What is a kidney worth?
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Another possibility: Signing up for Israel's national waiting list, which already has more than 500 people on it. But the wait time can be as long as four years for someone of Arie's age - those under 18 get priority - which means most go onto dialysis. For religious reasons, Israel's cadaver donation rate is relatively low, although its rate of donation among living relatives is above average. And anyway, organs from live donors are more effective than cadaveric ones.Skip to next paragraph
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So Arie and Mary, his wife of 36 years, feel they have no other alternative. They're left to consider paying a healthy stranger for a kidney. Mary has been an operating-room nurse for more than 25 years. She encourages Arie to find a living donor. "If you go for a transplant at the very end, after years of dialysis, your body is all worn out," she says. "If you do it before you get to dialysis, you have a much better chance of the surgery being successful."
Buying a kidney in Israel is against Health Ministry regulations, but there's no penalty associated with the rule - yet. As in many countries, the legal ground is soft. Going abroad for a kidney operation is perfectly legitimate, and in such cases questions are rarely asked about how the organ was obtained. Even under a new proposal that would punish brokers, recipients would not be prosecuted because they're victims of failing health and opportunistic organ brokers, says Meir Broder, legal adviser to the Health Ministry.
For Arie, who has spent a lifetime practicing law, the ethics of a kidney purchase are still complicated. He doesn't want, for instance, to exploit a poor person who's just trying to feed a family. Yet he's torn.
"Everyone is the boss of his own body, and if someone healthy wants to give away one of his own kidneys, I can't see why it shouldn't be done," he says. "There has to be informed consent."
Then there's the religious element. Arie and Mary aren't particularly devout, but they discuss the guidance Judaism offers. Arie finally concludes, "There really is nothing holy except for God and human life," and since "donating an organ is saving a life," it's entirely ethical.
Religious beliefs often figure in decisions about organ trading. They're invoked both to encourage and discourage it. The Old Testament story of Hagar bearing a child for Abraham (because his wife, Sarah, is "barren"), is often cited as the first case of surrogate motherhood. Some people use this scripture to justify paying someone to be a surrogate for an organ, says Dr. Scheper-Hughes of Organs Watch. Or as one Israeli doctor said to her, "God performed the first transplant" when he took a rib out of Adam and created Eve. In many Christian circles, too, there's the belief that "your body is a gift from God," says Scheper-Hughes, "or that you have use-rights over your body, but that it belongs to God."
Yet one reason Israelis rarely donate organs after death is that many Jews believe the body is sacred, and should be whole at the time of burial. Orthodox Jews believe that the deceased should be intact for the Resurrection they believe will follow the coming of the Messiah. But views are shifting.
"If someone needs to save his life and the only way to motivate someone to help him do that is by financial incentive, then I don't think they should prevent people from doing that in order to save lives," says Robert Berman, the founder of the New York-based Halachic Organ Donor Society, which has enlisted prominent rabbis to encourage donation.
"The fact is that people are dying and that there are not enough organs going around to save their lives," he says. "There's a widespread misperception that organ donation is categorically prohibited by Jewish law. It is not. Jewish law supports saving lives."
Meanwhile, after many conversations, Arie and Mary agree they're making the right choice. "This decision," says Mary, "completely changes the course of your life."
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