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Appropriate Explanatory Strategies

1

According to the National Kidney Foundation (NKF), more than 120,000 people are on the U.S. transplant waiting list, with “nearly 3,000 new patients” joining the list every month and an estimated 12 patients dying every day while waiting for a kidney (“Organ Donation”). The NKF, the nation’s foremost nonprofit advocacy group for kidney disease patients, bemoans the worsening kidney shortage and “advocates for ways to increase the supply of organs for transplantation” (“Policy”). However, the NKF Web site also claims responsibility for the current U.S. transplant policy that outlaws financial compensation for organ donors—a ban seen by many as the major obstacle to reducing the kidney shortage.

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2

In fact, the NKF claims it played a central leadership role not only in drafting the National Organ Transplant Act (NOTA) but also in getting the law passed through its impressive lobbying power (“History”). The key passage of NOTA prohibiting compensation states that “it shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation” (Sec. 301a). Although the law has been modified to permit kidney exchanges and remove several disincentives to donation (Gomez), the “valuable consideration” clause has been defended by the NKF. At the same time, it has been criticized by proponents of alternative solutions to the kidney shortage.

3

One of the most vocal critics of NOTA’s prohibition against compensating donors, and of the NKF’s advocacy in particular, is Sally Satel, M.D. A prolific author, Satel has written extensively about transplant policy for distinguished venues such as The New York Times, The Washington Post, and The Wall Street Journal. She edited the book When Altruism Isn’t Enough: The Case for Compensating Organ Donors. She is also a lecturer in psychiatry at the Yale University Medical School and a resident scholar at the American Enterprise Institute, a conservative think tank “committed to expanding liberty, increasing individual opportunity and strengthening free enterprise (“About”).” And she is a kidney transplant recipient. In a 2009 op-ed, Satel gave vent to her disappointment in the NKF, accusing the group of trying “to sabotage any attempt to explore the possibility of rewarding organ donors,” and even misrepresenting a study of donor motivation (“National”).

4

This essay compares the underlying values driving the arguments in the NKF position statement “Financial Incentives for Organ Donation” and Satel’s article “When Altruism Isn’t Moral.” Their views are diametrically opposed. Whereas the NKF defends the status quo and urges retention of the valuable consideration clause, Satel deplores the “woeful inadequacy of our nation’s transplant policy” and proposes “rewards” to “encourage more living and posthumous donation” (pars. 5, 6). The basis of their disagreement is the proper role of altruism. The NKF emphatically endorses the current “altruistic system” (par. 5). Satel, in contrast, argues that current policy is failing precisely because it is an “altruism-only system” (par. 13).

5

Altruism, according to Satel, is “the guiding narrative of the transplant establishment,” its underlying ideology or value system (par 5.). The NKF would agree with Satel’s description of current policy requiring that “organs should be a ‘gift of life’” and donating should be “an act of selfless generosity” (Satel, par. 5). In using the phrase, “altruistic gift of life,” the NKF statement makes explicit the connection between the act of giving and what is being given (par. 2). If the act of giving is tainted, for example by self-interest rather than selflessness, then the gift itself becomes unacceptable. That is why, in the anecdote that Satel uses to begin her article, the transplant surgeons need to be convinced that Matt Thompson, the potential donor, “was donating his kidney for the right reasons” — namely, for purely altruistic reasons (pars. 1-2).

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6

Satel’s disagreement with the NKF is essentially about morality. Or rather, it is about what she sees as the NKF’s moral absolutism in what she assumes is “a morally pluralistic society” (par. 21). The NKF statement represents a worldview in which there are certain moral truths about which it is assumed everyone agrees. Examples of moral certainty in the NKF policy statement include the claims that “payment for organs is wrong” and “inconsistent with our values as a society” (pars. 6, 2).

7

We can see the NKF’s and Satel’s opposing views of morality played out in their arguments about the commodification of human organs. The NKF statement explains what is wrong with treating the human body as a commodity: “Any attempt to assign a monetary value to the human body, or body parts, either arbitrarily, or through market forces, diminishes human dignity” (par. 2). This argument is based on the belief that the human body is not something to be treated as “property” to be bought and sold (par. 2). Rather, it is sacred, made in God’s image.

8

Satel refutes the commodification argument in a number of ways. For example, she points out that commodifying body parts has a long legal tradition from Hammurabi to current personal injury law (par. 19). She also questions the cause-effect reasoning that commodifying body parts is necessarily dehumanizing: “There is little reason to believe—nor tangible evidence to suggest—that these practices depreciate human worth or undermine human dignity in any way” (par. 19). But her main argument is about how we evaluate “the goodness of an act” (par. 18), in other words, our moral reasoning.

9

Satel critiques the NKF’s way of assessing moral value by arguing that its moral logic relies on “false choice” reasoning. She summarizes NKF’s thinking this way: “Giving a kidney ‘for free’ is noble but accepting compensation is illegitimate” (par. 11). This distinction between altruistic gift giving and receiving a reward hinges on the idea that inserting a reward into the exchange commercializes it and damages the act’s moral purity. Satel quotes Kieran Healy, a professor at Duke University studying economic sociology, to describe the either/or dilemma that framing the debate around altruism creates: “the debate is cast as one in which existing relations of selfless, altruistic exchange are threatened with replacement by market-based, for-profit alternatives” (par. 11).

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10

In other words, Satel thinks the NKF sets up a false choice between selflessness and self-interest. In contrast to the NKF, Satel believes that mixed motives probably drive most gift giving. For example, she suggests several self-interested motives that may be involved in giving the “gift of life” — such as offering “an organ as an act of redemption,” “a way to elicit praise and social acceptance,” or “a way to avoid the shame and guilt of allowing a relative to suffer needlessly and perhaps even die” (par. 13).

11

Purity of motivation plays a key role for the NKF in evaluating “the goodness of an act.” But for Satel, what appears to matter most is that the act has the potential to save a human life. For her, it doesn’t matter if the donor gains materially, earns enhanced social status, or just gets a “‘warm glow’” of self-satisfaction “from performing acts of charity” (par. 16). Instead of “remuneration” crowding out “generosity” (par. 15), as critics of financial compensation like the National Kidney Foundation claim, Satel argues that the opposite is true: the combination of payment with the opportunity to do good could offer a real solution to “increase the pool of transplantable organs” (par. 18).

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Works Cited

“About.” American Enterprise Institute, 2015, www.aei.org/about/.

Gomez, Maya. “Possible Solution to the Kidney Shortage?” Paper, Writing 1101, Huntly College, 2015.

“Financial Incentives for Organ Donation.” National Kidney Foundation, 1 Feb. 2003, www.kidney.org/news/newsroom/positionpaper03.

“History.” National Kidney Foundation, www.kidney.org/about/history. Accessed 30 Apr. 2015.

“Organ Donation and Transplantation Statistics.” National Kidney Foundation, 8 Sept. 2014, www.kidney.org/news/newsroom/factsheets/Organ-Donation-and-Transplantation-Stats.

“Policy and Legislation.” National Kidney Foundation, 2015, www.kidney.org/advocacy/issues.

Satel, Sally. “The National Kidney Foundation’s Bizarre Logic.” American Enterprise Institute, 11 June 2009, www.aei.org/publication/the-national-kidney-foundations-bizarre-logic/.

---. “When Altruism Isn’t Moral.” American Enterprise Institute, 30 Jan. 2009, www.aei.org/publication/when-altruism-isnt-moral/.

United States, Congress, House. National Organ Transplant Act. Government Printing Office, 19 Oct. 1984. 98th Congress, House Report 98-1127.