Op-Ed: Allow incentives for donating organs


NEW YORK (JTA) — The Jewish community in the New York metropolitan area, and to a degree around the world, is grappling with how to respond to last week’s high-profile corruption arrests there.

While money-laundering and bribery charges are nothing new, unfortunately, the charges against Levy Izhak Rosenbaum seemed most shocking. He was arrested for conspiring to broker the sale of a human kidney for transplant, a "business" he privately claimed to be in for many years.

The American system of organ donations, which forbids any incentives for donation, has created a niche market for just this type of wrongdoing.

The statistics are overwhelming. Some 102,640 patients are waiting for an organ donation in the United States, according to the United Network for Organ Sharing. More than 7,000 people died last year while they waited, and over 2,000 have died this year.

These deaths are entirely preventable. But the current system, which is based on pseudo-moralistic concerns, actually creates incentives for black markets, rewards only the most wealthy and punishes the poorest.

If morality matters, what could be more immoral than all these unnecessary deaths?

Take the recent case of Steve Jobs, co-founder and CEO of Apple. He traveled to Tennessee, which has a shorter waiting list than other states, when he needed a liver transplant this spring. He did it legally, but the rich have advantages when it comes to receiving transplants because they can get on numerous lines and jet to a waiting organ at a moment’s notice.

For those who aren’t fortunate enough to game the system one way or another, options are limited. Unless you’re lucky enough to have a relative or some other highly motivated and altruistic donor, there is little one can legally do to improve their chances in the painfully slow race against death.

The shortage of organs available for donation from unrelated donors has led to the macabre black market that exists today. Gruesome underground kidney markets are nothing new. National Geographic reported on a poor neighborhood in India known as "kidney village" – residents illegally sell their kidneys for about $800, far less than the $160,000 Rosenbaum allegedly charged.

Now it is emerging that Israel also is becoming a black market hot spot. A whole new industry — transplant tourism — is meeting the needs of the wealthy patients, creating demand.

Patients now face a choice between two extremes: Wait for a fundamentally broken system and risk death, or venture into the unregulated Wild West of the black market for organs.

There is a better and more ethical alternative.

We don’t need to delve too deeply into the black market to see that donated (or purchased) organs have a high value to potential recipients. Yet because of the ban on incentives for donations, a familiar economic principle comes into play: Whenever a product’s price is held below market demand, a shortage ensues. Despite campaigns to increase altruistic donations, organ donations are basically stagnant.

This failed status quo is no more ethical than exploring new approaches, which actually could save lives, even if we cannot foresee all the possible downsides. Many innovative plans could help shorten the line for an organ, and they do a better job than the current system of taking incentives into account.

As Dr. Sally Satel argues in her book “When Altruism Isn’t Enough: The Case for Compensating Kidney Donors,” a practical and ethical government-regulated donor compensation system would put the likes of Rosenbaum out of business.

The level of communal guilt voiced — by Jews not involved in the scandal — has reached new levels. The news broke at the start of the Nine Days, a period seemingly reserved for bad news for the Jews.

This, however, is a time not for self-flagellation but for self-reflection and to increase good deeds. Perhaps instead of crying about the misdeeds of others, it is a time to look inward and consider how we personally would behave.

If your life depended on getting a kidney that wasn’t otherwise available, would you conduct business with Mr. Rosenbaum? I would.

Would you prevent one of the 13 deaths taking place today among those in line for a kidney by donating one of yours? Would you do so for compensation? I’d do neither.

But given an incentive, perhaps others would. Clearly the incentive to save a life isn’t enough, or synagogues would be sponsoring kidney drives alongside their blood drives.

It would help to know that according to the halachic authority Rabbi Shlomo Zalman Auerbach, selling a kidney is not only permissible, it is a mitzvah.

Auerbach wrote that “even if the person selling his kidney is poor (and needs the money for himself) or to pay off his debts, since he obtains this money by saving the life of another Jew, he will certainly be doing a mitzvah. This is true even if he would not have donated his kidney only to save life.”

That it is a good deed to save life, even for compensation, is a Jewish value we should embrace in response to the chilul Hashem, desecration of God’s name, of this crisis.

Even the most tightly regulated system that creates incentives for donors would save lives, reduce the shortages that promote the black market and level the playing field by helping all potential recipients, not just those who can afford a trip to Tennessee, Kidney Village or Brooklyn.

(Jeff Stier is the associate director of the American Council on Science and Health in New York.)

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