A Vital Issue: Sigrid Fry-Revere on Iranian Kidney Markets
2014-09-20 · Guest: Sigrid Fry-Revere (Author of The Kidney Sellers) · 52:40
Unintended Consequences of the National Organ Transplant Act
Bob Zadek interviews Sigrid Fry-Revere about the unintended consequences of the National Organ Transplant Act of 1984, which banned organ sales in the US. They discuss the Iranian model of compensated kidney donation as a potential solution to the chronic organ shortage and the ethical distinctions between a black market and a regulated system of compensation.
Topics: Organ Donation, National Organ Transplant Act, Kidney Markets, Medical Ethics, Public Policy, Iran, Dialysis, Healthcare Economics
Speakers: Bob Zadek, Sigrid Fry-Revere
The Unintended Consequences of the National Organ Transplant Act [00:00]
Bob Zadek: Hello everyone, welcome to the Bob Zadek Show. I’m your host, Bob Zadek, every Sunday at 9:00 AM. Thanks so much for listening. We are the only live libertarian talk radio show on the air all weekend, the show of ideas, not attitude. Thanks so much for listening. 800-345-5639 to join my conversation anytime the moment seems appropriate.
In America, we have a federal statute that is, I think it’s fair to say, directly responsible for killing more Americans, or at least responsible for the death of more Americans, than those who died in the 9/11 terrorist attack, than all the Americans who died in Korea, all the Americans who died in the Vietnam conflict. And this policy will soon be responsible for killing more Americans than the number of Japanese who died in the bombing of Hiroshima and Nagasaki. Federal law that is responsible for killing Americans.
Not only that, but to learn about a more enlightened approach to the issue governed by this federal statute, America needs to learn a lesson about medical ethics and about humanity from the nation of Iran. Iran can teach America about how to be more humane in the issue of organ donors, organ transplants, and what are sometimes referred to as the sale of body parts. And that is today’s topic. This is a difficult issue. It’s an issue where we have to both dig deeply into our own minds and into our hearts to find the right answer.
To help me sort out this interesting, hard, important issue, I’m proud to welcome to my show Sigrid Fry-Revere. Sigrid has spoken on TEDMED talks in 2014 on the issue of sale of organs and organ transplants. She has written more than 100 articles for the New York Times, Los Angeles Times, Wall Street Journal, Cambridge Quarterly of Healthcare Ethics, and many, many more. Most importantly, Sigrid has written The Kidney Sellers: A Journey of Discovery in Iran. Sigrid, welcome to the show this morning and thanks so much for giving us your time.
Sigrid Fry-Revere: Thank you very much.
Bob Zadek: Now Sigrid, this all starts in the middle 1980s with the passage of a federal statute, the National Organ Transplant Act. Tell us about that statute and the death, the problems, and the heartache that that statute has caused, all of which are, of course, the classic case of unintended consequences.
Sigrid Fry-Revere: Absolutely. I mean, you couldn’t have given a better introduction to this topic. What happened in actually the end of the 1970s and early 1980s is we figured out how to transplant organs from one body to the other without the recipient rejecting the organ. So we developed immunosuppressant drugs that made that possible. And the first transplants like that were actually between twins, then between relatives, and then a light bulb went on and we said, “My goodness, we could transplant organs from recently deceased people.” So when someone died, we could use their organs to save lives. Wonderful, wonderful discovery. Optimism abounded.
Only problem was we had trouble getting the organs to the patients who needed them fast enough. The original purpose behind the National Organ Transplant Act was to develop a nationwide system that would help us get organs to the people who needed them from cadavers to the people who needed them fastest. And in the last 30 years, I must say, I think America has become the best in the world at doing this. We have the best deceased organ transplant system in the world.
The problem is we were over-optimistic in the ’80s. We thought we could solve the organ shortage with organs from cadavers. And because poor Dr. Barry Jacobs suggested that it would save money if we just used living donors, and part of his plan involved using donors from foreign countries, as a last minute almost decision, that act that was intended to help us do a better job of distributing deceased organs also banned pretty much every way anyone could possibly compensate living donors because they were scared of exploitation.
