Surrogacy: Legalizing Incentivized Donations Saves Lives

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Surrogacy: Legalizing Incentivized Donations Saves Lives

In the article Why Legalizing Organ Sales Would Help to Save Lives, End Violence the author states There are only about 20,000 kidneys every year for the approximately 80,000 patients on the waiting list. In 2008, nearly 5,000 died waiting (Gregory). These numbers are on the rise and we must pass sensible regulations to allow for the legal sale of kidneys or people will continue to die as a result of the shortage of available organs.

Many people find the idea of paying for an organ to be unsavory and worry such a system has the potential to exploit the poor. Capron and Danovitch express this fear in an article for Los Angeles Times, Turning organs into a financial commodity would undermine the safety and efficacy of the system now in place and would not necessarily increase the supply. The United States has served as a model for ethical organ transplantation and abandoning our long-standing prohibition on buying organs would lead us into an ethical minefield with negative repercussions the world over (We Shouldnt Treat Kidneys as Commodities). Yet, it is this ethical model that has led to an underground market which does, in fact, prey on and exploit the poor and vulnerable populations of our world. A wealthy patient can buy their cure with little regard to the sacrifice of the person who made such a transaction possible. Indeed, the black market is responsible for people being coerced into giving up their kidneys and then enduring inhumane surgeries with potentially poor outcomes for the rest of the donors lives. Despite the prohibition against the procurement of organs in such ways, the black market thrives still.

By allowing incentivized donations, we could increase the number of available kidneys and reduce the impact of illicit organ trade. Not only would it save the lives of patients on the transplant list, but it would also save the lives of those victimized by the unregulated market. Iran has seen great success since they implemented such a model in 1988. It can be done, carefully and responsibly. According to National Kidney Foundation, In this system, all potential donors are registered by the government and undergo a rigorous process of informed consent and donor evaluation. No brokers are involved in the state-run program, which offers a fixed amount to the donor, along with posttransplant care (AJKD). They also do not allow anyone from outside of their country to benefit from this system or buy their way in; it is equitable, and everyone is given a fair chance, donors and patients alike. Additionally, because of the care Iran takes for its donors, medical outcomes match those of altruistic, or unpaid, donor outcomes here in the United States (AJKD). Iran has eliminated their kidney transplant waitlist. If other countries adopted a similarly regulated, fair, and transparent model, the demand for kidneys obtained by questionable and inhumane means would be greatly reduced.

As it stands here in the United States, patients on the transplant list must wait an average of three years and that wait time is expected to increase (AJKD). Kidney patients are not just in waiting, they are undergoing painful and costly dialysis treatments. Patients lengthy stays on waitlists, while undergoing dialysis, lead to poorer outcomes when they finally do get their kidney (AJKD). Yet, those patients are the lucky ones. Thousands more per year will lose their lives while desperately waiting. Patients must wait on a viable deceased donor or a matched living donor and there are not nearly enough available organs gained by using these sources.

Currently, for living donors in the U.S., immediate medical care is covered via the recipients insurance companies. However, they must pay their own way to get where they are needed, even if that means flying cross-country. Donors typically stay in the hospital for two days and then are required to stay in nearby lodging for an additional week so they can be monitored. Once home, they face a recovery period for an additional 4-5 weeks. None of their expenses are covered and they are not reimbursed for wages lost during the process of making this very generous donation. Those are just the monetary expenses. Let us not ignore that these kind-hearted people are risking their lives for someone else, not to mention the pain of surgery and recovery.

In our country, people are compensated for hair, blood, plasma, semen, and breast milk donations. Donations of regenerative tissues and fluids carry very little risk to the donor, yet donors are paid for them. People are also enticed into participating in medical research by receiving monetary compensation. Additionally, women are paid for egg donations as well as to host pregnancies, also known as surrogacy, for those who are unable to do so. The reproductive donations come with certain risks to the donor as they require hormone manipulation and invasive procedures. Pregnancy and childbirth are taxing and come with a potential range of medical complications to the women providing surrogacy services. There are responsible regulations in place so donors can be compensated for their time, expenses, and risks.

Even though mortality rates are low across the various donations and services, note the risk for live organ donation is greater than that of surrogate pregnancy. Yet these donors are not even compensated for their own expenses. Using fair, careful, and ethical regulations, which include stringent screening and informed consent practices, live organ donors can and should be compensated. Funding such a system would partly, if not wholly, come from the money saved by greatly reducing the amount of dialysis treatments needed as patients are receiving kidneys instead of waiting years on dialysis. Increased organ donations by incentivizing them would save the lives of more patients as well as the lives of those pulled into and abused by the underbelly of illegal and inhumane organ trafficking practices. It can be done; Iran is proof.

Works Cited

Capron, Alexander, and Gabriel Danovitch. We Shouldnt Treat Kidneys as Commodities. Los Angeles Times, 30 June 2014, https://www.latimes.com/opinion/op-ed/la-oe-0630-danovitch-and-20140630- story.html. Accessed 28 Apr. 2020.
Friedman, Amy L. Payment for Living Organ Donation Should Be Legalized. BMJ (Clinical research ed.) vol. 333,7571 (2006): 746-8. doi:10.1136/bmj.38961.475718.68, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592395/. Accessed 28 Apr. 2020.
Gregory, Anthony. Why Legalizing Organ Sales Would Help Save Lives, End Violence. The Atlantic, 9 Nov. 2014, https://www.theatlantic.com/health/archive/2011/11/why-legalizing-organ-sales- would-help-to-save-lives-end-violence/248114/. Accessed 28 Apr. 2020.
Jafar, Tazeen H. Organ Trafficking: Global Solutions for a Global Problem. American Journal of Kidney Diseases, 2 Nov. 2009, https://www.ajkd.org/article/S0272- 6386(09)01177-9/fulltext. Accessed 28 Apr. 2020.

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