To those who argue that legalizing organ sales would help the poor, Nancy Scheper-Hughes, founder of Organ Watch, pointedly replies: “Perhaps we should look for better ways of helping the destitute than dismantling them.” No doubt we should, but we don’t: our assistance to the poor is woefully inadequate, and leaves more than a billion people living in extreme poverty.
In an ideal world, there would be no destitute people, and there would be enough altruistic donors so that no one would die while waiting to receive a kidney. Zell Kravinsky, an American who has given a kidney to a stranger, points out that donating a kidney can save a life, while the risk of dying as a result of the donation is only 1 in 4000. Not donating a kidney, he says, thus means valuing your own life at 4000 times that of a stranger – a ratio he describes as “obscene.” But most of us still have two kidneys, and the need for more kidneys persists, along with the poverty of those we do not help.
We must make policies for the real world, not an ideal one. Could a legal market in kidneys be regulated to ensure that sellers were fully informed about what they were doing, including the risks to their health? Would the demand for kidneys then be met? Would this produce an acceptable outcome for the seller?
To seek an answer, we can turn to a country that we do not usually think of as a leader in either market deregulation or social experimentation: Iran.