Can the dilemmas of kidney transplantation be resolved? For Christians?

Are your kidneys available to me? - Ninth in a series

  • Hiring dynamic leaders to manage the operations of the hospital departments,
  • Working with Congress to revise legal and financial barriers,
  • Settling the question of when death occurs— or efforts to do so,
  • Stepped up solicitations for living donors, and more,

are all being done.

An Organ Donor Bill of Rights and the Living Donor Advocate are also in the mix.

The Organ Donor Bill of Rights was penned by Nancy Scheper-Hughes, who has stated, “If you were able, as I have been, to talk to kidney sellers the world over, you would find that even years after the operation, the sellers are still suffering from its effects on their bodies, minds, social status, intimate relations, and working lives.” She hopes this Bill will be read by the body brokers.

Article 1
All humans have the right to bodily integrity. Organs are every person’s birthright, their bodily patrimony. Humans both are and have a body. (A post-Cartesian notion of the person is not ‘cogito ergo sum’ but rather ‘I am embodied, therefore I am’.)
Article 2
There are no ‘spare’ kidneys, lungs, or part-livers. To share these human parts is a sacrifice not to be normalized, routinized, or taken lightly.
Article 3
Although living donation is honorable and ethical, it is never to be presented by the recipient or his surgeons as an obligation.
Article 4
Green donation (deceased donors) should be the default system. Red donation (living donors) should be viewed as the exception, not the rule.
Article 5
Acknowledge that vulnerable populations – young people, the unemployed, prisoners, the mentally ill, the mentally deficient, guest workers, the uninsured, economic and political refugees, those in debt – are exploitable and that the ‘choice’ to sell a kidney is often coerced.
Article 6
Recognize the role of relative power/powerlessness based on gender, race, class, education, citizenship, nationality in organ selling, transplant tour, internet brokering schemes.
Article 7
Establish a principle of solidarity with the weak, the frail, the sick and the economically and existentially shaken.
Article 8
Recognize that the medical, psychological, social and political consequences of kidney selling, like the scars themselves, are often kept hidden from view.
Article 9
Revise hospital protocol to increase surveillance of living donation to include a ‘donor’s doula’, a guardian-advocate at the bedside, independent of and un-beholding to, or financially dependent on the transplant team, to represent the living donor during screening, surgery, and post-surgical follow up.
Article 10
No living organ donation from the unemployed or medically uninsured. (ref)

Dr. Scheper-Hughes suggests, “if you are able and willing to pay someone for a kidney (or a liver lobe) to save your life, please make sure that the money is paid to someone you know, even to someone you love, someone who you will be able to watch out for over the long term should their health fail and, turning the tables, they may need you to give them a helping hand.”

Article 9 is now part of the current American regimen:

In the US, all transplant hospitals are required to have either a Living Donor Advocate or a Living Donor Advocate Team. The role of this job is to screen candidates who desire to be living organ donors to ascertain if they understand the risks and benefits of donation, if they can provide informed consent, and to look after their safety and welfare. They aim to discover the motivations and expectations about donating, and if there is any coercion to donate. (ref)

Other attempts to solve the dilemmas of kidney transplantation are being carried out in biotech labs. Will lab-grown kidneys fix our transplant waiting lists? Various experiments have shown promise. Example:

Scientists removed the cells from a rat kidney, leaving only its collagen scaffolding, then re-seeded the scaffolding with neonatal kidney cells and endothelial cells, producing a functional man-made kidney that, when transplanted into rats, filters waste and produces urine. It raises hopes for a bioengineered human kidney.

The referenced article also mentions at-home and portable dialysis as new techniques, but stresses that one new kidney is what frees patients from devices.

The prospect for growing kidneys in labs using stem cells from human embryos or for developing inter-species kidneys for human transplant are real, yet these are not expected to be on the market anytime soon.

Would you want to have a kidney that came from a pig? Many people have porcine (pig) or cow heart valves in place of their own and may be considered chimeras, yet there is a significant difference between a man who has a pig valve in place of his own faulty valve, and animal embryos merged with human in a petri dish to invent a chimeric kidney or other body part.

Animals have long been incubators for human medical advancements, but where do you draw the line?

For the Christian, the line is drawn at using human embryos in research. Life begins at conception. This is a scientific truth that, like the definition of death, is now disregarded. It is rejected by those who desire to use human embryos “for the greater good.” An excellent article that explains why life begins at conception is here.

Also, for the Christian, there should be no acceptance of fusing the types or “kinds” that God created, but regenerative therapies may hold promise, and these, I believe, could meet with Christian approval.

What other lines should a Christian draw? We cannot steer the sciences but we should have our own insights and convictions to live by and to share as we may feel led.

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The payment option

Are your kidneys available to me? - Seventh in a series

By NIH - link, Public Domain, Link
If you read the last post, you may be wondering, “How did taxpayers become liable for Medicare’s renal dialysis payments?” And, “Would we also be liable if a kidney seller becomes incapacitated?”

There are many questions that are circular rabbit trails. We can only shake our heads and try, as Christians, to determine how we ought to think and to act in respect to current and prospective biomedical procedures and practices. Are they OK with God?