The Kidney Shortage and the Limits of Deceased Donation [06:28]
Bob Zadek: So let me just back up just to help the audience catch up with us. First of all, this focuses primarily but not exclusively on kidney transplants and the transfer of kidneys, because of how pervasive kidney disease is and how it dooms those people who suffer from kidney disease, a life of dialysis, which is a very, very, very hard way to live. And with the possibility that by doing a kidney transplant, you can give somebody, give a living human, a life. At no cost, you give them a life. What more important gift is there than that?
Also, the audience must understand that most every human is born with two kidneys and you only need one to live. So therefore, a live person could donate or sell, and that will be today’s topic, a kidney, which will save the life of somebody else without harming the donor or the seller. So we are talking about many, many body parts, but primarily the numbers are there most importantly and most significantly when the discussion is kidney transplant.
Sigrid Fry-Revere: Absolutely, you’re absolutely right. And another reason it’s primarily kidneys is that kidneys make up 84% of those people waiting for transplants. So if you solve the kidney issue and you include in that other live donations like livers, where you can also do a live donation of part of the liver, or bone marrow—selling bone marrow is also banned under the act even though it’s not an organ—and if you roll all those in together, you’re talking about 90% of the American population waiting for organs could be helped by living donors.
And the important point is, just so our friends can understand the import of this show, the important point is there are many more—there’s a much higher demand for these organs than there is supply. There is some supply, but the supply only comes from those people who voluntarily agree to give away their organ on their death or while they are alive with informed consent. But there is no opportunity for an individual or for the marketplace to say, “You have something valuable, an extra kidney, which there is a market for.” And most or many economists as well as medical ethicists believe that if donors are allowed to sell organs, and not only give them away but to sell them, the supply will increase and many, many, many more lives will be saved. And that is the issue. The issue is how do we increase the supply to save the life of Americans, because right now the statute that we referred to earlier in the show in effect acts as a bar towards increasing the supply, therefore killing Americans and of course others around the world.
Sigrid Fry-Revere: Absolutely. And there’s about 10,000 Americans that die every year, that’s another way for people to look at it, who could be helped. And the other thing that’s important is everyone always says, “Well, let’s just get more people to sign their organ donor cards for when they die so that their organs can be used.” The problem there is less than 1% of people who die, die under conditions where you can use their organs. The reason is they die too far from the hospital, or they are too sick or too injured when they get to the hospital. Okay, so even if every single American signed their donor card or, as some people are suggesting, were forced to donate when they died, we would still not get anywhere near solving the shortage. We’d maybe get, you know, some people say 3,000, some people say 6,000 more organs. So, you know, that’s not the answer.
The Hidden Financial Burden of Altruistic Donation [11:30]
Sigrid Fry-Revere: The other thing people need to know, that when someone does an altruistic donation—in other words, which happens in a third of the time with kidneys—when they say, “I will give to you for free,” they aren’t giving for free. It costs between $5,000 and $20,000 to be a donor. And those are costs that the donor has to bear him or herself, with very limited exceptions for where rich recipients can pay some of that money, reimburse some of that money, or if you’re super, super poor, the government will reimburse your travel costs.
Bob Zadek: So it’s very important is, not only does federal law prohibit the creation of an economic marketplace for these organs, but it even prohibits reimbursing the donor for the donor’s medical expenses, which probably will not be covered by health insurance anyway.
Sigrid Fry-Revere: Well, wait, wait, let me quickly correct you before we go too far down that line. All medical expenses are covered, okay? That is covered usually by the, or always by the, whatever insurance covers the recipient. All medical costs are covered. But what people—the $5,000 to $20,000 is what people spend because they have to fly to the transplant center, they have to take off work, their spouse has to take off work to take care of them while they recover. They may need a babysitter, they may need someone to help with their business. They may lose—and I don’t even think this is included—but in addition to the costs of actually donating, and again that—people who donate a kidney, I mean, it is safe because we’ve been doing it for a long time, but it still is abdominal surgery.
