How transparent markets can help transplant patients

I received a response to my last blog post about a young boy who offered to exchange his kidney for cash to pay his school fees.

This boy, the response said, was on the fringes of immoral action because instead of taking another job, such as washing clothes, and saving money, he chose to turn his body into a commodity.

By writing that blog post, I wanted to communicate the failure of public school funding and to demonstrate the absence of coherence in education. Instead it appears I exposed a youthful Kenyan to ridicule for apparently not valuing his life enough.

In this blog, I will therefore address the possibility of regulated markets in the sale of organs generally and for kidneys specifically.

I reviewed some data that estimates there are between one to four million Kenyans suffering from one form of kidney disease or another. The World Life Expectancy website collated data from World Health Organisation (WHO) that identified kidney disease as the 22nd distinct cause of deaths in Kenya in 2014.

Kenya was ranked 85th worldwide in terms of the share of its population that dies of kidney disease, which is responsible for about 3080 deaths or 1 per cent of all fatalities in 2014. These figures suggest that more than ten Kenyans die from a kidney disease every day.

The quest to save these lives cannot be in vain, but moral posturing about commodification of the human body does not help.

Bearing in mind that the country has a handful of renal specialists, and is still building capacity to treat kidney disease outside Kenyatta National Hospital, it is clear that Kenyans suffer greatly from this affliction.

In these circumstances, it is understandable even if not excusable, that a perceptive child notices an opportunity to alleviate his suffering by exchanging a working kidney for school fees.  

So while no minor should have to offer a kidney for sale, I am convinced that there is a good reason to consider regulated, transparent markets for kidney exchange in Kenya. It is understandable too that the posh and serious are concerned that the offer to exchange creates a market that would “cheapen” human life.

Economists understand that markets are a good mechanism for organizing activity in the face of scarcity. Transplant technology is available in Kenya and the medical literature shows that a kidney transplant while, not risk-free, can be done with a very high degree of safety under professional conditions.

What seems to matter most is the need to find a donor who proves a suitable match for the patient.  We must weigh the benefits of saving lives by providing direct cash incentives to adults willing to donate their kidneys without compulsion.

This is not only possible, but also desirable, given that clinical dialysis is expensive and not a long-term solution for kidney failure.

The ethical issues about how incentivise more healthy Kenyans to donate kidneys are real. A regulatory model that allows for some compensation would be repugnant to many healthy people but it does not mean that there is no place for sensible regulation that allows for incentivized donations to enlarge the pool of potential donors.  

These incentivised could be managed through legislation that would mandate a database of willing donors who would have the option to require compensation or forego reward in exchange for making a safe donation for a patient in need.

Any mechanism for matching kidney donors with patients may sound outlandish because it has not been tried, but the mere fact that we have newspaper adverts asking for donations with healthy people offering kidneys for sale implies that the existing mechanism is inefficient.

The adverts confirm there is overreliance on family donations, when the number of willing donors could be expanded. Economists who understand stable market designs have designed solutions to this matching problem, with variations on how to compensate donors while ensuring that no exploitation occurs.

The leading thinker in this area of market design is Alvin Roth, a winner of the Nobel Prize in Economics for 2014, who has designed exchanges that ameliorate the shortage of kidneys in the United States.

So we must hang our heads in shame that a 14 year old is so desperate for school that he offers his kidney for sale. However, it is not in any way immoral for a well-informed adult willing to save a life to offer a kidney in return for compensation.

Kwame Owino is the chief executive officer of the Institute of Economic Affairs (IEA-Kenya), a public policy think tank based in Nairobi. Twitter: @IEAKwame