WEBVTT - Why Can’t I Buy a Kidney?

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<v Speaker 1>It went for a regular medical checkup, which as being

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<v Speaker 1>a doctor, of course, I hadn't done for ten years,

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<v Speaker 1>and my blood tests were not good.

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<v Speaker 2>In two thousand and four, Sally Setel discovered her kidneys

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<v Speaker 2>were failing. It had come out of the blue, and

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<v Speaker 2>her doctor said she would eventually need a transplant.

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<v Speaker 1>So it was a bit of a race against time

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<v Speaker 1>in a way. You know, how long would I feel

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<v Speaker 1>fine before having to go on dialysis? And during that period,

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<v Speaker 1>which turned out to be about eighteen months, I frantically

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<v Speaker 1>looked for someone to give me a body part.

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<v Speaker 2>To get a new kidney. Sally had two choices, add

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<v Speaker 2>her name to the national wait list for kidneys from

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<v Speaker 2>deceased donors, or ask her living family members and friends

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<v Speaker 2>if they'd be willing to give her one of their own.

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<v Speaker 2>But Sally knew that wouldn't be easy. Not only would

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<v Speaker 2>she need someone to agree to donate their kidney, that

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<v Speaker 2>person would also have to be a match. So she

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<v Speaker 2>started searching, but she was also added to the list.

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<v Speaker 2>At that point, there were about sixty thousand people ahead

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<v Speaker 2>of her. It would take years.

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<v Speaker 1>You know, Initially I kind of wanted to buy a

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<v Speaker 1>kidney to be honest, because I wanted to avoid what

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<v Speaker 1>I thought could be, you know, really complicated relationships.

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<v Speaker 2>Buying a kidney, however, is against the law in the

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<v Speaker 2>United States and nearly everywhere else in the world, but

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<v Speaker 2>black markets do exist.

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<v Speaker 1>There are so many, so many desperate people just frankly

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<v Speaker 1>roaming the world looking for someone to save their life.

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<v Speaker 1>And obviously these are a people who have funds, you know,

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<v Speaker 1>can engage in this kind of thing, but you know,

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<v Speaker 1>it's our show.

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<v Speaker 2>Sally didn't want to be part of that, so all

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<v Speaker 2>she could do was convince someone to donate to her,

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<v Speaker 2>while she also waited her turn on the deceased donation list.

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<v Speaker 1>So that was highly frustrate and by that time I

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<v Speaker 1>wasn't feeling very well.

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<v Speaker 2>Sally was still healthy enough to avoid dialysis, but she

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<v Speaker 2>was declining. She didn't have family she could ask, so

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<v Speaker 2>she started talking with her friends. Some seemed eager to help,

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<v Speaker 2>but then spoke to their families and changed their minds.

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<v Speaker 2>Others got cold feet. She connected with the Donut online

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<v Speaker 2>and it seemed promising, but eventually fell through.

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<v Speaker 1>We actually even had a date, as they say, to

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<v Speaker 1>have the surgeries, and then he just totally disappeared.

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<v Speaker 2>One day, she got an email from a friend with

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<v Speaker 2>the subject line serious offer. Finally this one was real.

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<v Speaker 2>They underwent the testing and it was a good match.

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<v Speaker 2>She got the transplant and it went well. Sally found

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<v Speaker 2>that she wasn't burdened by feelings of indebtedness to her

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<v Speaker 2>donor friend. She lived in decent health for a decade,

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<v Speaker 2>but then faced another blow.

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<v Speaker 1>If you get a living kit, neither supposed to last

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<v Speaker 1>between fifteen to twenty years. Unfortunately mine didn't. But you know,

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<v Speaker 1>I had another friend who had worked with me at

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<v Speaker 1>the time I was going through this ordeal of trying

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<v Speaker 1>to get a kidney the first time. She was younger

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<v Speaker 1>and wanted to have kids first, which she said, if

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<v Speaker 1>you ever need another one, you know, I'll keep mine

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<v Speaker 1>warm and you can ask me.

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<v Speaker 2>In twenty sixteen, Sally took her up on that offer.

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<v Speaker 2>She had a second kidney transplant. Today, Sally is doing well,

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<v Speaker 2>but she knows tens of thousands of others with renal

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<v Speaker 2>disease and not as fortunate. She's since become an advocate

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<v Speaker 2>for encouraging living organ donation, and she'd liked to see

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<v Speaker 2>a significant change happen for living organ donors. She thinks

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<v Speaker 2>they should be compensated.