And obviously people have to decide whether they want to undergo the time and money to donate because of they’re doing the abdominal surgery, but what people forget is that they also take six weeks to three months to recover afterwards where they can’t do all the things they usually do, whether it’s taking their kid to soccer practice, running their business, or mowing their lawn. So that’s where the money comes in, is during the recovery time. And they often, whoever has that surgery, often their spouses take off work too, so that costs the family money. And when you realize that the average American only has about $1,000 a month in discretionary money to spend that isn’t being used on everyday living like mortgage or food, things like that, $5,000 is five months of not going to the movies, not doing anything, you know, not going on vacation. Everything you use that little bit of extra money you have for would have to go for five months for have the privilege of helping someone. So that’s the real problem, is that altruism is being punished in this country. Not only are you not allowed to pay someone to get a kidney, but what I think is even worse is that if you’re kind enough to want to help someone, you have to be rich enough to do it on your own. And if you’re not, you know, people go $5,000 and $20,000 into debt to help someone. So they’re being punished for helping someone.
Bob Zadek: This is Bob Zadek. I’m talking with Sigrid Fry-Revere. We are talking about the very difficult subject of organ transplants, organ donors, and more importantly, should Americans be allowed to sell and to buy organs from other—not only Americans, but from other humans. What are the ethical and social implications of such a policy? 800-345-5639 to join the conversation.
The Iranian Model: A Regulated Market for Organs [17:02]
Bob Zadek: Sigrid, now I mentioned in the introduction to today’s topic, Iran. Now Iran, everybody listening to my show will have a visceral and I dare say negative reaction to Iran, and that of course is not surprising given the headlines. But what—tell us about Iran and why on a subject such as sale of organs, why we will spend time discussing the what most people consider to be the repressive government of Iran.
Sigrid Fry-Revere: First let me say I think Iran is a very oppressive government, and my having gone there didn’t change my mind on that fact. But Iran was the only country, still is the only country, that has a legal market in selling organs. And it is the only country in the world to claim not to have a kidney shortage. So I felt I needed to go there and see what was happening.
Now, the very important thing I want to stress is that Iran has had 30 years of experimenting with living kidney donation and paying donors. So while we experimented and perfected our system for deceased organ donation and essentially failed using the approach we were using, they used a more simple, letting humans help humans approach, which is cheaper and turned out to be more effective and more successful.
And the other thing I think it’s necessary to say is that when I—what I learned from Iran is actually that a free market in organs is not the answer. And I want to stress that because people often associate me with that notion, and I don’t believe in that. I believe in doing a better job of compensating donors for all their expenses. Now, that doesn’t mean I don’t know a lot about the market in organs and I will definitely talk about that, but that is not what I or my organization, Stop Organ Trafficking Now, is advocating. We advocate that we do a better job of compensating living donors for all their expenses in the US, and that if we did that, we could reduce the organ shortage by at least 30%. And that would certainly—I mean, saving 30,000 lives right off the bat would certainly be a great improvement over what we’re doing today. Whether we can solve the shortage by doing that, I don’t know. But we believe that compensating, doing a better job of compensating living donors through private charities, for example, or government pitching in for those who are the poorest and can’t do it themselves, is the real answer that is non-controversial. You know, markets is very controversial, and so is not paying anything. So we sort of are hoping for a middle ground that will start saving lives and teach us how the US should proceed to get to the point of saving everybody on the list.
Bob Zadek: Now tell us—I know it’s a complex subject, but give us the bullet points of the parts of the Iranian system, how it works, and what you like about it.
Sigrid Fry-Revere: Okay. Again, the thing that’s very important about Iran is that they’ve had 30 years history. They started out with a free market open to foreigners, and that actually was a disaster. Then they closed the market only to Iranians for both selling and buying, and that was a little better, but not good enough because donors felt that they needed health insurance. That money wasn’t enough because you could pay someone a lot of money, but they have to have enough to also buy health insurance and aftercare, and they often did not get enough money to do that because people who needed organs weren’t rich enough to provide it.
