KEY POINTS:
There are about 24 million spare kidneys in Australia and New Zealand one for each man, woman and child. And a kidney given for financial gain works just as well as one donated benevolently.
That's why it is obscene that there are thousands of people who spend years on dialysis, waiting for a life-saving kidney that often never comes.
Netherlands-based TV programme Big Donor should be commended for highlighting the dispiriting plight endured by people with kidney failure. In the show, a terminally ill woman with the assistance of viewers was to select one of three candidates to receive one of her kidneys.
The show turned out to be cleverly crafted hoax, designed to draw attention to the shortage of donor kidneys. The donor was in fact an actress, not a terminally ill cancer sufferer.
Before being announced as a stunt, the show attracted worldwide international condemnation. Dutch legislator Joop Atsma blasted the show because it allowed the audience to play referee on what could be a matter of life and death.
But the programme should be praised for illustrating the highly questionable choices that we as a community condone regarding cardinal moral issues.
Doctors and hospitals make decisions regarding life and death daily. Life-saving body parts are in scarce supply, as are expensive drugs and some forms of medical treatment.
Who should live and who should die is the most fundamental moral issue. Decisions of this nature involve highly controversial judgments regarding the worth of human life.
The line that all human life is intrinsically important doesn't cut it when there is one life-saving kidney but 100 hundred needy patients. In such circumstances it is necessary to decide which life is most valuable.
Decisions of this nature are acutely difficult, but that is all the more reason that they must be made within a transparent framework, which engages the preferences and wisdom of the entire community, as opposed to the whims of well-intentioned yet sometimes ethically barren medicos.
When we are confronted with difficult ethical choices, in my view the morally correct decision is the one that will maximise net human flourishing, where each person's interests count equally.
In the donor situation, this means preferring the potential recipient who needs it most - who is closest to death - and who on the basis of age and talent is likely to contribute most to the community. Many people will disagree with this framework. We need wide-ranging community debate on the issue.
The Big Donor show highlighted the incalculable and unnecessary suffering that our medical system inflicts on sick patients.
The average waiting time for a kidney transplant in Australia and New Zealand is about four years. About one patient a week dies waiting for a kidney.
The reason that so many people are undergoing dialysis and dying from kidney failure is simply because people lack the incentive to give up their spare kidney.
There is a ready solution: money. The current ban on being paid for kidney donations is misguided and indecently paternalistic.
Governments should set a minimum price that will be paid by the health system for a kidney. This should reflect the pain and suffering involved in donating the organ and the increased risk to the donor's future health.
Once a threshold of say $50,000 is set, hospitals should be able to buy kidneys at sums above this amount. The price should increase until an equilibrium emerges between the demand and supply of kidneys.
But won't this lead to the exploitation of the poor who will be coerced into selling their kidneys? No.
While there is no doubt that the poor will disproportionately sell their kidneys, this no more amounts to exploitation than the fact that it is the same people who spend their lives selling their labour cheap to the wealthy in the form of cleaning toilets and working in brothels.
While some kidney donors might blow the $50,000-plus, many would use it wisely as a springboard for financial security -as a home deposit, for example.
Poor people are financially challenged. But they are not dumb. They are capable of making informed, self-regarding, autonomous choices.
Our bodies are no less an asset than our time and resourcefulness. In fact this is the one asset that is possessed equally by the rich and the poor. There is no principled basis for not allowing the poor to recoup this asset.
The fallacy of the argument that benevolence should be the only motivation driving organ transplants is highlighted by the fact that surgeons and hospital make thousands of dollars transplanting organs, as do drug firms who provide follow up medication.
The only person who misses out on the cash is the one who gave the most - the donor. Rarely is paternalism so vulgar.
Of course, some kidney donors down the track will themselves require a kidney transplant if their only kidney fails. But this won't be a problem because under the proposed scheme there will always be a ready supply of donors.
Critics will object that this proposal will lead us down the slippery slope of suicidal people wanting to sell hearts and other non-spare parts organs. They are wrong. A clear distinction can be made between essential and non-essential organs and body parts such as kidneys and bone marrow.
Lawmakers need to take of heed of this - it is a matter of life and death.
* Lawyer Dr Mirko Bagaric is the author of Being Happy: How to Live and Dealing with Moral Dilemmas.