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<v Speaker 1>You know, people talk about an organ shortage, and that

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<v Speaker 1>is true, but I almost think about it in terms

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<v Speaker 1>of an altruism shortage.

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<v Speaker 3>And so.

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<v Speaker 1>What I believe we should do when I'm not alone,

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<v Speaker 1>I am the more outspoken folks I think, but I'm

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<v Speaker 1>certainly not alone in believing that we should reward people

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<v Speaker 1>who donate kidneys so that others will be motivated to

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<v Speaker 1>do the same. And you know there are money exchanges

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<v Speaker 1>for other bodily products. You know, we pay for plasma,

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<v Speaker 1>We pay for eggs and sperm and even bone marrow. Now,

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<v Speaker 1>and why shouldn't we offer people compensation or a reward

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<v Speaker 1>for giving a kidney and saving someone's life and saving

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<v Speaker 1>someone's mom, sister, spouse. You know, why shouldn't we do that?

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<v Speaker 2>I'm Lauren Aurora Hutchinson. I'm the director of the Ideas

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<v Speaker 2>Lab at the Johns Hopkins Berman Institute of Bioethics. This season,

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<v Speaker 2>I'm going behind the scenes to discover how some of

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<v Speaker 2>the most significant medical innovations have impacted people's lives and

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<v Speaker 2>continue to whether it's redefining death or creating babies. A

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<v Speaker 2>new technology is usually waiting in the wings, along with

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<v Speaker 2>a whole entourage of ethical questions on today's show, is

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<v Speaker 2>it ever ethical to compensate someone for a kidney? And

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<v Speaker 2>why do we allow the sale of some body parts

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<v Speaker 2>and not others from Pushkin Industries and the Johns Hopkins

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<v Speaker 2>Berman Institute of Bioethics. This is playing god. Sally Stel

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<v Speaker 2>has been through quite a lot since the day her

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<v Speaker 2>doctor's discovered her kidneys were mysteriously failing and the prospect

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<v Speaker 2>of needing a third is very real. But she's also

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<v Speaker 2>the first to say she's been lucky, too successful transponts.

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<v Speaker 2>She knows that for many others the outcomes are not

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<v Speaker 2>as good, and that many are waiting for a kidney

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<v Speaker 2>they might never receive. Sally ended our conversation with a proposal,

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<v Speaker 2>since many people people are in dire need of a kidney,

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<v Speaker 2>and most healthy people can donate one kidney, we should

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<v Speaker 2>encourage more people to donate by compensating them, Which leaves

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<v Speaker 2>me wondering would it be ethically acceptable to use money

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<v Speaker 2>or other forms of compensation to incentifize living donors instead

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<v Speaker 2>of prohibiting it.

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<v Speaker 4>You know, we have been debating that question for a

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<v Speaker 4>really very long time.

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<v Speaker 2>This again is my colleague at the Berman Institute, Jeffrey Kahn.

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<v Speaker 4>There's a big need and there's just not enough supply.

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<v Speaker 4>The data is that as many as one in seven

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<v Speaker 4>adults in the United States live with renal disease as

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<v Speaker 4>kidney disease, and if someone needs a kidney transplant, they

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<v Speaker 4>generally get added to a national wait list for a

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<v Speaker 4>kidney from somebody who has died, a deceased organ donor,

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<v Speaker 4>we call that, and so that puts patients like Sally

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<v Speaker 4>in a really tough situation. No one wants to stay

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<v Speaker 4>on dialysis, although that's really important to say. Dialysis is

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<v Speaker 4>the technology that allows people to wait. That technology has

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<v Speaker 4>gotten much better over the decade since it was first invented.

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<v Speaker 4>But it's time intensive, it is not pleasant, Your quality

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<v Speaker 4>of life is not great.

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<v Speaker 2>So how did that policy come to be? What's the

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<v Speaker 2>history behind it.