So the government stepped in and started providing both health insurance and money to pay the donor’s costs. And beyond that is where the market would make a difference. In other words, charities and recipients would then pay donors on top of that. I think the biggest innovation in Iran was putting non-profit charities in charge of kidney matching. And the reason that’s important is if you look at the black market or gray markets in organs, which is what Iran had to begin with, a gray market where it’s legal but unregulated, what happened was that the brokers took all the money. If you go to the black market where it’s illegal to sell or buy organs, the brokers will get anywhere from $50,000 to $200,000 to make the arrangement, and then the poor donor only gets a couple thousand dollars if they get paid at all because it’s illegal what they’re doing. And so when Iran put this in the hands of non-profit brokers, they assured that whatever money the family and charities could scrape together would go to the donor.
So in Iran, we calculated that for the year we were there, donors got twice the average individual income in Iran for the year we were there. That’s about the same as $100,000 in the US today. Wow. So they get paid royalty, which is why they have a waiting list of donors.
Bob Zadek: They have a waiting list of donors, not recipients.
Sigrid Fry-Revere: Isn’t that impressive? I mean, if you need a kidney, you go and you get matched to a donor almost immediately.
The Human Toll of the Status Quo [22:41]
Bob Zadek: A waiting list for donors and not recipients. Now, just to have the magnitude of this problem is mind-boggling. You mentioned the number of—and let’s focus on America—the number of Americans who will die simply because their time ran out before they were matched with a donor, because there is such an overwhelming shortage. What is that approximate number of people who will die simply because of the shortage of donors?
Sigrid Fry-Revere: Okay, there’s a couple ways to look at it. There’s 100,000 Americans waiting for kidneys alone, 120,000 for organs all different types of organs. Of those people waiting for kidneys, 15% will get a chance at a transplant. Only 15%, okay? That means approximately 10,000 Americans dying every year while they wait. And people who live on dialysis, what most people don’t understand is dialysis only cleans about 10% of the toxins out of your body that a healthy kidney will, which means your body is slowly being poisoned to death by its own waste products even while you’re on dialysis. And the average lifespan on dialysis is only four years. The average wait for an organ is five. So you have to be an exceptional person, young, healthy, to even really have a chance to make it to that five-year average. Now of course that’s an average for all over the country. In some places it’s only a two or three-year wait, in some places it’s a seven-year wait. But the point is your overall chance in the US of getting an organ is so slim that a lot of people don’t even bother getting listed. There are 400,000 Americans on dialysis. And what’s important there to know that people might not realize is that if you’re a diabetic or you have hypertension, your chances of getting chronic kidney disease is very high.
Bob Zadek: Sigrid, I have to go to break now just for 60 seconds. This is Bob Zadek. I’m talking with Sigrid Fry-Revere. We are talking about the subject of sale of and compensation to organ donors to increase the supply to save American lives. 800-345-5639. Back in 60 short seconds.
Political and Institutional Resistance [26:30]
Bob Zadek: Welcome back to the Bob Zadek Show every Sunday at 9:00 AM. Thanks so much for listening. I’m your host, Bob Zadek. 800-345-5639 to join my conversation with Sigrid Fry-Revere. We are talking about increasing the supply of kidneys and other vital organs to save American lives and the role the free market and individual choice and responsibility can play in this process.
Now Sigrid, you have mentioned earlier that your organization, Stop Organ Trafficking Now, I believe is the name of the organization, they do not support or encourage or advocate for the allowing Americans to be compensated, that is to sell their organ, to commodify their organ, to sell their organ for some market price, whether we’re talking about a kidney, a cataract, a heart, or whatever other organ we are talking about. But you do advocate compensating the donors so as to remove an area of resistance so as to increase the supply. Now that approach seems so, if you will, apple pie, but I certainly don’t want to trivialize it. It’s American lives we are talking about, and even one life is of course of paramount importance. But yet we are talking about hundreds of thousands of lives. So in with your position, how could anybody oppose it and why is it not the law?
