Friday, May 20, 2011

The kidney divorce

The disheartening case of a New York surgeon who wants the kidney he gave his soon-to-be-ex-wife -- or $1.5 million (US) in compensation -- returned to him has the caught the eye of medical ethicists.

Not the least because his demands seem to put a monetary value on human parts. Dr. Richard Batista says the $1.5 million reflects in part the value of the kidney he donated to Dawnell Batista in 2001, and he should be compensated for it.

Bioethics professor Steven Miles at the University of Minnesota, where the transplant in question took place, told his local paper that the case goes against very notion of organ donation.

"The entire language of organ donation in the United States is very clear. The word donation means strictly a gifting relationship and certainly everyone understands it is irreversible. ... In no way can she purchase it from him or is it direct property of the marriage. We don't share organs to create a business partnership."

Ethicists agree that the question of whether Batista can get his kidney back is a non-starter, and have moved on to the question of whether the case puts a price on something that is illegal to sell in the U.S. -- or Canada, for that matter.

Batista's lawyer Dominic Barbara says the $1.5 million reflects how much money Batista's wife made as a result of being able to continue working and not having to go on dialysis. "A price can't be placed on a human organ but it does have value," Barbara said.

Robert Veatch, a medical ethicist at Georgetown University's Kennedy Institute of Ethics, disagrees.

"It's illegal for an organ to be exchanged for anything of value. When you give something, you can't get it back. It's her kidney now and . . . taking the kidney out would mean she would have to go on dialysis or it would kill her."

Writing in, national correspondent William Saletan questions whether compensation can't be demanded, at least in this case, without commodifying a vital organ.

"Batista can't take his kidney back, but that's not what he's after. He wants his ex-wife to let him visit their kids, on pain of compensating him for what he gave her. And what he gave her, according to his attorney, wasn't just an organ but a livelihood. According to Newsday, the attorney says the $1.5 million demand 'reflects damages, including how much money she made as a result of being able to continue working and not having to go on dialysis.' So the dollar figure isn't based on the price of an organ (which would be considerably cheaper, based on the going rate of kidneys abroad); it's based on the income one spouse accrued thanks to the other's sacrifice. And sacrifices between spouses are treated differently, under the law, from sacrifices between strangers or friends. There's a tradition and expectation of common benefit. You and your spouse become one flesh—in this case, literally."

As Saletan points out, kidneys are being sold abroad, fairly cheaply, and more jurisdictions such as Singapore looking into getting into the business.

Based on how Batista is valuing his kidney, however, could we see a sliding scale for buying kidneys, based on how much the life saved is deemed to be worth?

And who decides?


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