By CORY FRANKLIN M.D

   There is only one problem—the story is not completely an urban myth. 

   The U.N. World Health Organization calls shortage of organs “a universal problem.” There is a high demand and small supply of kidneys which can be taken from a living donor. Credible reports indicate a thriving, worldwide black market.

   Recently, a major South African hospital chain and its chief executive were charged with human organ trafficking in an ongoing scheme that stretched from South America to the Middle East since 2003. India, in particular, has been a source for organs with stories of poor laborers being duped or forced into giving up kidneys, which were then transplanted into wealthy people who travel to India from around the world for the operations.     

   While nothing remotely like this has happened in the United States, or at least reported publicly, this organ black market is an ominous development. The sale of an organ is currently illegal in the United States with bioethics groups, transplant organizations and the Vatican all inveighing against putting an actual price on a kidney. Citing the host of abuses, they envision the exploitation of the poor who might opt for quick cash, recipients reneging on payment agreements, shoddy postoperative care for poor donors, and a black market in organs—the ultimate urban myth transformed into reality.

   But there are nearly 75,000 domestic patients with renal failure waiting for kidneys. Each year several thousand die before receiving one. Consequently, there is a growing movement in the United States to commodify organs—expand the pool of available organs by offering compensation to potential kidney donors (a person can live with one healthy kidney). Supporters have proposed legal changes including a regulated free market in organs—an “incentive system” that might save the lives of some of those who currently die awaiting donor organs. The claim is a well-regulated Federal incentive system would actually prevent a black market of exploited donors. One Nobel Prize-winning economist has even calculated a price he says would eliminate the current waiting list.

   Without putting a price on a kidney, the organ donation system needs streamlining. Simply relying on altruism fails to provide for the number of kidneys needed to eliminate long and sometimes fatal waiting times. The Federal government should provide new incentives such as tax credits and the assumption of some long-term health care costs for those willing to donate a kidney. A radical idea worth discussing -once they have given their gift, perhaps kidney donors should never have to pay either income tax or their future health care bills. Such a plan would not necessarily mean lost revenue for the government since thousands currently disabled by renal failure would then be able to return to work.

   But absolute faith in the free market corrupts absolutely. When kidneys or other organs become simply another commodity, there will be no shortage of those willing to exploit others. Black market organ trafficking demonstrates something Sylvester Stallone once said, “If you think people are inherently good, get rid of the police for 24 hours and see what happens.” That’s why, in addition to providing added organ donation incentives, the Federal government should reinforce its vigilance against the unauthorized procurement and sale of organs.

   The problem of encouraging organ donation illustrates an eternal medical dilemma —the conflicting role money plays in healthcare. The quest for profit drives research and technology that provide immeasurable benefit to American patients. But even in medicine, the naked edge of the free market invites exploitation, fraud, and crime. International trafficking in transplantable organs is the worst conceivable black market. And that’s no urban myth.