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<v Speaker 4>It's a kind of interesting history, actually, and it goes

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<v Speaker 4>back to nineteen eighty four when a law called the

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<v Speaker 4>National Organ Transplant Act NODA is its acronym, and that's

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<v Speaker 4>how it's referred to, was passed by Congress and that

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<v Speaker 4>law makes it illegal in the United States to buy

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<v Speaker 4>and sell organs, really to exchange anything of value in

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<v Speaker 4>return for an organ. And it was driven by a

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<v Speaker 4>guy who tried to create what we would think of

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<v Speaker 4>as an eBay for kidneys before eBay existed. He was

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<v Speaker 4>a physician who had lost his license, so he was

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<v Speaker 4>kind of a sketchy guy, but he found a way

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<v Speaker 4>to make some money by being the mental man and

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<v Speaker 4>brokering kidneys from people who you could then sell. That

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<v Speaker 4>was a driver, largely the driver in fact, that led

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<v Speaker 4>to the passage of the National Organ Transplant Act, And

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<v Speaker 4>so ever since nineteen eighty four we've had this law

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<v Speaker 4>in place which says you may not exchange anything of

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<v Speaker 4>value in return for a solid organ. Now, solid organs

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<v Speaker 4>are kidneys, livers, hearts, lungs, as opposed to bone marrow,

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<v Speaker 4>which is not a solid organ. But that's the distinction

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<v Speaker 4>that is in the law.

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<v Speaker 2>Can you talk a little bit about that distinction. I

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<v Speaker 2>know we already sell somebody parts like sperm, egg and plasma,

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<v Speaker 2>but ethically what makes them different from a solid organ

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<v Speaker 2>like a kidney.

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<v Speaker 4>Well, it's a good question to ask. So you could say, well,

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<v Speaker 4>you know, we certainly regenerate sperm. There's no shortage of that,

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<v Speaker 4>and women have a certain limited but large number of

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<v Speaker 4>eggs from the time that they're born and bone marrow

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<v Speaker 4>and plasma regenerate. But you know, the truth is our

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<v Speaker 4>public policy is often inconsistent, and that's just the case here.

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<v Speaker 4>And so you know, the law was crafted in reaction

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<v Speaker 4>to a particular situation. Somebody was trying to buy and

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<v Speaker 4>sell kidneys, and so they passed the law to prevent

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<v Speaker 4>what they thought was an immoral, unethical, illegal market. And

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<v Speaker 4>so that's how the law was crafted. And I think

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<v Speaker 4>it wasn't as far thinking as the conversation we're having

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<v Speaker 4>would imply.

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<v Speaker 2>So it's more of a legal distinction than an ethical one.

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<v Speaker 2>At the moment, it sounds like.

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<v Speaker 4>Well, and the law, you know, we hope tracks to ethics,

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<v Speaker 4>but it doesn't always track perfectly to ethics, I guess,

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<v Speaker 4>is the way I would say it. But really interestingly,

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<v Speaker 4>there are innovations or ways that people are going about

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<v Speaker 4>getting a kidney that start to feel a lot like compensation,

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<v Speaker 4>but technically haven't been considered that for the purposes of

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<v Speaker 4>noda of the law.

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<v Speaker 2>So what is considered ethically acceptable today that doesn't involve

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<v Speaker 2>a direct exchange of money between people.

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<v Speaker 4>Right, So, there's now an online site called Matching donors

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<v Speaker 4>dot com where people like Sally put their information on

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<v Speaker 4>the site I need a kidney. Here's a little bit

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<v Speaker 4>about me, usually as a photograph, some background, and then

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<v Speaker 4>people who are willing to be donors can go to

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<v Speaker 4>that site and effectively shop for somebody that they want

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<v Speaker 4>to give their kidney to. What's a concern about that

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<v Speaker 4>is there's nothing that stops people from meeting this way

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<v Speaker 4>to make agreements about what they will receive in return

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<v Speaker 4>for being a donor. So that's one option. There are

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<v Speaker 4>two other ways that people can also access kidneys through

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<v Speaker 4>living donation that also start to feel like something being

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<v Speaker 4>exchanged that's valuable that isn't so far at least been

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<v Speaker 4>deemed compensation. One is something called daisy chain donations, where

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<v Speaker 4>if you're willing to be a donor to your loved

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<v Speaker 4>one or your friend, but you're the wrong blood type,

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<v Speaker 4>you can give to somebody else who is the right

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<v Speaker 4>blood type, and then another donor can give to someone who,

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<v Speaker 4>again they're not the right blood type for their loved one,

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<v Speaker 4>but they give to somebody else, and so on and

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<v Speaker 4>so on until somebody gives to your loved one in

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<v Speaker 4>a kind of circle. So you're not getting money as