Sigrid Fry-Revere: Very, very good question, which is actually why it is the topic of a TEDMED discussion. For 30 years the debate has been “don’t pay donors anything” or “have a market.” And I’m really the first one to talk publicly and to write articles and to try to get people to think of the solution, which would just involve allowing Americans to help Americans and not look at it from the two extremes. And I think it’s just people are so used to looking at it as the dichotomy of paying nothing or inducing people to buy with huge amounts of money that it’s hard for them to see the middle ground. And every time I mention the middle ground approach, people usually put me in one camp or the other, and it’s going to take some time for people to get used to it.
Also, you know, I’ve been lobbying on Capitol Hill and I’m a bit cynical based on what I hear there. You know, I approach people with what I see as a brilliant win-win situation, and believe it or not this will also save Medicare money—
Bob Zadek: We’re going to talk about that in a moment, and I’m going to ask you to help us understand the economics of transplant versus dialysis in a moment. But finish your comment about the so far unsuccessful lobbying efforts.
Sigrid Fry-Revere: Well, the reason so far I think the lobbying efforts have been unsuccessful is I get two comments. I get one, “We’re not interested unless you can prove Medicare will save money,” and I do not have as yet an economic analysis done by economists. So far it’s just my own staff that has done the number run. So we need—Congress doesn’t care as much about saving lives as saving money. I know that’s horrible, but the only thing we’re going to get Congress to agree on from a bipartisan perspective is if we can prove it will save lives and save money. That’s one.
And the other is, where’s the AMA? Where’s the National Kidney Foundation? Where are the big organizations? Where are they all on this topic? And I can’t claim responsibility for them starting to talk about these issues, but they are. They are starting. But you know, this is like getting a cruise liner to change course in a pond. You know, these are huge organizations, and it’s probably going to take years of discussion before they will get out of the framework of paying donors incentives versus paying them nothing, which is the debate they’ve had for 30 years. And for example, the National Kidney Foundation has been against paying anyone anything for so many years that they would have to admit that they were wrong, you know? And that’s very hard for an organization to do.
So I’m optimistic that with time and more people who discuss this, the more people who will understand that there is a different way of looking at this issue. And I say it’s looking at it from the donor’s perspective. We need to take care of donors. When I tried to donate and I was excluded because I didn’t have enough money and my friend died, I didn’t want someone to say my kidney is a commodity or I am a commodity. I was providing a service to humanity. That’s the way I look at it, if you want to look at it in economic terms. And to call me a vendor or someone, you know, like that, that’s demeaning. So I think we need to look at it from the donor’s perspective, and what do donors need to get them to donate? And sometimes money is necessary to allow altruism to happen. And it’s just, you know, the donor’s perspective no one has really talked about. So we got to get these ideas out there, we got to get people talking about it, and hopefully eventually we’ll be able to turn those cruise liners in the pond and, you know, get people to come around to, you know, an idea which right now they just keep saying, “What’s the catch? There must be a catch. Why hasn’t anyone thought about this before?”
Bodily Autonomy and Ethical Frameworks [31:39]
Bob Zadek: I find it so interesting. Of course, I am one with a high level of faith and confidence in markets, free markets. And I find it so interesting that you in your efforts, you have to avoid being accused of being one who is seeking a market-driven solution, as if that’s toxic, no pun intended in light of the function of the kidney. But what I find—and you said a moment ago and you are obviously speaking very much from the heart as well as from the mind—you didn’t want to think of yourself as a commodity and commodify and you’re nothing but a bunch of parts that can be sold. And I, again speaking from the heart as well as the mind, I don’t see a problem with that.
If in fact the women’s movement, to draw a rough parallel, a cornerstone of the women’s movement has been of course the battle over abortion, a woman’s right to choose, it’s—and women, the mantra has been “it’s my body, I can do what I want with it.” And that has resonated well within the movement, resonated well in Congress and with many, many Americans. Well, if those words really have a meaning, “it’s my body, I can do what I want with it,” why isn’t one of the things I ought to be allowed to do with my body if I want is to sell parts of it?
