Paying for Kidneys by Sally Satel

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It is a sad time for the 96,000 patients waiting for kidneys, livers, hearts and lungs: The chasm between supply and demand grows wider each year. By this time tomorrow, 18 people in need of an organ will be dead because they did not get one soon enough...

Transplant policy also made news last winter. The United Network for Organ Sharing (UNOS), the nonprofit entity overseen by the Department of Health and Human Services that maintains the national waiting list and allocates cadaver organs, held a public meeting to propose that younger adults get priority for kidneys. Currently all adults, regardless of age, receive well-matched kidneys on a first-come, first-served basis.

But UNOS is understandably troubled when a young kidney, able to prolong by decades the life of, say, a 40-year-old, instead goes to a 70-year-old who dies a few years later, taking the organ with him (the chance that such an organ could be retransplanted is slim). At the UNOS meeting, which I attended, reaction to the proposal was mixed. "Who's to say an older person's five years of life are any less important than a younger person's nine years?" one of the many skeptical attendees asked. "That's playing God."

No, it's playing man -- the all-too-human business of deliberating strenuously and in good faith about what is right. Should the utilitarian imperative of enhancing survival across all transplant candidates take precedence over fairness to individuals? This is the tragic choice that comes with medical rationing...

We need to move beyond the idea that organs must be relinquished as gifts. The altruistic motive is deeply noble and loving. But relying upon it as the sole legitimate reason for giving an organ is causing too many unnecessary deaths.