One Kidney Is Enough

A solution to an unnecessarily fatal condition.

A number of years ago I developed a leiomyosarcoma, which is an unusual form of abdominal cancer. Although I had previously been a health worrier, I was too caught up during the next number of days dealing with the very real risks of my condition to worry very much about anything. There was too much to do: choosing a surgeon, a hospital and such. Because the cancer was attached to my kidney, I knew I was likely to lose the kidney; but I was more concerned with simply surviving. Besides, as a physician, I knew that the loss of a kidney was not likely to impair my health. After the operation I was told I had a 60% chance of surviving, and now, a decade later, the risk of the cancer returning and killing me is down to about 3%.

As it turned out, I did lose the kidney. I asked the urologist who operated on me whether I needed in the future to take special precautions such as eating a low protein diet, or staying away from certain medicines, or anything else. And he said no. I checked with a nephrologist who said the same thing.

This is what happens when someone is born with one kidney, or when someone loses a kidney at an early age because of an accident: the other kidney grows in size and compensates entirely for the missing kidney. The remaining kidney is still able to do its primary job, which is to rid the body of wastes. When someone loses a kidney at an advanced age, as I did, the remaining kidney does not compensate entirely. As a consequence, my blood level of BUN and creatinine, indicators of normal protein breakdown, are always mildly elevated, but that elevation has no clinical significance. I am fine. I engage in athletics, I work full time. In fact, I went back to work within a week of my operation.

I want to emphasize that my health has not been affected in any way by the loss of a kidney. The way I live has not been affected in any way. Having only one kidney does not make me more vulnerable to those diseases, such as diabetes or hypertension, which can injure both kidneys and render them useless. That is what the experts tell me. Again, I do not miss my kidney.

Now, consider these facts:

1.  Four thousand people die every year in the U.S. waiting for a kidney transplant. Many of these people are on dialysis, which is the only way of keeping alive someone who has lost kidney function. It is a treatment that is so unpleasant that a number of patients elect to stop dialysis even when they know death will follow soon after. This year 99,520 people are on a list waiting for a kidney transplant.
2. There is a shortage of kidneys for transplant. For that reason many family members of such patients volunteer to give up one of their kidneys to save someone they love. As far as I judge, these volunteers are regarded with great respect. They are doing an honorable thing.
3. Because of the world-wide shortage of kidneys for transplant, some men and women have been kidnapped and operated on to remove a kidney, which can be sold on a black market for as much as $40,000 dollars.
4. Someone giving up a kidney for transplant is not likely to suffer any more inconvenience than I have experienced. There is the risk, of course, inherent in any major operation and the potential for complications. Recovery may not be uneventful. Donors may lose more than a week of work. Something can always go wrong, but those complications are no more likely than those seen in intestinal surgery, for example. Following surgery, the donor is not likely to suffer any impairment of his life or health.
5. There are many poor people who would be glad to donate a kidney—an organ which they can do without—for a sum of money much less than $40,000. Ten or twenty thousand dollars would make a huge difference in the lives of these individuals and their families.

And yet, paying a person to donate a kidney is considered unethical! It is not permitted. It is illegal.

When I was in medical school, students often donated a pint of blood for fifteen dollars. No one considered that unethical. I remember a particular research project where a student donated about a square inch of skin for money. His cooperation was solicited by the medical school; and no one thought there was anything unethical involved. It turned out there was a potential problem that arose when people off the street were paid to donate blood. Namely, some unprincipled persons would lie about whether or not they had certain diseases that would disqualify them from donating blood. The money was all that mattered to them. For that reason, paying people for their blood has become rare. The problem for paying anyone for blood however, is a practical problem rather that an ethical problem. So, why is paying someone for a kidney unethical?

If selling a kidney became acceptable, all those thousands of lives of men and women without kidney function would be saved. The donors would suffer no lasting disability. And yet permitting them to save these other strangers is regarded as unethical! I think it is all those sanctimonious individuals who have made up this rule who are unethical.

But why in the first place do they think selling a piece of oneself should be a violation of some sort of human right? I think they imagine a scene where a lot of rich people in rich countries will be purchasing parts of other impoverished human beings. And so they would. The scene is vaguely disquieting. They might say that it is wrong to put pressure on anyone to give up a vital—or not-so vital-organ just for money. Of course, what is wrong is that a considerable part of the world’s population is so poor that they feel pressure to work dangerous jobs or live in unhealthy and disease-ridden circumstances in order to survive. It is the fact that they are forced to live that way that is unethical. If they had a relatively large sum of money, they could avoid a host of actions that are inimical to their health and welfare. Maybe, once the risks of nephrectomy were explained to them, they would choose not to undertake such a procedure. But they should have the right to make these judgments themselves.

After writing this blog I realized I probably do not really understand the moral objections some people have to selling body parts. I asked my kids what they thought was behind that opinion. These are their responses:

Eve: It’s because of the reason you gave at the end: poor people would feel pressured, or be pressured, into giving up a body part. The system isn’t fair and is already rigged towards the wealthy who have political power. Your premise is that poor people need the money and would like the opportunity, but you know people would do it out of desperation and that is upsetting to contemplate.

Jim: I don’t think it’s unethical. But some people might think this takes advantage of the poor. Other might find it vaguely sacrilegious, insofar as it somehow violates God’s plan. And I think others just view it as icky, which is probably not exactly the same as unethical.

So, this is what it comes down to: Poor people around the world suffer in all the ways it is possible to suffer from poverty and may be forced, among other things, to work in mines that cause disease and  death. In some countries, they may be forced to sell their daughters into slavery. Because we are not responsible for those choices, we can afford to look away. We do not have to consider their plight. But once we offer them any choice, we are pressuring them to do one unpalatable thing or another. The very thought of taking away someone’s kidney is distasteful. Narrowing their choice to the awful circumstances they already find themselves in is considered better. They cannot be trusted to make the sensible decision of accepting money for a bodily part they do not really need.

Being comfortably without a kidney, as I am now, I wonder if when I was younger I would have been willing to sell my extra kidney for money. Not for five or ten thousand dollars, which would not have been enough to recompense me for my time and trouble. Not even for a hundred thousand dollars, I figure. But I would have jumped at the chance to sell a kidney for two hundred thousand dollars! I could have guaranteed my children’s education. If I had that kidney back now from the necessity of cancer surgery, I would be willing to give it up all over again if someone offered me that much money for it. I could pay for my grandchildren’s education. Does that mean I am being pressured by the expense of education to sell a body part? In a way it does. So what? Shouldn’t I be allowed to make such a choice, being an adult of sound mind (more or less.)

For many people around the world, ten thousand dollars would mean as much as two hundred thousand dollars mean to me.

(c)  Fredric Neuman