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Comment by echelon | Hacker News Reader

Kidneys in the US are largely sourced from cadavers.

If we enticed poor people to sell their kidneys, some percentage of them would wind up needing kidneys again without an ability to pay for them.

This turns into a kidney marketplace where the rich win out over the poor.

FCFS with triage based on need, immunocompatibility, and health outcome is the most equitable model.

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Poor people need kidneys far more often than rich people.

Diabetes and uncontrolled high blood pressure are the top cause of kidney failure. These two conditions are far more common in the poor, and far more likely to be poorly managed.

Also if the price of a kidney relative to median income in the U.S. was similar to Iran, then a kidney would cost $15,000. This is expensive but still far cheaper than dialysis. And there is no reason an ACA plan or Medicaid wouldn't pay for it.

If the ACA or Medicaid will pay for kidneys for those who can't afford, what stops the price of kidneys from becoming equivalent to the price of dialysis should the kidney not be bought?

> FCFS with triage based on need, immunocompatibility, and health outcome is the most equitable model.

In theory. In practice rich people can jump ahead the line no matter what system. I.e. Steve Jobs and the liver that went to waste.

According to CNN, "it is unlikely that someone like Steve Jobs can 'cut the line' of the transplant waiting list. The reason that some people might be able to get transplants more quickly is that they're standing in more lines. Nothing prevents someone from being evaluated and listed at multiple transplant centers. As long as a patient has the wherewithal to fly around the country -- and be available at the drop of a hat if a liver becomes available (this is where the private jet comes in handy) -- a patient can, in theory, be evaluated by all the transplant centers in the country."

https://www.cnn.com/2009/HEALTH/06/24/liver.transplant.prior...

Yeah, that's why parent poster said "in practice". It's stupid that this is allowed.

If you legalize selling organs, less rich people will be able to afford them. I don't like the idea of merchandizing humans. It is worse than prostitution. Maybe worse than slavery, as humans become disposable.

The difference is we are talking about saving lives, not prurient interests.

> This turns into a [marketplace] where the rich win out over the poor.

Same could be said for gambling and sales tax.

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