ReligionDispatches.org

I’ve been writing a lot about false common ground these days so it was a pleasure to discover that Michael Novak and I have come to a common way of conceptualizing government benefits for living kidney donors.

Novak, in my book, is a conservative, free market philosopher and cultural thinker. He is a scholar at the American Enterprise Institute, has traveled world wide making the Catholic case for capitalism. Along with George Weigel and the late Richard John Neuhaus he spent the last decade educating young Eastern European Catholics at a Polish summer school in how to be effective Catholic capitalists. He once supported contraception and thought Humanae Vitae [1968 encyclical reaffirming the Roman Catholic view on birth control, abortion, and other "life" issues] was wrong. Now he is against contraception and of course abortion and embryonic stem cell research. He went to the Vatican in 2003 to try to convince the Pope that the war in Iraq was “just.” Not much we agree on.

But Novak, like many of us, can be influenced by the suffering of friends. In an interesting piece published in First Things online on April 1, Novak comes out in support of a bill that will reshape our thinking about organ donation and hopefully cut through some rather stale arguments that pit a concept of pure altruism against regulated markets in organs. He calls the bill, which is to be introduced by Senator Specter in the near future as a “major step forward for the ‘culture of life’.”

I strongly agree and have worked with Senator Specter’s office on developing the bill over the last year. What’s the problem? People are dying because there are not enough organs: hearts, livers, lungs, kidneys donated to meet the need. In all of the above, except kidneys, we are dependent on donations from deceased people. You know, those of us who have that organ donor heart on our driver’s license which says “If I die in a way that permits my organs to be used, please take them.” The greatest need is for kidneys—and the kidney is the organ that each of us have, in essence, a spare, we could give away while we are alive.

According to the National Kidney Foundation, there are 485,000 Americans with end-stage renal disease, that point at which there are three choices: death, dialysis or transplant. More than 341,000 are on dialysis; 140,000 have functioning transplants. About 87,000 people die each year from end-stage renal disease, some on the waiting list, others who could benefit from a transplant but never get on the list.

In 2007 there were only 16,629 kidney transplants; 10,588 were from organs donated by 7,241 deceased people and 6,041 from living donors. In spite of all the heart-rending stories about the lady from Dunkin’ Donuts who gave her kidney to a customer and the millions of dollars the federal government has given to nonprofits charged with organ procurement to educate the public about the social good and medical ease of donating organs, the number of kidneys donated has risen only modestly over the last decade. In 2007 the number donated was the lowest since 2000.

I know a lot about this because about a year and half ago, my own kidneys weakened to the point that my doctors advised me to start looking for a living donor so I could have a transplant during a narrow window of weakness just before the kidneys failed. This is the time when one has the best prospect of a very successful transplant.

Now, thinking about sharing your body with another human being can be a pretty spiritual thing. For some of my friends who are more down to earth, their bodies are a little bit like cars and they see transplant as a simple replacement of a part that has worn out—the carburetor for example. I see it a little bit like communion or sharing in the mystical body of Christ. Following transplant, I will have within a small part of someone else's body and there will be a daily reminder of our co-corporeality as my body will try to reject that kidney and I will take drugs every day to prevent that. It reminds me of sex (without the rejection part).

It’s a little like pregnancy where women regularly share their bodies with another life and, in fact, risk their lives every time they become pregnant. We have become inured to this risk of life that is part of every pregnancy and think perhaps because pregnancy is so common and perhaps because it is only women who take that risk that it is normal and routine. We are not blown away by women’s generosity in becoming pregnant. And, we have even come to see the donation of sperm and eggs to others as normal. A lot of us are accepting of the buying and selling of sperm and eggs. Just read newspapers in Ivy League college cities for the ads seeking high quality eggs.

