Should You Be Allowed to Sell a Kidney?: An Exploration into the Black Market for Kidneys

When I say “black market”, what do you think of?

Drugs? Sex? Big scary mobsters sitting by lavish pools surrounded by half naked girls?  

There’s another black market that affects millions of people each year.  This market isn’t hyped up with glitz and drama, and people’s lives literally depend on it. 

It’s the black market for kidneys.

Kidney disease affects 280 million people worldwide and claims 2.4 million lives each year. Those numbers are only going up as more and more people descend into unhealthy, overweight, and sedentary lifestyles. (Click HERE for more facts on kidney disease). Proper diet and exercise are the best way to keep your kidneys healthy. But if it’s too late, kidney failure isn’t the end all be all. A patient can live on dialysis for an average of 5-10 years. Alas, getting a transplant is the only way to return to a normal life. A donated kidney can come from the recently diseased (be sure to become an organ donor!!!!). But it can also come from someone who’s still alive.  

 You see, humans have two of these toxin-filtering suckers, but only need one to live. Isn’t evolution a funny thing?  If someone with failing kidneys has a big chunk up change (up to $200K in the US) and a live donor who’s a match, three hours on the cutting board can spit out two happy, healthy people on the other side.

However, I wouldn’t hand over my Macbook Pro to a stranger on the street. So why would I give up a kidney?  Even though I can live with just one, it is still an invasive surgery that has risk factors and recovery time involved.

When costs outweigh the benefits, the solution is to increase the benefits, which is usually done through monetary compensation.  

The roadblock is the fact that selling organs is illegal across the globe, with the exception of kidneys in Iran.  The ban is put in place to protect the poor and vulnerable from being coerced into selling their bodies for monetary gain.  Altruism alone isn’t enough for most to undergo the operation for anyone apart from a loved one, thus, there is a kidney waiting list thousands of names deep. 

This, my friends, is a perfect example of how government regulation impairs a natural flow of supply and demand.   There are thousands of people willing and able to pay for a kidney in order to stay alive, and a world full of impoverished citizens who would gladly hand over an organ for a cash sum that would pull them out of poverty. 

Voila, a black market for kidneys is born.

I want to focus on the Philippines. A country that is experiencing a surge in kidney disease due to increasing rates of diabetes and hypertension, and a hotspot for the kidney black market.  

In 2020, 16.6% of the population in the Philippines fell below the poverty line, which is estimated at 10,481 pesos ($201 usd) a month for a family of 5.  I have had the opportunity to visit Manilla, the capital city, a hand full of times, and was taken aback by the sharp divide between luxurious mega malls and heart-breaking poverty. I saw areas with trash thrown all around, make shift shacks for homes, and kids who were nothing but skin and bones. I was hounded by beggars wanting a dollar, and I’ll never forget the time when a little girl practically got into the taxi with me in search of change. 

Unfortunately, I didn’t get any photos on my visits (if only I knew I would one day start a blog…….). But give “Manilla Poverty” and “Manilla” a google image search to get some visuals.

In contrast, there are modern skyscrapers, huge malls, and luxury goods available.  Manilla has the highest rate of income inequality in Southeast Asia. While the country’s GDP has been going up, the wealth isn’t realized by everyone. 

The income gap, rising rates of kidney disease, increased demand for transplants, and high poverty rates are an ideal setting for a thriving black market for kidneys.

Doctors at the top of the operation hire agents, who maybe hire more agents, who lurk around low income neighborhoods to target potential donors.  A patient may be paying nearly 10K usd for a kidney, the doctor takes most of the profits, the bottom level agent may get $10 usd,  and the donor is usually left with 2-3K.  While that is a small piece of the pie, it is enough to pull a family of 5 well above the poverty line for an entire year.  There are stories of kidney donors who used the money to build homes, send their kids to school, and live a life beyond trying to resell bananas found in the garbage. (Click HERE and HERE for more)

At first glance, it’s a win win. But, as with any black market, problems arise.  First and foremost, because the operation is illegal, there is rarely proper follow up health care. It’s crucial for those with one kidney to take adequate recovery time followed by prioritizing a healthy life style with no smoking or drinking and daily exercise.  Often, that information is not conveyed and health conditions are not monitored.  Secondly, agents are incentivized to get more donors. It may not be coincidental that a few houses burn down in a neighborhood an agent may be scouting. 

While the ban on legally selling a kidney is designed to protect the poor, isn’t it doing the opposite?  Those who sell a kidney into the black market are getting short changed and deprived of proper medical care. Both issues that legalizing the process would mediate. 

Making the kidney market illegal is founded on ethics and morality. But I think that the argument of “ethics” is thrown out the door when 1 in 5 people are destitute.  Those living in extreme poverty are facing abysmal living conditions in crime-ridden areas, and children have to leave school to enter the labor force to help put food on the table.  Even then, malnutrition rates are exorbitant, and 95 Filipino children die every day because they can’t eat a proper diet. 

Is that really worse than the increased health risks of living with one kidney instead of two?

It seems to me that protecting the poor would be giving them the ability to make an informed decision that would allow them to rise above poverty to provide adequate nutrition and opportunities to their children to help stop the cycle.   

On the other side of things, that massive waiting list can start to go down, and people can have a fresh chance at life. Legalizing the kidney market would provide life changing opportunities for both people laying under the hospital lights. 

Stilly skeptical?

Instead of me rattling on with ideas and predications, let’s take a look at some proof.

When Iran was facing a massive kidney shortage, the country legalized the market in 1988.  Long story short, there hasn’t been a shortage since, and the model adapted has overcome potential ethical issues.  In fact, it is speculated that legalizing the black market for kidneys actually leads to less coercion because desperate patients can buy a kidney from a willing seller as oppose to pressuring a family member into an altruistic donation.  

Find the detailed model here:  

https://cjasn.asnjournals.org/content/1/6/1136.full

When a good or service is illegal, a black market will inevitably arise whether it be drugs, firearms, alcohol, ivory, prostitution, or organs.  With a black market comes crime, extortion, and an unsafe, risky trading environment.   

So, should it be legal to sell organs?

I think the answer is yes. At least until science figures out how to grow one which surely won’t be long.

But I’ll keep chewing on this one for a while.

What do you think?  Comment or email with your thoughts! 

Want some more thoughts on the ethics?  Give this a read:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563357/