And let’s distinguish because there’s a very important dichotomy. For our listeners, I would like to ask the listeners to make a distinction because it’s very important. We can discuss this topic in two, with two approaches. Number one is the sale of organs after you die. Should you be allowed to have your will say, “Sell my organs at the market price and give the money to my estate”? What’s wrong with that as a moral or economic or medical principle? And then we can discuss if we wish second, what about somebody who is alive?
Now Sigrid, why is there such resistance to the creating a market which would I think create increased supply, creating a market in body parts after somebody has died? What’s the dehumanizing principle there? I don’t see it.
Sigrid Fry-Revere: Okay, I tend to agree with you on after you die, 100%. I mean, I come from a free market background, so I understand the arguments. But you brought up the women’s movement, okay? The whole abortion issue changed when it went from “I’m pro-abortion” to “pro-choice.” That gave the pro-choice people a chance because they were losing the debate before that. Terminology and the words you use mean everything.
Bob Zadek: Words matter, you’re exactly right.
Sigrid Fry-Revere: And in Iran, what kidney sellers are called—they don’t use the word selling. They very rarely use the word selling. What they are doing is saving a life and they are being—they are providing a service to humanity. It’s much easier for someone to say yes to giving up a kidney if it’s put in terms of “you are giving a service to humanity.” It’s treated as such a respectful thing in Iran that you even are exempt from military service. They happen to have mandatory military service, but people who donate a kidney are exempt from military service because they have already served their country by saving a fellow Iranian’s life. You see, it’s a very different way of looking at it.
And for me, and I think for a lot of potential donors, if you treat me more like a fireman who’s saving someone’s life than like a hot dog vendor, I am more likely to do it because being a firefighter is an honorable thing. Not that being a hot dog vendor is a bad thing, don’t get me wrong. It’s just not how I want to see myself when I make the sacrifice of giving actually part of my body to save a life. This is a pretty dramatic thing to do and it shouldn’t be taken lightly. And I think treating me like a hot dog vendor is taking it lightly. Treating me like a hero, like a first responder or someone who saves a life and is providing a service for which I should be compensated, is just a very different way of looking at the issue. And I think it’s one that will win the day if we give it a chance.
The Inequity of the Current System [36:56]
Bob Zadek: Now the arguments against—see, I start with a very strong commitment to allowing an individual to as part of an estate plan to provide that the body parts will be—and the word is harvested, I’m sorry to use a word like that, an inhuman word—will be harvested so as to give another human—
Sigrid Fry-Revere: And the right word is recovered, by the way.
Bob Zadek: Recovered, okay, thank you. But to give another human sight or health and along the process to compensate the estate of the donor. I find nothing inhuman about that. And after all, it is something of value. And what’s most offensive to me about the statute that prohibits that is everybody who is involved in the transplant process is compensated. The surgeons, the ones who transport the organ from one place to another, the drug companies, the hospitals—everybody makes money off the organ except for the donor. That’s a fact.
Sigrid Fry-Revere: Absolutely. It’s like saying the farmer is not allowed to make money on the wheat he grows.
Bob Zadek: Precisely.
Sigrid Fry-Revere: Exactly. And I was arguing when I worked for the Cato Institute, that’s one of the things I argued for until I realized how ever much you—see, my priority is saving lives. Okay? And if looking at it in a market way is not going to do that, I am not going to advocate for it because I am going to advocate for a way that’s going to save lives in the current political climate. And unfortunately, we’ve got about all the deceased organs we can use. We can only marginally increase the number of deceased organs even if you paid every patient $100,000 for a deceased kidney, we still wouldn’t get enough. What we need is to encourage living donation to actually make a real dent in the shortage. 75% of the organs we could possibly retrieve are already being retrieved. And that remainder—I mean, I’m the ethicist on the Washington Regional Transplant Community’s Committee on Organ and Tissue Advisory Committee. And you know, they fight over kidneys from people who have cancer. They fight over kidneys that come from 95-year-olds. You know, we’re doing the best we can and there’s only marginal room for improvement with deceased organs. So you’re right philosophically, it’s a good argument, but it’s not going to put a dent in saving lives. What’s going to put a dent in saving lives is increasing living donation.
