Harvesting the poor

I'm sure nothing will go wrong with a government program that buys kidneys from poor people.

A bill to establish such a program has been proposed in Congress, and it was recently promoted by the Niskanen Center, a technocratic think tank, which explains that the proposed law offers donors “who do not know the identity of their recipient … a refundable tax credit of $10,000 per year for five years.” The goal is to encourage donation by “people who are not already motivated by having a loved one in need.” This would, per Niskanen, “save lives, reduce the kidney wait list, and save taxpayer dollars by lowering federal health expenditures.”

In the think tank’s view, the “big question” is “whether $50,000 will motivate enough new donors.” After all, the ten-year average is only “385 nondirected kidney donations” a year, and doling out $50,000 over five years might not draw in enough people to clear the kidney-donation waitlist. This program is not about rewarding people who are already inclined to donate or making sure that they are not unduly burdened by any potential costs to doing so. Rather, this is a straightforward cash-for-kidneys plan, and having the IRS distribute the cash via a tax refund fools no one.

And those most motivated to sell a kidney will be the destitute and desperate; the well-to-do won’t do it. And the prospect of a program designed to harvest organs from the poor is much more ominous given the current state of organ donation.

This summer, the New York Times (hardly a bastion of Christian conservative bioethics) published a report showing that the current organ donor system is careless at best—borderline murderous at worst. In one especially ﷟disturbing case,

an unconscious Kentucky man began to awaken as he was about to be removed from life support so his organs could be donated. Even though the man cried, pulled his legs to his chest and shook his head, officials still tried to move forward. Now, a federal investigation has found that officials at the nonprofit in charge of coordinating organ donations in Kentucky ignored signs of growing alertness not only in that patient but also in dozens of other potential donors.

As the paper reported in another story on the subject, efforts to increase transplants have led to more patients suffering “premature or bungled attempts to retrieve their organs.” The investigation “revealed a pattern of rushed decision-making that has prioritized the need for more organs over the safety of potential donors.” In short, at least some of the people charged with getting organs have been willing to push the limits in order to get more, even if that means killing patients, some of whom were showing signs of recovery.

As if eager to confirm everyone’s worst fears, a group of doctors then wrote an op-ed for the New York Times headlined, “Donor Organs Are Too Rare. We Need a New Definition of Death.” This new definition looked suspiciously like doctors hastening patients’ demise in order to facilitate the harvesting of their organs.

Of course, as advocates for the kidney-harvesting proposal might point out, live kidney donation (after all, we each have a spare) is very different from the sorts of cases the New York Times reported on. And increasing live kidney donations might even reduce the pressure to harvest organs from the dead (or dying, or merely incapacitated).

This distinction would be more persuasive if we were not also witnessing a concerted effort to treat the poor as raw materials to be used by the rich. Commercial egg donation and surrogacy are obvious examples. Well-off women don’t become surrogates, and though the ideal egg “donor” might be bright and beautiful with a wonderful future before her, she might well be financially broke in the present. Once the door to paying for live organ donations is open, it will go the same way.

A corollary to treating the poor as material to be used, rather than persons, is that they are expendable when they become too expensive. As Canada in particular has shown with its “medical assistance in dying” program, assisted suicide and euthanasia are less about compassion than cost-cutting—culling the poor and disabled from the balance sheets. Euthanasia is the even darker side of the cash-for-kidneys proposals that seek to buy spare parts off of the poor.

Loving our neighbors means that we must never reduce them to resources to be extracted, let alone excess expenses to be eliminated. Poor people must not be seen as factories for donor organs.