The XX Factor

Kidneys: You Have Two of Them!

It used to be that medical establishment types-people firmly opposed to markets in kidneys and most anything else-would emphasize the scope of the kidney shortage in order to shame people into signing their donor cards. More recently, as academics and policy makers have started to take the idea of monetary incentives for kidney donation very seriously, some of those same advocates have started arguing that the list isn’t that bad, the line isn’t that long-certainly not long enough to do anything drastic, like, say, offer financial compensation for time missed from work during a donation. That would, as they say, “cheapen the gift.”

Here’s something I haven’t seen before: Double X contributor Virginia Postrel -a kidney donor and a longtime supporter of financial compensation for kidney donation-downplaying the size of the shortage:

With 300 million people in the United States, the numbers shouldn’t be so daunting. Eighty thousand people wouldn’t even fill the Rose Bowl. Surely we could find enough kidney donors to end the list. But solving that problem demands creativity, daring, and, above all, a sense of urgency-a radical break with the fatalism fostered by dialysis culture. Kidney patients ought to command the kind of outrage that demanded a cure for AIDS. The list doesn’t have to exist. It is a result not of medical necessity or economic constraints but of public ignorance, conscious policy, and complacent institutions. To end the list, we first have to give up the idea that “organ donor” means someone dead.

She’s right. The vast majority of us have an extra kidney hanging around; this is an eminently solvable problem. (When kidneys fail, they typically fail together, so your spare probably won’t even serve you as backup.) But as Postrel’s terrific Atlantic piece goes on to explain, both cultural and bureaucratic constraints work against the switch from deceased to living donors. On the cultural end, healthy donors who offer their kidneys to strangers are treated as deranged eccentrics by medical ethicists and some doctors. On the bureaucratic end, even the kind of trivial compensation offered to blood donors-Movie tickets! Paid vacations!-remains verboten in the fallow world of kidney exchange. Both relegate living donation to some conceptual space outside the “normal” range of do-gooding behavior.