The power of the selfless gift

September 21, 2006|By Michael Bourne

NEW YORK -- Five years ago, I received a phone call that changed my life. That day, I was quietly working in my home office in Alexandria, Va., when my mother called to tell me that my uncle, Richard W. Bourne, a Baltimore law professor, was in danger of dying of kidney failure.

Another relative had been scheduled to donate his kidney to save my uncle's life, but at the last minute - literally as they were prepping him for surgery - this relative had backed out, and now my uncle was once again on the list to receive a cadaver kidney that would almost certainly come too late to save him.

"Well," I said, "why don't I do it?"

I'm still not sure why I said this, except that it seemed the right thing to do. I had two functional kidneys; my uncle had none; and we could both make do with one. By what moral calculus could I put my fear of hospitals and surgery ahead of his life?

Shortly before Christmas, surgeons at the University of Maryland Medical Center in Baltimore removed my left kidney and placed it inside my uncle's body, where it remains today, efficiently filtering his urine. Technically, the operation went off without a hitch - but let me tell you, it was no fun.

Unfortunately, I had postoperative complications, as kidney donors often do. I was never in serious danger, but my wife spent three nights sleeping in a chair next to my bed, certain I was near death. I was certain I was near death. I've never felt so awful in my entire life.

Recently, economists and patients' advocates have begun arguing that organ donors like me should be paid for our sacrifice. In the "Freakonomics" column in the July 9 New York Times Magazine, to take one recent example, Stephen J. Dubner and Steven D. Levitt observe that everyone involved in a transplant operation benefits except the poor donor, who is wheeled out of the operating room minus a vital organ.

Mr. Dubner and Mr. Levitt, citing other economists, argue that paying donors a fee would encourage more people to donate organs, saving untold lives while at the same time providing a potential revenue stream for poor people with an overabundance of organs and an underabundance of cash.

I'm going to leave this last point alone. Even Mr. Dubner and Mr. Levitt concede that no matter how much economic sense it might make, most Americans regard paying people for their organs as repugnant. And most Americans are right. It is repugnant - and wrong.

But what economists like Mr. Dubner and Mr. Levitt fail to grasp - what I, myself didn't understand until I became a kidney donor - is the power of a purely altruistic act. No one is more powerful than a man who is giving away something of value and asking nothing in return. When that person is risking his life, this power is infinitely more valuable than mere cash.

To see why this matters, and why we should not experiment with so-called "market-based solutions" to organ shortages, you have to understand what a big business transplants have become.

Surgeons performed more than 16,000 kidney transplant operations in the U.S. last year. These are quick, relatively simple procedures that, because they nearly always save a life, earn vast sums for those who do them. Paying donors for their organs would increase these profits, because it would remove one of the single largest expenses transplant specialists face: making sure the donor doesn't back out.

After all, I became a kidney donor only because my uncle's first choice balked. Just imagine how costly this was. Doctors had put this man through an expensive battery of tests, sent him to a psychologist, prepped two operating theaters - and then had to turn out the lights and go home. They had no choice. The would-be donor was the only person in the room not getting paid. When he said no, they had to say, OK.

This is what I learned on the way to the operating room: Kidney donation reverses the power dynamic between doctor and patient. Usually, when I go to the doctor, I need her far more than she needs me. So she makes me wait forever to see her. She's brusque and mumbles her explanations. But as an organ donor, I didn't need the doctors at all. I was perfectly healthy. The doctors, on the other hand, needed me - desperately. Without me, there would be no operation.

So they listened. They made sure I understood everything, and when I didn't, they explained it again, more slowly. They knew that if I didn't feel safe, if they spooked me in any way, I could walk away and no one would get paid.

If I had been compensated, the power balance would have been restored in the doctor's favor. I would have been, in effect, just another well-paid hospital employee. Yes, I still could have said no, but then I would be turning down money I had already sunk into my mortgage - or, if I were poor, money I had already spent on back rent or my grocery bill.

I am fiercely proud of what I did back in 2001, and if I had it to do all over again, I would.

If you are considering donating an organ to a friend or loved one, by all means do it.

But don't let them give you a dime.

Michael Bourne teaches in the English department at Fordham University's Lincoln Center campus in New York. His e-mail is michael.bourne@earthlink.net.

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