Kidneys, coming soon to a high street near you

2:29 pm - December 6th 2007

by DonaldS    

      Share on Tumblr

Consider this:

A kidney patient who travelled to the Philippines to search for a live donor has defended his decision to become a so-called “transplant tourist”.

Stories like this hit the bullseye of the inherent tension between ‘liberal’ and ‘left’ ways of looking at the world.

A liberal (even ‘libertarian’) solution would be simple: we should be allowed to sell a kidney. It’s our body, and we should be free to do what we want with it. The borders of the state must stop at the dermis. Liberty is that simple. Or simplistic.

A left analysis would first point out that the burdens of this ‘freedom’ would fall disproportionately on the poor. Should they need a kidney, they won’t be able to afford one. A rich person is unlikely to need to sell his; a poor person, the opposite. Kidney sellers will be poor; purchasers usually rich. A freedom isn’t a freedom unless its universal; it’s more like a privilege. Just like my freedom (or ‘right’) to buy a Porsche. In a system that relies on exploitation, what we call capitalism, words like ‘freedom’ are sometimes meaningless. (There’s an analogy here with smoking in pubs, but that’s another story.)

There’s really no ‘left-liberal’ solution to this, not in the philosophical sense anyhow. There’s also no place for supporting or condemning one man’s attempt to prolong his life. Perhaps the place to start is with common sense. Support for the BMA’s position on presumed consent is little more than acknowledging the existence of a market failure that can be corrected. Easily and liberally.

    Share on Tumblr   submit to reddit  

About the author
Donald is a regular contributor to Liberal Conspiracy. He is a travel journalist, editor, author and copywriter. In the wake of the 2005 General Election, he co-founded and edited The Sharpener for a couple of years. He writes the occasional book or newspaper article for money, as well as sharing his thoughts here for free. Also at: hackneye
· Other posts by

Story Filed Under: Blog ,Economy ,Equality

Sorry, the comment form is closed at this time.

Reader comments

Isn’t it possible to argue that, given kidney sales by the poor sometimes afford them opportunities they may desperately need, denying them that choice is not helpful. As long as people are fully informed of the dangers of the choice they’re making, why not?

To add to that, I wouldn’t however want to see advertising for kidney parts which could be misleading.

“Support for the BMA’s position on presumed consent is little more than acknowledging the existence of a market failure that can be corrected. Easily and liberally.”

Ahem! This is not a “market failure” but a planning failure. There is no legal market in organs, so it cannot “fail”. It is a failure of policy.

Of course, it is not impossible that a market in organs might also fail or might have unintended consequences but the benefits might also be tremendous. Imagine, for example, if the presumption was that you owned your organs as property even after your death. You could sell them at a high value, and bequeath the money to your family. This might be particularly useful if your family relied on you for support before your death.

If that was allowed, you would see far more people consensually (i.e. liberally) putting their organs on the market in the case of their death. That would reduce the demand for organs from living donors. All this is possible, but by the state making the claim on organs, you remove the possibility of a just rights-based consensual system developing. And that is dangerous.

Isn’t it possible to argue that, given kidney sales by the poor sometimes afford them opportunities they may desperately need, denying them that choice is not helpful. As long as people are fully informed of the dangers of the choice they’re making, why not? ~ Sunny

Yay! The Free Market.

Good grief, is it really the prior of this “liberal left” site that “what we call capitalism” is a “system that *relies* on exploitation”?
Why not just cut the “liberal” bit and have done with it??

Yes Aaron – Yay! The free market.
Let the putative Filipino kidney seller do what he/she thinks best.
How is denying him the choice to sell, in order to salve *your* comfortable conscience, helping him out?


You’re only employed by capitalists if they think they can pay you less than the value of your work. That’s exploitation. The fact that entering such a relationship might still be to your benefit doesn’t make it any less exploitative.

On the main point, it’s a weird kind of ‘free’ market where all the potential sellers are shit-poor and all the buyers rich.

You mean that those people who risk their capital demand a return on that capital?
How exploitative.

chrisc – I’m a free marketer (though I think markets are not free enough generally and are biased towards big business) but its not actually heresy to suggest capitalism is exploitative.

It is, otherwise there wouldn’t be any return on capital. I don’t think that form of exploitation is bad per se (though it can be when people are paid a pittance), but it seems you’re baulking at the word without engaging the main thrust of the post.

