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To save more lives, let people sell their organs

March is National Kidney Month -- a good time to trumpet the bad news about the growing organ shortage.

Today, 83,000 people wait for a new kidney, a record high. Perhaps one in five will actually receive one this year.

Despite decades of urging people to sign donor cards and donate to loved ones, 12 people die daily, unable to survive a five or more years' wait for a kidney.

No wonder desperate people on the waiting list advertise on billboards and on the Internet. Some even travel abroad to get a kidney on the black market. Awful? Yes, but you cannot blame sick people for trying to save their own lives.

We can save many of those lives by doing the responsible thing: Increasing the supply of organs by rewarding healthy, well-informed donors.

Unfortunately, U.S. law deems pure altruism the sole legitimate motive for donating organs. Someone who accepts any material reward for sparing his fellow human being years of life-draining dialysis and premature death is -- believe it or not -- committing a felony.

Of course, brokers who traffic in kidneys and exploit illiterate and impoverished people should be thrown in jail, but we are not suggesting a free-for- all marketplace. What we propose is for Congress to allow donors to accept a carefully devised and regulated benefit, perhaps a tax credit, a contribution to a retirement plan, or early Medicare.

But compensation and organs don't mix, say some critics. Not so. The desire to help others -- for enrichment -- is as old as humankind. Think of police officers, firefighters, doctors and teachers. Their sacrifice and service are no less valuable because they are paid.

Polls show that the majority of Americans are receptive to the idea of offering incentives to kidney donors. Still, some understandably worry that compensating donors, even if done legally, will encourage people to sell their kidneys out of desperation.

The answer is a well-designed plan that prevents donor exploitation. Providing in-kind rewards were offered to donors, such as a contribution to a retirement fund, an income tax credit, lifetime medical care -- rather than lump-sum cash payments -- would not attract desperate people who might otherwise rush to give a kidney for instant cash.

Such an incentive program would carefully screen would-be donors for physical and emotional health, as is currently done for volunteer living kidney donors.

A monthslong waiting period would ensure that donors are not acting impulsively or with less than fully informed consent. Finally, all donors would be guaranteed follow-up care.

Notably, the donor incentives would be provided by an entity such as a governmental entity, charity or insurer; not by individual patients. Thus, organs procured would be distributed to the next needy patient in line -- with no advantage to the financially well-off.

Who would fund the benefits? Possibilities include the federal or state government, private charities, or insurance companies.

The cost savings would be impressive.

Dialysis costs about $72,000 per year whereas anti-rejection medication that kidney recipients need costs between $12,000 and $15,000 annually.

We emphasize rewarding living donors to solve the kidney shortage because even if everyone signed his or her organ card -- and we surely hope they do -- it would not close the growing gap between supply and demand.

The reason is that not enough people die in a manner that allows their organs to be transplanted. Another major benefit of a safe and regulated incentive system is that it will help put black markets out of business.

Altruism is a beautiful virtue, but insisting that it remain the only legal way to donate an organ is exacting a deadly price. We must also compensate people who are willing to relinquish a life-saving kidney -- so their act can encourage others to do the same.

Satel is a resident scholar at the American Enterprise Institute and editor of "When Altruism Isn't Enough: The Case for Compensating Kidney Donors." Perry (Mark.Perry@aei.org) is a professor of economics at the University of Michigan in Flint.

McCLATCHY-TRIBUNE

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