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Elissa Stein Headshot

How Much Is that Kidney in the Window?

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In this week's British Medical Journal, an opinion piece called for a reversal on the ban of selling human organs for money. As there is such a discrepancy between those in need of organs and those willing to donate, the author suggested standard monetary incentives for potential donors could potentially narrow the gap. She also noted that if more kidneys became available, they could be used pre-emptively, to prevent the need for dialysis. The system -- money dispersal and fairness in recipient choices, would be strictly monitored.

And those suggestions set off a flurry of outrage.

There were concerns about people in dire straights selling off parts of their bodies to pay bills. Of students (she mentioned this as a way of perhaps paying of educational loans), who weren't mature enough to think through all the ramifications. Of the fairness of the monitoring system, which is already an issue under scrutiny, as in which criteria are the most important when deciding who gets an organ. Truthfully, all reasonable issues to examine and discuss.

Another truth is there are already organs for sale. For people who can afford them. There are also far too few donations -- altruistic, to a stranger, or designated, when the donor knows the recipient. Further truths: the quality of life for thousands and thousands of people with renal failure is gravely compromised, waiting lists for cadaver kidneys are years long, and people die debilitating deaths, often with little hope in site.

Ethical, medical and moral questions are being raised. One can discuss these, conceptually, forever. As people wait. And suffer. With lives eventually ending.

I come to this discussion with a point of view that not too many have. An exceedingly personal point of view. I donated a kidney 8 weeks ago. My brother hit renal failure last summer and started dialysis, which from almost the beginning, was a disaster. His port failed and four surgeries later -- one of which ended in a fight for life in the emergency room -- he was told a live donor kidney was his best bet. The waiting list for a cadaver was 9 years. In all honesty, he wouldn't have survived that long with the temperamental chest catheter that became his last resort.

His skin was always grey. There were permanent black smudges under his eyes. He often fell asleep in a chair in my living room after dinner. He texted me when out walking his dog that he'd had to sit down on a bench, half a block from home, until he had the energy to get up and move again. From the time he asked me if I was willing to be tested, through surgery, which was more than 6 months later, and even now, I've been terrified something would go wrong, the transplant wouldn't happen or wouldn't work, and then what?

What options were left? What chances would he have? I've heard from or read about countless people who aren't lucky enough to know someone who is match, or who's able to go through the intense experience that being a donor is. I've also discovered remarkable, selfless people, who give up an integral part of their basic operation system to save someone else's live.

But, there aren't enough of them.

Yes, we can continue to ponder the ethical, medical and moral questions surrounding organ donation and financial renumeration. The bigger question though is, is there a better solution?