While of course people should not be stopped if they are fully informed and it is the way they want to get their lives on track with the income gained…what is to say that the price is fair? What you have the potential for is a slippery slope where as it becomes more popular you have people selling body parts for less and less amount of money as buyers (who are ultimately the people in a position of power here despite any illness) are able to barter between donors for a better price.

I think it is both liberal and left to say that such a practice should be allowed to take place, it’s just that the details of regulation to protect the donor that would seperate the two, but realistically how can that ever happen when there are no borders for the person needing an organ, and a freedom to choose countries that take part in it (hypothetically) by how cheap their product is?

A left analysis would first point out that the burdens of this ‘freedom’ would fall disproportionately on the poor.

What burden? There is certainly no burden on the buyer – he gets to live. And the seller must think he is better off for the deal, or he would not have chosen to sell.

Would you object if the seller had donated his kidney for free?

If not, why would receiving money (I assume) for his kidney make the seller worse off?

In your hands anyway the ‘Liberal Conspiracy’ amounts to a boring plot to alter the meaning of the word liberal to suit your own preferences.

Assume someone was motivated to sell his kidney to someone in need, but not out of economic desperation. In Donald’s dreary ‘Liberal-Left Kingdom’ would they be allowed to do so?

Yes it is a bit like the smoking thing in the sense that you can’t bring yourself to admit that you favour limiting liberty in order that some other good may arise so instead you indulge in this intellectual dishonesty whereby you try and pretend that liberties you don’t approve of aren’t really liberties.

12. Lee Griffin

The issue for the left should not be the practice, it should be the assurances that exploitation cannot take place on those that choose such a path. Regardless of any comments on how liberal everything is, the fact is that if a market is created for kidneys then it means that people doing it for financial reasons rather than altruistic ones could find themselves severely psychologically impacted, especially if they originally were in such a state as to believe selling their own organs was the only way out of any situation they were in.

Compulsory assessment and counselling for kidney donors for a short period at least surely should be a must, but such things cannot be done while the black market is a significant part of the equation…and lets not all pretend that everyone currently giving their organs away in this world are doing so because they want to feel good or believe they are going to get some financial gain from it.

to #6, Donald S

Surely the sellers are money poor, but kidney rich – whereas the buyers are money rich but kidney poor.

Being a billionnaire isn’t much fun if you spend all day on dialysis. And having two kidneys isn’t much fun if you can’t even afford the luxury of over-loading them with booze occasionally.

Surely a kidney market would increase the numbers of successful kidney transplants, as well as transferring money from the rich to the poor…

People doing it for altruistic reasons could be severely “psychologically impacted”. And our current prohibition of such trades can have a severe non-psychological impact on would be buyers.

They have a severe shortage of kidneys.

And then, sooner or later, they die.

Sunny – sorry, obvious that I would agree with #13!

And yes, I do baulk at the rather juvenile bandying of the word “exploitation”…

>you favour limiting liberty in order that some other good may arise so instead you indulge in this intellectual dishonesty whereby you try and pretend that liberties you don’t approve of aren’t really liberties.

No, I’m just not credulous enough to think that the liberty to buy a kidney from an unfortunate does anything like enough to qualify as a liberty. If you want to argue that a small minority should have the privilege of buying spare body parts from the reserve army of poor (or ‘organ-rich’), then go for it. But don’t pretend it has anything at all to do with being a liberal.

BTW, I’m very much in favour of free markets, but this market ain’t, nor could ever be, ‘free’.

In any case, the path suggested by the BMA would cut the shortage of organs, without the need for anyone to sell them.

To explain: the evidence cited by the BMA is that there’s sufficient altruism out there anyway, without the need for (imperfect) marketization of the system. Moving to presumed consent with an opt-out just means we can harvest that altruism more efficiently.

14. Of course, and I’m not stating that such a situation is ideal either. In the perfect world we would move to an opt out rather than opt in system of organ donation and in this country at least we would have no more issue with shortage of donors.

If that doesn’t solve it then I am personally not against the idea of making a market out of organ donation, in all honesty this wouldn’t be any different that someone going to a private clinic for their healthcare to pay for the privilege of circumnavigating the waiting lists.