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<v Speaker 4>a donor, but what you're getting is a kidney that

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<v Speaker 4>goes to the person you care about, even if you

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<v Speaker 4>can't be the person who's donating directly. So that isn't

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<v Speaker 4>called compensation, but it certainly feels like something of value

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<v Speaker 4>going to someone you care about in return for something

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<v Speaker 4>that you're giving. And then the third way is through

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<v Speaker 4>a voucher program. So if you're willing to be a

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<v Speaker 4>living donor, you get a voucher that you are allowed

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<v Speaker 4>to give to somebody else who will then go to

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<v Speaker 4>the top of the line for a kidney donation should

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<v Speaker 4>they ever need it. It's an opportunity to identify somebody

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<v Speaker 4>who you think, at some point in their life may

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<v Speaker 4>need a kidney transplant, but of course maybe never will,

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<v Speaker 4>so it's a voucher that may never get redeemed, but

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<v Speaker 4>if if it's needed, it allows the person who holds

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<v Speaker 4>it to go to the front of the line. So

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<v Speaker 4>you're being given something a voucher for a kidney transplant,

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<v Speaker 4>effectively in return for your being a donor. A voucher

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<v Speaker 4>for a kidney transplant certainly feels like something of value,

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<v Speaker 4>even though it isn't money into your bank account. So

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<v Speaker 4>there's all these innovations that people are undertaking out of

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<v Speaker 4>frankly strong need, almost desperation to find enough kidneys to

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<v Speaker 4>transplant all these people who are waiting.

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<v Speaker 2>So Sally, who we heard from earlier in this episode,

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<v Speaker 2>has seen firsthand what donors go through in order to

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<v Speaker 2>donate their kidneys, and she believes strongly that they should

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<v Speaker 2>be financially compensated. So could you talk a bit more

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<v Speaker 2>about the main reasons why some ethicists think that any

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<v Speaker 2>kind of compensation for organs is a concern, and what

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<v Speaker 2>bad situations they're worried about happening.

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<v Speaker 4>Sure, and I would put myself into the category of

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<v Speaker 4>emphicists who are concerned about this. And the issues really

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<v Speaker 4>fall into th remain categories. One is exploitation, the second

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<v Speaker 4>is commodification, so turning human body parts into a commodity,

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<v Speaker 4>and the third is the impact on altruistic donation. So

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<v Speaker 4>taking exploitation first, there is a real concern and I

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<v Speaker 4>think everybody recognizes this that when people are desperate and

0:13:23.400 --> 0:13:26.760
<v Speaker 4>need money, they will do things that maybe are against

0:13:26.760 --> 0:13:29.640
<v Speaker 4>their better judgment. So that's the worry, and that helps

0:13:29.679 --> 0:13:32.040
<v Speaker 4>us bridge to the second point, which is about commodification.

0:13:32.600 --> 0:13:35.160
<v Speaker 4>We're buying and selling parts of human bodies and that

0:13:35.240 --> 0:13:39.000
<v Speaker 4>feels wrong. It just doesn't seem like it's an appropriate

0:13:39.040 --> 0:13:42.960
<v Speaker 4>thing to take a piece of a person's body and

0:13:43.120 --> 0:13:46.880
<v Speaker 4>sell it. So that's problem or concern number two, and

0:13:46.920 --> 0:13:48.800
<v Speaker 4>then concern number three is are sort of a hard

0:13:48.840 --> 0:13:51.720
<v Speaker 4>one to assess, but that is a concern that if

0:13:51.760 --> 0:13:55.160
<v Speaker 4>we pay people to be living donors, that there'll be

0:13:55.240 --> 0:14:01.000
<v Speaker 4>a negative impact on the deceased donor population, that people

0:14:01.080 --> 0:14:04.920
<v Speaker 4>just be less willing to be altruistic donors after they've died,

0:14:05.040 --> 0:14:07.319
<v Speaker 4>or even when they are alive, if there's a market,

0:14:07.640 --> 0:14:08.520
<v Speaker 4>they'll be turned off.

0:14:09.480 --> 0:14:11.640
<v Speaker 2>Thanks so much, Jeff, great to talk with you today.

0:14:12.400 --> 0:14:14.280
<v Speaker 4>Thank you, Lauren. Great to talk to you as well.