Currently in America:

Sec. 301. (a) It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation…
(b) Any person who violates subsection (a) shall be fined not more than $50,000 or imprisoned not more than five years, or both. (ref)

This law presumes that organ sharing is right and good, as long as there is no payment involved. Heaven forbid commodifying the human body! Perhaps, though, those who wrote the law overlooked or forgot that there are significant payments made to the doctors and others. (Evidently, in many cases, this law’s word knowingly comes in handy. It’s unlawful to knowingly acquire…)

There will inevitably be a black market for body parts as long as federal law prohibits payment to sellers while there are many times more people needing transplants than there are donors.

Nancy Scheper-Hughes (see previous posts) tracked down “body brokers” and interviewed surgeons and other medical staff in the course of her research-on-a-mission.

An example of a statement from a surgeon paints the picture of how organs slip in under the radar.

Alternatively cajoling and asking pointed questions, Scheper-Hughes pressed on. The doctor said that some of the transplants set up by Rosenbaum* seemed ‘fishy.’ “Some of the recipients were from New York, and it did feel a little strange that they found this donor from Israel.” He went on to suggest that it was likely that everyone involved at the hospital had good reason to be suspicious. “There is no question that everyone in the program felt that it would be very possible that there was some kind of incentive there. I didn’t feel that I had to be the police. As long as I don’t know and as long as I don’t have any evidence, I’m not going to deny the transplant just because I have the suspicion,” he said. (ref)

Does it make sense to help one, probably older, person live longer at the expense of another, younger person who is giving up a kidney? In America the recipient will have healthcare options, but perhaps the seller from some other part of the world will have no recourse to compensation for aftercare. How can this inequity and exploitation be avoided?

Would it help if the U. S. began to compensate donors, that is, to pay sellers? The fee of $45,000 for a kidney mentioned in the previous post may initially draw in quite a number of people. But would it prevent exploitation of the poor here or in other countries?

Not likely, says Scott Carney. In his article, “If you’re willing to buy a kidney, you’re willing to exploit the poor” he states:

For argument’s sake, let’s assume that the United States would be able to create its own equitable system. What would happen in the rest of the world? Whether we like it or not, we live in the era of globalization, and if the U.S. legalizes the market for body parts, there is no reason to think that international economies won’t play a role in how a patient decides to procure transplant organs.
According to the National Foundation for Transplants, a kidney transplant costs about $260,000. In the illegal organ markets in India, Egypt and Pakistan, the same procedure rings in at just shy of $20,000 — certified organ included. (ref)

Mr. Carney goes on to point out we can look at what happened in the market for human surrogate babies to determine how the legalization of organ selling would go down.

In the United States, it is legal to pay a woman to carry a child, so long as the money is called “compensation” and not coercion. Even so, an American surrogate might cost as much as $100,000 in such arrangements. Once the market was clearly defined in the United States, other countries, with looser definitions of human rights, fought for their share of the market. In 2002, India became the go-to destination for procuring a budget surrogate womb. To the surprise of no one, the Indian industry soon began to cut corners. Women were housed under lock and key in houses known to the press as “baby factories.” Because U.S. patients demanded to know the condition of their children during the entire course of the pregnancy, surrogates became virtual slaves under the doctor’s perpetual surveillance.
The factories multiplied and soon tens of thousands of international customers reasoned that if it was legal to hire a surrogate at home, why not save money abroad? (ibid)

Is the certainty that some people will be exploited enough reason for Christians to oppose transplantation from live persons, whether donors or sellers? We have seen that

  1. there are not enough live donors to supply the demand
  2. a black market exists to try to fill the gap
  3. even payment will not prevent exploitation; it simply legalizes it

There does not seem a clear way for Christians to assent to organ transplantation, whether they espouse social justice as their highest belief or simply believe the Bible.

In the next post we will play devil's advocate and consider some concepts that may support permission for kidney selling or donation. We will then look at the health risks of donating a kidney and societal implications of selling them.

*Rosenbaum was an organ broker who was convicted and sent to prison. [The article states—]He is the only person so far ever successfully prosecuted for organ trafficking under the 1984 National Organ Transplant Act.

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Angel fish
Public Domain, Link

...and every living creature that moveth, which the waters brought forth abundantly, after their kind, and every winged fowl after his kind ... the living creature after his kind, cattle, and creeping thing, and beast of the earth after his kind ...the beast of the earth after his kind, and cattle after their kind, and every thing that creepeth upon the earth after his kind: and God saw that it was good. -Genesis 1


A SistersSite eBook

Flesh and Bone and The Protestant Conscience is an e-book on It is 99¢ and in the Amazon lending library as well. It is also available here in PDF format. The book description follows.

Would you let your conscience be your guide?

Does God care if the skin and bone of the dead are passed along to the living for medical uses? Is organ donation OK with God? Should you sign a Living Will?

Did you know that dead organ donors are often anesthetized before their organs are removed? Do you know the current definition of death? The conscience cannot function without facts.

As we ponder the ethics of in vitro fertilization, stem cell research and man-made chimeras, our thoughts trail off. How then should we live? (Ez 33:10)

How should a Christian think about euthanasia by starvation when doctors and the state attorney general all agree it is time to withhold feeding from a brain injured patient? Some things are family matters, but someday it may be our family.

Here is a small book to help you think about whether you want to sign your driver's license, donate a kidney, cremate your loved one, and many other practical questions that may arise in the course of your healthcare decisions or watch over others.

It offers a special focus on the doctrine of the Resurrection that is related to such decisions. Sunday School classes and Bible Study groups could use this book to facilitate discussion about the issues covered.