But why are some of you looking at things so simplistically? This is more than a physical transaction that people go through. It’s not just a case of some rich person giving some money to a poor person that wants to sell a part of their body. There is also a stark ignorance here to the fact that where there is business there is the opportunity for exploitation. Baulk at the word as much as you want but, even in its potentially exaggerated state, where there are black markets for this sort of practice there is also exploitation where the person “donating” is merely an asset of forms that a third party is profiting from.

I’m not suggesting that on a basis of looking at this country alone that such practice would be wide spread, but can we honestly deny that there are shady elements operating within the country that wouldn’t take advantage of vulnerable individuals. Off the top of my head, certainly given the instance of sexual abuse and prostitution that young women and girls coming into this country are and have been forced in to, illegal immigrants would top my list of people that could be easily exploited.

We can stick our head in the sand on here or we can discuss the issue in a more realistic fashion without being afraid of touching on the potential extents of where “liberal” policies can become harmful, otherwise what the hell are we here for?

Look at what the article says too:

The Week In Week Out team travelled to Baseco, a place known locally as “No Kidney Island” because so many adults there have sold their kidneys in a bid to escape poverty.

The programme discovered some had undergone the surgery for as little as £1,000, and an organ broker admitted lying to hospital officials about the donors she recruited.

It’s clear that there is a danger here of being exploited. The poor people who want to sell their kidneys desperately are unlikely to be educated (especially in developing countries) and can be exploited. That is a fact and I believe what Donald is also trying to get at.

So govt intervention *shock horror* may be needed, if only to facilitate a better transaction. It’s like (class c) drugs and prostitution – I’d rather they were legalised and regulated than banned.

Yes I agree that “informed consent” is critical and, therefore, in this situation problematic.

“So govt intervention *shock horror* may be needed”

I probably agree, though the devil is in the detail as always.
And the problem with drugs is that there is *too much* intervention, isn’t it?
(Why just class c by the way?)

And (for the last time) comparing the exploitation of an uneducated kidney seller – the exploitation lying in the high probability that he/she will get nowhere near the full market price – to the supposed “exploitation” of the whole of capitalism is not terribly helpful to the argument!

Umm, if you’re going to talk about kidneys and markets in them, might it not be worthwhile noting what some liberals (not left- ones, but real ones) have suggested?

So in the name of ethics – and our refusal to consider an alternative system that actually works – we condemn a number of our fellow citizens to an early and painful death; after years of draining dialysis, of course.

This might shock those who consider Iran to be an outpost of Barbary where crazed zealots hunger for a nuclear bomb – but there is no waiting list for kidneys in Iran. In Iran there is also a regulated market in which live donors get paid for their donation of a kidney. It is not a coincidence that when the State offers what amounts to roughly a year’s average income to those willing to save the life, lives actually get saved. It’s worth pointing out too that kidney donation itself is of the same order of risk as carrying a surrogate child.

Here in Britain, dialysis costs on average £30,000 a year. Imagine that sum, a figure well over the typical annual income, paid as a fee for a donation; it would surely tempt many to offer up a spare. No one is suggesting that there should be an unlimited market in which desperate would-be donors appear at the A&E, clutching a bloody, self-excised kidney and bargain a price with doctors. But what is surely feasible is a regulated market with financial incentives to encourage the saving of lives.

It won’t happen, of course. The discussion will not even begin and preventable deaths will continue all because commonly accepted “ethics” prevent us from accepting that there are some things just too important not to have markets in. Now, that antimarket bias really is unethical.

Interesting, Tim, but given that the BMA assess that there would be an adequate supply of organs using a liberalized system based on altruism, I can’t see why one would want to move to marketize it. Unless, of course, you had some prior bias towards marketizing as the solution to everything.

And, yes, there is a stong and irrational antimarket bias at large, but not with me. I’m happy to marketize anything that can sensibly and fairly be marketized. I just don’t think that applies here.

And, while I recall you’re a genial fellow, I don’t think anyone writing after about 1900 (and certainly no one after Rawls) would count you as a ‘liberal’, never mind a ‘real’ one, whatever you call yourself.

Campbell Bannerman (PM, post 1900) would have called me a liberal:

“the man who is governed best is the man who is goverened least” and all that.

Okay, you got me. I concede. 1900 was an exaggeration. Just.

(And I don’t disagree with the sentiment of the quote.)

Reactions: Twitter, blogs

Sorry, the comment form is closed at this time.