0:14:15.480 --> 0:14:18.400
<v Speaker 2>We're going to take a short break. When we return,

0:14:18.520 --> 0:14:22.080
<v Speaker 2>we'll hear from Dr Mario Matchis, a behavioral economist at

0:14:22.120 --> 0:14:26.360
<v Speaker 2>Johns Hopkins University, about why we should allow financial compensation

0:14:26.520 --> 0:14:30.160
<v Speaker 2>for kidney donation, and to walk us through his proposal

0:14:30.280 --> 0:14:33.680
<v Speaker 2>for what a system of reimbursement and incentives could actually

0:14:33.760 --> 0:14:46.120
<v Speaker 2>look like. Playing God will be right back in this episode,

0:14:46.160 --> 0:14:50.200
<v Speaker 2>So far, we've seen how common chronic kidney diseases and

0:14:50.240 --> 0:14:53.880
<v Speaker 2>that so many Americans are on dialysis, and there's an

0:14:54.000 --> 0:14:59.000
<v Speaker 2>interesting economic perspective on whether we should allow financial incentives

0:14:59.000 --> 0:15:00.000
<v Speaker 2>for living kidney don't.

0:15:00.800 --> 0:15:06.960
<v Speaker 3>So the debate about compensating kidney donors is often polarized,

0:15:07.400 --> 0:15:13.160
<v Speaker 3>with two sides arguing for extreme solutions or policies.

0:15:13.760 --> 0:15:17.240
<v Speaker 2>Doctor Maria Matches is a behavioral economist at Johns Hopkins

0:15:17.320 --> 0:15:22.200
<v Speaker 2>University and often works on what people call repugnant transactions.

0:15:22.960 --> 0:15:28.320
<v Speaker 3>A repugnant transaction is a transaction where you have people

0:15:28.320 --> 0:15:30.760
<v Speaker 3>who would like to engage in an exchange, like a

0:15:30.800 --> 0:15:34.640
<v Speaker 3>buyer and a seller, but where third parties object to

0:15:34.760 --> 0:15:39.840
<v Speaker 3>the transaction, usually for ethical moral reasons, and they wish

0:15:39.920 --> 0:15:43.520
<v Speaker 3>to prohibit that transaction from taking place.

0:15:44.560 --> 0:15:47.440
<v Speaker 2>Mario says he has seen two sides of the debate

0:15:47.560 --> 0:15:50.120
<v Speaker 2>about paying kidney donors.

0:15:50.320 --> 0:15:54.720
<v Speaker 3>On the one hand, a total prohibitions of money exchanges,

0:15:55.160 --> 0:15:57.560
<v Speaker 3>and on the other hand, like a free market where

0:15:57.600 --> 0:16:02.000
<v Speaker 3>individuals can buy and sell organs. Now between these two

0:16:02.000 --> 0:16:04.200
<v Speaker 3>and this is not, in my view, a very productive

0:16:04.240 --> 0:16:08.320
<v Speaker 3>way to have the conversation. There are many intermediate solutions

0:16:08.360 --> 0:16:15.240
<v Speaker 3>between these two extremes. One solution is to compensate donors,

0:16:15.280 --> 0:16:22.840
<v Speaker 3>reinbursing them for the costs that they incur. Another type

0:16:22.880 --> 0:16:27.360
<v Speaker 3>of cost is the cost of undergoing the surgery, the

0:16:27.520 --> 0:16:33.320
<v Speaker 3>risk implied in you know, undergoing a major surgery. There

0:16:33.320 --> 0:16:37.240
<v Speaker 3>are also sort of, you know, the psychic costs of

0:16:37.840 --> 0:16:43.120
<v Speaker 3>the anxiety implied in undergoing a surgery that should be

0:16:43.200 --> 0:16:47.080
<v Speaker 3>taken into account when computing the total costs for a

0:16:47.160 --> 0:16:51.960
<v Speaker 3>living person to donate a kidney. And this policy proposal

0:16:52.280 --> 0:16:58.280
<v Speaker 3>is that removing these incentives to kidney donors might lead

0:16:58.400 --> 0:17:04.080
<v Speaker 3>to an increase in kidney donations. Now, the idea that

0:17:04.520 --> 0:17:09.120
<v Speaker 3>the act of donating a kidney should be financially neutral

0:17:09.200 --> 0:17:11.800
<v Speaker 3>for the don or, that it should not result in

0:17:12.440 --> 0:17:16.040
<v Speaker 3>net costs for the don or, that idea is not controversial.

