Kidneys: compensation and altruism

 Apropos of my debate with Debra Satz this afternoon, here are two articles about kidney donation, from pure altruism or with compensation, in the New York Times and in The Journal of Medicine and Philosophy.

In the NYT:

Let People Sell Their Kidneys. It Will Save Lives., By Dylan Walsh, April 2, 2024

"There are 100,000 people in the United States waiting for a kidney. More than half a million are on dialysis, which from my experience I know to be more of a means of survival than a form of living. ... The National Kidney Foundation estimates that without more investment in preventing diabetes and other ailments, more than one million people will be suffering from kidney failure by 2030, up from over 800,000 now.

...

"Creating a market for kidneys is not a new concept, but it’s historically been met with disgust: Sell what? To be fair, some of the ways to structure such a market would be irresponsible, coercive and deserving of that disgust.

"But others are more thoughtful and prudent. One approach is to make the federal government the sole purchaser of kidneys. Donor and recipient would never meet. Compensation would be fixed, haggling impossible. After the kidney is acquired, the transplant process would unfold in the typical manner."

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In The Journal of Medicine and Philosophy:

Semrau, Luke. "The Altruism Requirement as Moral Fiction." In The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, p. jhae011. US: Oxford University Press, 2024.

"Abstract: It is widely agreed that living kidney donation is permitted but living kidney sales are not. Call this the Received View. One way to support the Received View is to appeal to a particular understanding of the conditions under which living kidney transplantation is permissible. It is often claimed that donors must act altruistically, without the expectation of payment and for the sake of another. Call this the Altruism Requirement. On the conventional interpretation, the Altruism Requirement is a moral fact. It states a legitimate constraint on permissible transplantation and is accepted on the basis of cogent argument. The present paper offers an alternative interpretation. I suggest the Altruism Requirement is a moral fiction—a kind of motivated falsehood. It is false that transplantation requires altruism. But the Requirement serves a purpose. Accepting it allows kidney donation but not kidney sale. It, in short, rationalizes the Received View."

Here's the concluding paragraph:

"I have argued that the Altruism Requirement is a moral fiction. No sound arguments demonstrate its truth. It continues to enjoy widespread endorsement on account of its perceived link to the Received View. It is taken as a means of allowing kidney donation but not kidney sale. Thus, it is unsurprising that, on examination, in ethical argument and in the practice of transplantation, it is, de facto, a No Payment Requirement."