Safety and Exploitation in Legal Markets [41:00]
Bob Zadek: One of the other market-related issues—and I always will look for the opportunity to help our friends out there listening to the show understand the market implications of these conversations that I have every Sunday—but one of the market implications is of course once you create a marketplace for organs and the price determined by supply and demand, the argument is that only the wealthy will get the organ and the marketplace that is money will determine who lives and who dies, and many people believe that to be unfair. That of course is an argument easily adjusted for. The government, if they wish, can buy the organs at the market price for those who can’t afford it, or can private charity. But the argument is out there that in effect we have to do—since we have a shortage, there has to be some way to ration or allocate, and the market will allocate based on who can afford it, but that can be adjusted as it often is with so many other activities in American life with subsidies and compensation if that’s the policy decision the country makes.
But the harder, far and away the hardest ethical issue where free markets crash into ethics is—and this is an argument that is made around the world in third-world countries especially with medical tourism—is should people who are alive be allowed to sell a body part? And there you have issues of the fear of exploitation and people who are desperate doing bad things. So Sigrid, since you have devoted so much of your thought and your life to the ethical as well as the moral and the economic issues, tell us about the ethics, the ethical implications of creating a market with living donors, with somebody who simply needs the money to sell a cataract or a cornea or sell a kidney simply because—and perhaps simply is the wrong word—simply because they need the money.
Sigrid Fry-Revere: Okay, you’re going to like my answer to that, but I am going to preface it with I am not for creating a market. I know that, I know that, and I’m simply want the audience to know that. But I am a philosopher and I did go to Iran and I will tell you honestly what I found. What I found in Iran is that when you legalize a market, there is practically no exploitation. What I found in Iran was middle-class Iranians buying and selling organs, okay? Because once you legalize something, you make it safe. You allow donors to say, “Hey, I’m not going to deal with you because your contract isn’t fair.” Instead of having contracts that aren’t enforced and not having informed consent like you have everywhere else in the world with a black market where donors get cheated all the time and only the most desperate people resort to trying to sell their kidneys to get money and, you know, most of them get cheated.
Where you have a legalized market and it’s safe to get money for your kidney and you get aftercare—I mean, when we went up and down the floors in the hospitals, both pre-operation and post-operation, you have the donors in the same wards with the transplant recipients. You don’t have back-alley stealing of organs, you know, or people dying of infections because they had an organ retrieved in a makeshift clinic, you know? Because it’s legal, it’s clean, it’s safe, they put the money in escrow, there are contracts and people get their money. I’m a donor advocate, okay? When you legalize the transaction, you make it safe. And the second you make it safe, it’s not only the rich buying from the poor, it becomes the middle class buying from the middle class. And that’s what’s happened in Iran. Everybody who medically qualifies to get an organ usually gets one, because if they can’t afford it themselves, charity and government steps in, which is exactly what you said would happen. And that is what has happened in Iran.
Conclusion and Resources [45:30]
Bob Zadek: And what—there are religious implications. Several years ago the Pope, it was I think Pope John Paul II, he actually took a position that the buying and selling of organs violates—and this is a quote from the Pope—“the dignity of the human person.” Close quote. So there are not only are there ethical implications, but there are religious implications as well. And also the fear that third-world countries, the sellers in the third world—Manila, Indonesia are countries that often are mentioned, Pakistan—that they will be exploited and they will be driven by desperation. But of course the counter-argument is that you don’t have to look very far in the human experience to find people who are desperate doing highly risky activities simply out of that desperation. You can’t ban desperation by legislative fiat. All you can do is, as you said Sigrid, you can make it safe so that the circumstances are safer and it’s all done in the open to make it at least regulated to some degree but a permitted activity. And what I find most interesting—I mentioned abortion only because I found just in my own head the parallels, sort of the medical and ethical parallels to be pretty similar. But in all the words you used about being done in the open, supervised, aboveboard, those were the same arguments that were used to legalize abortion when abortion was being done in back alleys, we all know and remember all the horror stories that were used by those people who promoted abortion. So it’s the same argument. And exploitation, you have to ask yourself whether the fear of exploitation is a sufficient policy reason to not save lives. Here we are talking about clearly saving lives. And even if the marketplace does not solve the problem, every life saved is a life saved.
