White Collar Reset: Kidney for sale?

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In my last installment, I entertained the notion of opening a medical marijuana store in the New York City suburb my wife and I call home. This week, while we wait for the New Jersey legislature to finalize the legality of that option and as I begin year two in what is now semi-officially the direst U.S. job market since the Great Depression, I'd like to move on to the next previously taboo plan for recapitalizing our household.

I'm considering selling one of my kidneys.
Now, before you say, "Oh, come on, that's absurd!" and immediately skip to the next story about housing starts or crude prices, hear me out for a few seconds. I, too, had my doubts and recognized the potential for a jump-the-shark moment. But that was before I spoke to Dr. Sally Satel, M.D., a resident scholar at the American Enterprise Institute in Washington, D.C., and author of the book When Altruism Isn't Enough: The Case for Compensating Kidney Donors.

Legislation to Legalize Compensation for Organ Donors

Satel, who received a donated kidney from a friend in 2006, has become a passionate and highly sensible advocate for reforming the nation's organ donor system (despite occupying an office down the hall from Newt Gingrich and Lynne Cheney). She consulted on a draft bill sponsored by Pennsylvania Senator Arlen Specter that would be a groundbreaking first step toward decriminalizing the compensation of kidney donors. (Did I forget to mention my plan is a felony punishable by up to five years in prison?)

The bill, co-sponsored by fellow Pennsylvania Senator Bob Casey and Iowa's Tom Harkin, would allow the government to offer kidney donors a variety of in-kind benefits, such as free health and life insurance policies, a tax credit, or a generous contribution to a charity of their choice. Other proposals have suggested allowing for contributions to a donor's 401(k) plan. "Opponents are concerned about the appropriateness of paying cash for organs. I don't necessarily agree," Satel said, "but we do think our proposal addresses those concerns and will help reduce the organ shortage in this country, which is my main concern, without exploiting anyone."

While the two statistics admittedly most on my mind when I called Satel were 17.5 and 892 (that's the percentage of underemployed workers in last Friday's job report and dollars in my checking account, respectively), the number always front and center for her is 13. That's the average number of people who die every day in this country awaiting a kidney transplant. Despite decades of work encouraging people to sign donor cards and donate to loved ones, the number of kidney donors last year was less than it was in 2005. Clearly, the current system of appealing exclusively to people's better natures isn't working. What's interesting is how the economic downturn has suddenly created a whole new class of constituents for Satel's more free-market approach.

The biggest argument against organ sales has traditionally been the potential for coercion of the most disadvantaged members of society. "There's a sense that anyone willing to sell a kidney must be a really down-and-out person with no other options. In a lot of cases they've been people from Third World countries who are barely literate and don't really understand what they're getting into," Satel explained. "But when you're talking about white-collar people like you wanting to do this, educated people who've lost their jobs and have bills to pay but otherwise are going into it with their eyes open -- why shouldn't you be compensated? I liken it to surrogate mothers. We'd like to think their main motivation is to help a woman who can't have children have a child. But no one ever has a problem compensating the surrogate for her time and risk, and I don't see why kidney donors should be treated any differently."

Satel frequently receives emails from members of the public saying they agree with her position and suggesting they might be ready to act on it. "They'll say, 'I wish it were legal. I'd love to save someone's life. Plus, I have a mortgage to pay!'" It's impossible to know how many actually follow through on the idea, but recent events suggest the number could be higher than you might think.

Investigations Find Thriving Black Market for Kidneys

Over the summer, as part of a sweeping investigation that resulted in the arrest of five Orthodox Jewish rabbis and 44 public officials in New York and New Jersey on corruption and money-laundering charges, Levi Ishak Rosenbaum of Brooklyn was charged with conspiring to broker the sale of a human kidney for transplant for $160,000. According to the complaint, Rosenbaum claimed he had brokered such sales numerous times, although most of his sellers appeared to be from Israel.

In September, The Sunday Times of London ran an article titled "Cash-Strapped Sell Their Kidneys To Pay Off Debts," in which Times reporters went undercover to unearth five interested kidney sellers. They included a 26-year-old mental health nurse who said he needed to dig out from the hole created when a business he started went bankrupt, and a 43-year-old taxi driver who wanted to pay down his mortgage and redo his kitchen. Several times over the past year, ads have also briefly appeared on Craigslist offering "Kidney for sale." (Currently, the only kidney-related items advertised on the site are kidney-shaped tables, starting at $25.)

Satel believes, however, that most sales on the white-collar kidney black market are probably consummated without brokers or online ads. "I'm just basing it on what I would have done," she said. As it was, her donor, The Atlantic writer and libertarian thought leader Virginia Postrel, relinquished her kidney out of the kindness of her heart. "But if she hadn't come along, I absolutely would have paid someone. Are you kidding? I would have paid $50,000. I would have paid $100,000. And if I still needed a kidney and you and I were having this conversation, I'd do the same for you." Satel explained that all we would have had to do is come up with a credible explanation for the staff at the national donor registry for why I was giving this stranger one of my vital organs. "We're intelligent people. We'd come up with something. We'd tell them we met at a writer's conference. Or you read an article of mine and wanted to help. And then I'd write you a check. Who's hurt? I get to go on living. And you get a little help through this terrible time and transitioning into the next phase of your life."

The more Satel talked, the less selling my kidney seemed like some bizarre, macabre act of depravity, and the more I wondered why the hell I hadn't thought of it before.

My risk of serious complication or death from the procedure, she said, would be about 2 in 10,000 (or roughly the same as my odds of finding a job right about now). A principle concern -- what happens if something ever goes wrong with the kidney I have left -- turns out to be an issue only .001% of the time. "And even then, donors immediately get priority placement on the transplant list," according to Satel.

As for the procedure itself, it's all performed laparoscopically, reducing recovery time and scarring. That said, I'd still probably need to spend two nights recuperating in the hospital -- "It is major surgery," Satel said -- and another 10 days at home. Fortunately, getting the time off from work shouldn't be too much of an issue.

"So you want me to find somebody to buy your kidney?" she asked.

She was kidding (I think). And, technically, just in case any FBI agents happen to be reading, so am I.

But I'd be lying if I said I didn't find Satel's offer extraordinarily compelling. I'll put it this way: A hundred thousand dollars would do a lot more to stabilize our finances than the other items (a Pottery Barn cabinet, a Thomas O'Brien leather club chair, a cowhide rug) currently under consideration for sale around our house. Although I've been bringing in more freelance and consulting work, the checks have been slow to trickle in, and, at any rate, it will likely take months before I figure out how to organize and focus my business to where it comes close to approaching my old salary. The other option up for discussion -- emptying my 401(k) -- now seems more irresponsible and injurious to my future than my new kidney plan.

If all this were happening two years ago, my mortgage company would be encouraging me to take out a second mortgage or tap my home-equity line. That's obviously no longer on the table, but is tapping the one truly valuable asset I have left really so much different?

As my mortgage broker used to say about the home-equity line: It's just sitting there. Why not use it?

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