January 27, 2007
The bookâ€™s major shortcoming is its failure to address the fastest growing source of organs: living donors. More than two-thirds of the people on the national waiting list â€” about 68,000 â€” need kidneys. There are nowhere near enough brain-dead accident victims to fill that demand, regardless of family beneficence or organizational efficiency. Fortunately, nobody has to die to supply a kidney. They can come from living donors, who can live perfectly normal lives with a single kidney and who now account for nearly 40 percent of all kidney transplants. With the kidney shortage at crisis proportions, the debate over financial incentives is really a debate over whether living adults should be allowed to sell their own organs or, at the least, receive a tax credit or some other indirect compensation.
Although he barely mentions living donors, Healyâ€™s sociological message resonates through that debate. Financial incentives would operate within complex organizational structures, as well as contract and liability law. Bureaucratic institutions, notably hospitals and insurers, would shape the environment in which transplants take place. Many kidney sellers would still have humanitarian motives. â€œThe idea that markets inevitably corrupt,â€ Healy writes, â€œis not tenable precisely because they are embedded within social relations, cultural categories and institutional routines.â€ Commerce isnâ€™t antithetical to culture; it is part of it.
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