. This means that around 110,000-odd people each year, who could potentially use a kidney donation, cannot receive one because there is not enough supply. The way you increase labor supply is, in any case, by raising wages.
There are not enough nurses? Pay nurses more. Not enough waiters? Pay your waiters more. Not enough kidney donors? Here’s a crazy idea: pay us.
