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Donor Makes the Case That Kidney Sales Should Be Legal

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The buying and selling of human organs is generally frowned upon. But should this be the case? There’s an argument to be made that if kidney sales were legal, more lives could be saved (because more people would be willing to part with a kidney), and overall health care costs would decline (because a kidney transplant is cheap compared to years of dialysis and treatment). And what’s the suggested fair retail price for a kidney? About $50,000.

In a New York Times op-ed, Alexander Berger presses the idea that the selling (or buying) of a kidney should be completely legal and open to everyone. Berger is not a doctor or an academic. He doesn’t work in the health care field at all. He’s only 21 years old. So why should we care about his opinion?
Well, he has quite an interesting point of view. Berger is in the process of donating a kidney to someone he’s never met. He’ll endure what he calls a “safe and relatively painless” procedure that’ll required him to spend three days in the hospital and take several weeks off from work (at a nonprofit charity research foundation). And why is he doing this? Berger sees the donating of a kidney as little more than “one of the many ways a reasonably altruistic person can help others.”
Berger holds that his personal sacrifice is outweighed by the good that’ll come of his anonymous donation—namely, that the recipient should wind up living roughly 10 extra years. Relatively pain- and hassle-free years at that.

Berger acknowledges that most people don’t feel the same way as him. If they did, the waiting lists for kidneys wouldn’t be quite so enormous, and thousands of people wouldn’t die each year while waiting for a kidney. He writes that friends and family view the donation more as “a crazy act of self-sacrifice” than a logical response to help.
What, Berger wonders, would happen if the removal of one’s kidney wasn’t perceived as “crazy,” or even particularly unselfish? What if it was legal for money to enter the equation? What if the donor became more of a business partner—an individual who owns something valuable, and who would be fairly compensated for giving it up?
Berger isn’t suggesting that the recipients actually foot the bill for kidneys. That’d only help those rich enough to drop tens of thousands of dollars on a kidney, and it’d likely create an ugly auction-type situation, with people outbidding each other to keep their loved ones alive. Instead, Berger—and plenty of others, including plenty in the fields of medicine and ethics—propose a well-regulated legal market for kidneys, in which only government agencies or specified nonprofits could purchase the organs. Then …

they would allocate them on the basis of need rather than wealth, the same way that posthumously donated organs are currently distributed. The kidneys would be paid for by whoever covers the patient, whether that is their insurance company or Medicare. Ideally, so many donors would come forward that no patient would be left on the waiting list.

Compared to dialysis and treatment for a patient in need of a kidney, a transplant generally saves roughly $100,000. That means that even when factoring in a payment of $50,000 to the donor, a legalized kidney marketplace winds up saving money.
Because monetary compensation is very likely to attract more donors looking to cash in on the assets in their abdomens, such a system is also likely to save more people too.

Brad Tuttle is a reporter at TIME.