But organs, well, that’s a different matter. Dueling doctors have been fighting about how to solve the organ shortage for the past ten years. One group insists that we are only going to solve the shortage by initiating a regulated market of financial incentives for donors, similar to the incentives we now permit for egg and sperm donors; similar perhaps to the incentives we give to those who enlist in the military or participate in risky drug trials. These advocates concentrate on autonomy as the principle that should guide policy on organ procurement. They believe that the current system of careful criteria for who can become a donor which weeds out those for whom organ donation is a high medical risk or who are psychologically unprepared or being emotionally blackmailed can ensure that financial incentives would not result in coercion or abuse. And they note that if we can solve the organ shortage here in the US, we would remove the desperate spectacle of transplant tourism where people who cannot get transplants here go overseas to India, Pakistan, the Philippines and exploit unhealthy desperately poor people into selling their kidneys for a couple thousand dollars.

Another group of professionals in the transplant field believe that we should retain the current paradigm for donation which holds that donors should only give out of pure altruism. No donor, they say should be better off as a result of donating an organ. They should, to the extent possible, not be worse off, but they definitely should not be better off. The “yuck” factor tells them that if people received financial incentives they would lose human dignity. They hold certain values around gift giving and believe that human dignity would be violated if we were compensated for giving an organ. For the most part, this group does not believe we own our bodies.

I watched the tennis match between these two camps over the last year. The dialogue was stale; each side repeated arguments they had been making for ten years and neither really answered the arguments of the other. The result has been stasis. Policy on organ procurement is stuck in a 1984 law called the National Organ Transplant Act which is interpreted to preclude any benefit to donors that would make them better off than they were before the transplant. (It seems to me no donor could be better off no matter what you give them, since they are now short a kidney. And while transplants are very safe and one can live just as well with one kidney as two; there are risks).

Here is where Novak’s thinking and mine converged. We went to another virtue: generosity. Neither altruism nor autonomy need be the central value policy makers adhere to in regulating donation. In keeping with the mutuality physically present in transplant, the giving of a part of one’s body to another and the receiving and caring for that part of the other by the recipient, we need to find ways to return the generosity of the donor.

For me, there was a real example of this in the offers I received from friends. Many friends offered me a kidney. They were almost all people like me - relatively well off, healthy, with good health insurance, jobs that would gladly give them time off for tests, surgery and recovery and kind. They included a woman Episcopal priest, a Roman Catholic nun, a couple progressive theologians, lawyers, an abortion doctor, community organizers. They expected nothing in return. One day I got a phone call from a colleague in Latin America. The women I worked with wanted to help. They thought this could be a marvelous opportunity for north south sharing. They would find a woman in the movement who would like to give me a kidney: a healthy, intelligent well informed person working for women’s rights. In turn, I have something that could help that woman: money. My resources which I already spend to a considerable extent in supporting women’s rights could go to that woman to help her do the work she is doing. I thought: “is this not more ethical than taking a kidney from someone where really only I benefit? I want to give back.” I want to extend the body connection I have with my donor to participate in their life in a meaningful, non-intrusive way. I don’t want to buy a kidney but I do want to give a gift to my donor.

This is what the bill that Michael Novak and I both support will do on a governmental rather than individual level. Called the Organ Trafficking Prohibition Act of 2009 the bill increases the penalties for and blocks potential abuses in national and international trafficking and allows individual state governments (and prohibit individuals from) to offer donors gratuitous benefits that will return their generosity and, yes, make them better off, than they were before they donated. Most frequently mentioned benefits would include life long health and disability insurance, educational benefits, a tax deduction or a contribution to a charity of their choice.

Novak emphasizes that so long as measures are in place to protect the health of donors and to protect against handing immediate cash to the desperate who might donate in spite of a strong desire not to, such a policy would meet the moral standards set forward by the past two Popes who have each commented on the need to increase organ donation.

It seems to me that a policy that treats donors as generously as they treat the person to whom they give the gift of life is totally consistent with the values of all religions. What do you think?

Tags: catholic church, catholics, conservative, culture of life, humanae vitae, organ donation, progressive