0:17:16.160 --> 0:17:22.560
<v Speaker 3>Like ethically, ethically, there's broad support for compensating donors for costs.

0:17:22.960 --> 0:17:27.639
<v Speaker 3>Where there is less agreement is exactly in what types

0:17:27.680 --> 0:17:31.560
<v Speaker 3>of costs should be reinborseed and what types of costs

0:17:31.840 --> 0:17:35.280
<v Speaker 3>should not be reinborsed. For example, the idea of reinborsing

0:17:35.600 --> 0:17:39.320
<v Speaker 3>the cost associated with risk and anxiety. There is much

0:17:39.400 --> 0:17:42.359
<v Speaker 3>less agreement on that because that is more difficult to

0:17:42.480 --> 0:17:46.639
<v Speaker 3>quantify it doesn't really correspond to an out of pocket expenditure,

0:17:46.920 --> 0:17:50.800
<v Speaker 3>so there is a little less agreement on that. But

0:17:51.200 --> 0:17:56.560
<v Speaker 3>my sense is that a policy that would reinborse as

0:17:56.560 --> 0:18:02.359
<v Speaker 3>many costs as possible would be worthwid while policy to pursue.

0:18:02.880 --> 0:18:06.800
<v Speaker 2>In your policy proposal, you talk about eliminating all financial

0:18:06.840 --> 0:18:10.200
<v Speaker 2>disincentives for kidney donation, but do you think it would

0:18:10.240 --> 0:18:12.720
<v Speaker 2>ever be appropriate to go a step further and create

0:18:12.840 --> 0:18:14.160
<v Speaker 2>financial incentives?

0:18:15.160 --> 0:18:20.840
<v Speaker 3>So I personally am in favor of introducing financial incentives

0:18:20.880 --> 0:18:26.439
<v Speaker 3>that go beyond purely reinforcing donors for their expensive but

0:18:26.680 --> 0:18:29.840
<v Speaker 3>you know, different people have different views about that based

0:18:29.880 --> 0:18:34.960
<v Speaker 3>on their own, you know, personal or ethical values. I

0:18:35.000 --> 0:18:38.840
<v Speaker 3>think there's value in having a discussion and looking at

0:18:38.840 --> 0:18:43.960
<v Speaker 3>the evidence and understanding, you know, people's preferences, people's attitudes

0:18:44.000 --> 0:18:47.480
<v Speaker 3>about these issues. And I think that the conversation that

0:18:47.640 --> 0:18:51.000
<v Speaker 3>we should have is how do we create a system

0:18:51.200 --> 0:18:55.920
<v Speaker 3>with incentives that can lead to additional donations while mitigating

0:18:56.119 --> 0:19:00.000
<v Speaker 3>or possibly eliminating most of the of the ethical concerns

0:19:00.080 --> 0:19:03.280
<v Speaker 3>that people have. I think that such a system can

0:19:03.400 --> 0:19:05.399
<v Speaker 3>be designed, and that should be the goal.

0:19:06.280 --> 0:19:09.159
<v Speaker 2>So we know that you've done public opinion research to

0:19:09.200 --> 0:19:13.240
<v Speaker 2>figure out what people think about compensation. And from that research,

0:19:13.359 --> 0:19:16.320
<v Speaker 2>would you say that Americans are okay with compensation for

0:19:16.440 --> 0:19:17.040
<v Speaker 2>organ donation.

0:19:17.920 --> 0:19:22.080
<v Speaker 3>From my research, it would appear that a sufficient majority

0:19:22.520 --> 0:19:27.360
<v Speaker 3>of Americans, in sixty seventy percent, would be in favor

0:19:27.800 --> 0:19:31.520
<v Speaker 3>of a system that compensates donors. They would not be

0:19:31.600 --> 0:19:34.840
<v Speaker 3>in favors of a free market. They would not be

0:19:34.920 --> 0:19:37.680
<v Speaker 3>in favor of a system in which reach individuals would

0:19:37.680 --> 0:19:40.840
<v Speaker 3>be able to obtain a life saving kidney whereas four

0:19:40.880 --> 0:19:43.080
<v Speaker 3>individuals will not. But they would be in favor of

0:19:43.080 --> 0:19:48.119
<v Speaker 3>a system in which organ donors get compensated and an intermediary,

0:19:48.280 --> 0:19:52.720
<v Speaker 3>ideally a government agency would allocate the result in organs

0:19:52.800 --> 0:19:56.879
<v Speaker 3>in a fair way among patients in need according to

0:19:56.920 --> 0:20:01.800
<v Speaker 3>the waiting least according to medical criteria. Cash compensation would

0:20:01.800 --> 0:20:06.560
<v Speaker 3>be preferred things like, you know, refundable tax credits, or

0:20:06.600 --> 0:20:11.200
<v Speaker 3>contributions to a retirement account, or contributions to a college fund.