Sigrid Fry-Revere: You are absolutely right. And there’s two things I want to mention. One, there’s a huge difference between abortion, which arguably kills something, right? And compensated kidney donors, which inherently saves two people. It saves the person who gets the kidney, saves their life, and the person who’s selling it in Iran, they are being saved from some kind of financial crisis or need. Because it’s the middle class, often the need is not just getting out of debt, but it might be starting their own business or building an addition on their house, right? But they see it as saving each other. So that way it’s very different because, you know, abortion is an argument about whether or not we should be allowed to kill something, whether you think it’s a life or not, while compensating donors is about being allowed to save a life. Okay, that’s the first thing.
And the second thing, exploitation and what the Pope said has to do with the black market. 99% of what we see in this world is black market, and the black market is exploitative. Okay, that’s why Iran closed its borders. They said the only way we can make this a fair system is if we only let Iranians help Iranians, because the second we have Saudis come in or other people from rich countries, they will outbid the local population and we won’t save the local population. Secondly, if we have poor people coming in and selling their kidneys, we can’t ensure that they get post-operative care because they go home to poor regions where they may die. Okay, so the only way you can really assure safety, and I think the most ethical way to do it if you have any kind of national pride at all, is to say let Americans help Americans. We don’t have to let Filipinos come over and sell their kidneys or people from India come over and sell their kidneys. Let Americans help Americans and start there, because that’s the way you can ensure to protect donor’s rights. You know, at this point, I think recipients if we save their lives, that’s fine. We already have ways that they are getting helped, okay? There are so many charities out there that help recipients it isn’t even funny. You know, the example I use is someone goes to get a transplant and they get free lodging and their family gets free lodging, like through Ronald McDonald House or something like that near the transplant center, but the poor donor is down the street in a cheap motel paying for it him or herself. Now this is the US, right? Because it’s against the law to help the donor cover those expenses, at least while they happen. You know, if you have a rich recipient, the rich recipient can reimburse those expenses, but certainly not any expenses once they go home and have to deal with the recovery time.
Anyway, the point is that there is no exploitation if the system is done right. Exploitation exists in those countries where there’s a black market, which right now is 99% of the world.
Bob Zadek: My lesson would be free markets save lives. Your lesson is a bit different. How do our listeners support you or follow your work?
Sigrid Fry-Revere: The best way is to go to Stop Organ Trafficking Now. We have a huge database on articles that are both pro and against, because I believe knowledge doesn’t involve just presenting one point of view. So you can find articles that are against any kind of market, arguments that are for and the middle ground, which is the one I advocate. And we also have a petition on Stop Organ Trafficking Now website, which is a petition to encourage Congress to please consider allowing Americans to help each other by covering more of a donor’s expenses.
And lastly, we didn’t talk much about my book, but my book is a creative non-fiction adventure. I call it the modern quest because I went to Iran to try to find the answer to how to solve the organ shortage. And it’s a story of my quest, the people I meet, there’s lots of stories about people who sold their organs, what they told me was important in their lives, and believe it or not some people said parts of the book were really funny. So it’s an easy read. And for that, all you need to do is go to Google and search The Kidney Sellers and you will find my book.
Bob Zadek: Thank you so much for giving us your wisdom, your heart, your mind, and an hour of your time. Thank you so much and good luck with the petition drive. This is Bob Zadek saying thanks so much for listening, thanks to Sigrid for giving us an hour of her time. Speak to you next week. Have a good Sunday.