Kidney Vending

Abstract

As physicians and nephrologists who are actively engaged in the evaluation and the treatment of kidney transplant candidates, recipients, and donors, we are concerned by what we see as a growing threat to the core values that have permitted organ transplantation to flourish during the last half century. Kidney vending, once considered taboo in “respectable” circles, is being debated with some frequency, and in this issue of JASN , specific proposals for implementation have been made. To his credit, Matas (1) presents his case in a rational and dispassionate manner. In the professional and lay press, however, there has been a disturbing change of tone. Those who oppose vending have been derided as “beancounters” and “high-minded moralists” (2); the current system has been described as a “failure” (3); routine psychological evaluation of donors has been described as “intrusive, demeaning” (4); the Institute of Medicine’s caution against treating the body as if it were for sale (5) has been described as “outdated thinking” (6); and respected transplant professionals have been castigated in the national press because of their concern for the potential exploitation of donors (7). There is a lot at stake. The altruistic impulses of living donors and of the families of deceased donors are on the auction block and risk being displaced by the uncertainties of an unfamiliar market place. Matas seems unconcerned by this possibility, and to some proponents of organ vending, the anticipated demise of altruism in organ donation even comes as a blessing (2). To the detractors of our current altruism-based system, the acceptance by the general public of the difficult concepts (brain death, donation after cardiac death, living donation, etc.) that are at the core of our work is taken for granted, because the supply of donors has been inadequate for the need. Dollars …