0:20:12.000 --> 0:20:14.320
<v Speaker 2>And what do you think about dialysis? How does the

0:20:14.359 --> 0:20:16.760
<v Speaker 2>cost of dialysis play a role in how we should

0:20:16.760 --> 0:20:19.439
<v Speaker 2>think about whether we should pay a living kidney donuts.

0:20:20.320 --> 0:20:25.480
<v Speaker 3>Dialysis is very expensive. It's covered by Medicare, but it's

0:20:25.520 --> 0:20:29.800
<v Speaker 3>a very, very expensive procedure, and it also leads to

0:20:30.280 --> 0:20:34.479
<v Speaker 3>lower quality of life because it's cumbersome on patients, and

0:20:34.520 --> 0:20:38.000
<v Speaker 3>so it's not ideal from both an economic point of

0:20:38.080 --> 0:20:41.840
<v Speaker 3>view because it's much more expensive than a transplant. All

0:20:41.920 --> 0:20:46.359
<v Speaker 3>things considered, financially, a kidney transplant saves money to the

0:20:46.400 --> 0:20:50.399
<v Speaker 3>health system, to Medicare. In particular, there are estimates that

0:20:50.520 --> 0:20:56.200
<v Speaker 3>indicate that every kidney transplant saves US tax payers about

0:20:56.240 --> 0:21:01.919
<v Speaker 3>one hundred and fifty thousand dollars over all. So not

0:21:02.000 --> 0:21:06.880
<v Speaker 3>only kidney transplants are better medically for patients, but they

0:21:06.920 --> 0:21:11.800
<v Speaker 3>are also economically better for for Medicare and for and

0:21:11.800 --> 0:21:16.639
<v Speaker 3>for tax payers. So we society should do everything we

0:21:16.680 --> 0:21:20.800
<v Speaker 3>can to increase the number of kidney transplants that can

0:21:20.840 --> 0:21:27.520
<v Speaker 3>take place. With society, we should sit down and think

0:21:27.560 --> 0:21:31.960
<v Speaker 3>about how to design a system that exploits the power

0:21:31.960 --> 0:21:38.360
<v Speaker 3>of incentives to obtain more donations and to perform more

0:21:38.400 --> 0:21:43.199
<v Speaker 3>transplants and save more lives by designing the system in

0:21:43.240 --> 0:21:47.640
<v Speaker 3>a way that is ethically acceptable. That debate has started

0:21:47.680 --> 0:21:51.760
<v Speaker 3>to happen, but more needs to be done.

0:21:52.080 --> 0:21:54.639
<v Speaker 2>Okay, well, thank you so much for joining us today.

0:21:54.680 --> 0:21:58.520
<v Speaker 2>I really enjoyed this conversation and I really appreciate your time.

0:21:59.080 --> 0:22:01.199
<v Speaker 3>Thank you, it was a great talking with you.

0:22:03.920 --> 0:22:07.040
<v Speaker 2>As for Sally, she's doing well. She knows she will

0:22:07.119 --> 0:22:10.280
<v Speaker 2>likely need another kidney at some point, but for now

0:22:10.320 --> 0:22:14.760
<v Speaker 2>she's advocating for a system of donation incentives, a system

0:22:14.840 --> 0:22:17.520
<v Speaker 2>that she thinks will not only help her, but thousands

0:22:17.560 --> 0:22:19.000
<v Speaker 2>of others in need of an organ.

