Dr. Sally Satel in the Wall Street Journal is proposing that we pay for kidneys. She got hers from a friend, so she is aware of the problem of waiting for a kidney first hand.

However, when she laments that the Philippines is the latest country to “get tough” on organ transplants from paid donors, one wonders if she sees the poor who are exploited as full human beings.

Paying $50,000 to an Australian to donate an organ might work. But that’s not how it works here.

The naive scenario is that a person needs an organ, and there is a person needing money. Exchange the money, and voila, no problem. Well, this is already being done, except the money is called a “Charitable donation” to thank the donor, and the cut by the organ broker is also a “gift” not a fee.

In reality there is a go between who take one third of the money. So if you pay the donor $3000 (the going rate in Manila according to this article) the donor ends up with  $2000…because the fee to the go between/organ broker is $1000. A survey by the University of the Philippines shows a similar paltry fee given to the donor.

Since the broker is often inspired by greed, and often the donor is desperately poor, neither one will bother to mention health problems, and of course they will deny they are being exploited. And if the donor ends up with health problems, as many of them do, well, what chance does a poor person have to get justice against the rich?

That is why the Philippine Nephrologists oppose paying for organs. There is just too much corruption involved, and too many poor people will suffer because of the procedure. In Medicine, ethics insist a “Do no harm” to the patient, and the negative health results in the donor are just too serious to ignore.

While one feels sympathy for one who has to stay on dialysis for years for lack of a donor, does this hardship justify exploiting a poor person and ruining his health so that someone in a rich country can live a more normal life?

The Western panacea is, of course, regulation.

Yet one wonders how many of those proposing regulations is aware of the depth of corruption in much of the third world? The Heparin scandall, where a deliberate substitution of a drug that tested similar to heparin, is the tip of the iceburg in a multimillion dollar counterfeit drug scam in Asia.

There is one country with less than average corruption that did try to regulate paid organ donations, and that is Iran. Yet even there, a World Health Organization report showed that  over half were either unemployed or could only find part time work, and 58% of them had health problems following the procedure.

As for Australia or the US, presumably desperate poverty would not be a problem. However, some of us are old enough to remember when people were paid for blood. Often the donors were drug addicts or skid row bums, and back then, “transfusion hepatitis” was considered a normal risk not only for those receiving blood but for surgeons who did the operations.

Finally, paying for organs, like mandatory organ donation, requires a subtle trust in the medical system.

A quick read of Reverend Wright’s sermons show something that many of us already know: that there is a subtle lack of trust against the medical establishment by minorities, and this level of trust is not going to improve if we start removing organs from relatives dying of a brain injury over their family’s objections.

Trust is a subtle thing, and it only takes a few well publicized incidents to destroy the trust of people in their physicians.

In a world of self reliant, affluent, and logical people, Dr. Satel’s ideas would be fine. In the West, where a post Christian culture still has left behind remnants of honesty and charity, it might work. But in countries where corruption is widespread, poverty is rampant, and people are desperate to find money for their next meal, her suggestions are both naive and dangerous.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket. 

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