0:22:19.960 --> 0:22:25.800
<v Speaker 1>The one person who takes the risk, meaning an operation,

0:22:26.280 --> 0:22:29.360
<v Speaker 1>who gives a thing of value, the kidney, they're the

0:22:29.440 --> 0:22:33.359
<v Speaker 1>one person who doesn't get paid. And the entire edifice

0:22:33.520 --> 0:22:37.160
<v Speaker 1>of organ transplantation. You know, the hospital gets paid as

0:22:37.160 --> 0:22:39.639
<v Speaker 1>it should, the surgeons get paid, the nurses, the O

0:22:39.880 --> 0:22:43.119
<v Speaker 1>R rental, it's all paid. Money makes this happen. But

0:22:43.200 --> 0:22:46.240
<v Speaker 1>the only person who gets nothing is the person who

0:22:46.320 --> 0:22:51.120
<v Speaker 1>takes the risk and provides the organ. And you know,

0:22:51.160 --> 0:22:54.400
<v Speaker 1>why shouldn't they, especially if this will save could save

0:22:54.480 --> 0:22:55.520
<v Speaker 1>thousands of lives.

0:22:57.520 --> 0:23:00.600
<v Speaker 2>Next time on playing God And.

0:23:00.640 --> 0:23:04.280
<v Speaker 1>I just remember laying there and watching the lights above

0:23:04.359 --> 0:23:07.280
<v Speaker 1>me as we're walking down the hallway, and the first

0:23:07.280 --> 0:23:08.080
<v Speaker 1>thing I said.

0:23:07.960 --> 0:23:09.360
<v Speaker 2>Was do I have a uterus?

0:23:09.560 --> 0:23:11.800
<v Speaker 1>And the nurse who was pushing me look down and

0:23:12.240 --> 0:23:14.520
<v Speaker 1>they smiled and they're like, you have a uterus?

0:23:15.400 --> 0:23:18.800
<v Speaker 2>In twenty thirteen, the first uterus transplant to result in

0:23:18.840 --> 0:23:23.000
<v Speaker 2>a live baby being born took place in Sweden. Uterus

0:23:23.080 --> 0:23:27.000
<v Speaker 2>transplants can offer a life changing opportunity to individuals with

0:23:27.080 --> 0:23:30.879
<v Speaker 2>certain types of infertility, but when is it ethical to

0:23:30.960 --> 0:23:34.960
<v Speaker 2>transplant non life saving organs and what are the additional

0:23:35.000 --> 0:23:41.200
<v Speaker 2>ethical issues when a transplant becomes a reproductive technology. Many

0:23:41.200 --> 0:23:44.000
<v Speaker 2>thanks to our guests in this episode, Sally Settel and

0:23:44.080 --> 0:23:49.320
<v Speaker 2>Mario Mutchus. Playing God is a co production of Pushkin

0:23:49.400 --> 0:23:54.840
<v Speaker 2>Industries and the Johns Hopkins Berman Institute of Bioethics. Emily

0:23:54.920 --> 0:23:58.800
<v Speaker 2>Vaughan is our lead producer. This episode was also produced

0:23:58.840 --> 0:24:02.720
<v Speaker 2>by Sophie Crane and Lucy Sullivan. Our editors are Karen

0:24:02.800 --> 0:24:07.440
<v Speaker 2>Chakerjee and Kate Parkinson Morgan. Theme music and mixing by

0:24:07.480 --> 0:24:13.000
<v Speaker 2>Echo Mountain Engineering support from Sarah Bruguerre and Amanda Kaiwang.

0:24:14.080 --> 0:24:18.080
<v Speaker 2>Show art by Sean Krney, fact checking by David jar

0:24:18.400 --> 0:24:23.560
<v Speaker 2>and Arthur Gompertz. Our executive producer is Justine Lang at

0:24:23.640 --> 0:24:27.600
<v Speaker 2>the Johns Hopkins Berman Institute of Bioethics. Our executive producers

0:24:27.680 --> 0:24:31.639
<v Speaker 2>are Jeffrey Kahan and Anna Mastriani. Working with a Melia Hood.

0:24:32.200 --> 0:24:36.960
<v Speaker 2>Funding provided by the Greenwall Foundation. I'm Laurena Rura Hutchinson.

0:24:37.080 --> 0:24:48.119
<v Speaker 2>Come back next week for more Playing God. Generous support

0:24:48.200 --> 0:24:51.920
<v Speaker 2>for Playing God is provided by the Greenwall Foundation, making

0:24:51.960 --> 0:24:56.520
<v Speaker 2>bioethics integral to healthcare policy and research. Learn Moore at

0:24:56.560 --> 0:24:57.640
<v Speaker 2>Greenwall dot org