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Advertising for a Kidney

Perhaps it was because I had just heard a lecture by the French economist, Thomas Piketty, author of the best-selling book on income inequality, Capital in the Twenty-first Century which documents the obscene widening of the income and wealth gap in the United States.  Whatever it was, the advertisement that caught my eye that night in the just arrived November/December issue of the Yale Alumni Magazine provoked deep discomfort. 

At first glance the full page ad looked like the beginning of a typical feature story on a Yale alumnus – “Life Saving Kidney Donor Sought by Bob Opatrny, Saybrook ‘77” – accompanied by a lovely picture of the Yale graduate and his two young adult children.  But the first person narrative and the tiny label at the bottom of the page, “paid advertisement,” disabused me of that notion.  This was a slick, cleverly designed ad for a kidney.

Mr. Opatrny has advanced kidney disease and renal failure.  He faces an extended period of kidney dialysis while moving up the national waiting list for a kidney transplant.  Who can fault him for doing everything he can to reduce or eliminate his time on dialysis?  I certainly don’t.  With tens of thousands of people on the transplant list, patients can wait for as much as five years for a new kidney.  Why not hire an ad agency to prepare a clever ad disguised as an alumni feature to tweak the heartstrings – “I pray that when it is time, I will be able to dance at my daughter’s wedding” – and trade on the Ivy League ties of “old Blue?” 

Increasingly Mr. Opatrny is not alone.  An internet search revealed another family that bought ads on city buses in Renton, Washington.  A picture of their nine-month old daughter is accompanied by the words, “My daddy needs a kidney.”  At www.livingkidneydonorsearch.com you can read an article on the necessity for advertising – “Why Facebook is Not Enough” – featuring all kinds of market research on the most effective ways to reach an audience of potential donors.  “In many ways searching for a donor is like advertising a product,” the article asserts.

So what bothers me about all of this?  Certainly not the fact that Mr. Opatrny is using his creativity, his connections, and his financial resources to avoid painful years of dialysis.  Who wouldn’t do everyone possible to gain an edge in this race?  The Yale Alumni Magazine is no stranger to the practice of taking advertising dollars from marketers selling everything from fancy vacation rentals to high end retirement communities to academic enrichment programs that grease the wheels of high school students toward admission at elite colleges.  What’s different about offering privileged access to a kidney for one of its own?

But do we really want to encourage gated communities of privileged organ recipients within the transplant world, people whose elite old school connections and wealth give them an edge over those who do not?  Is the marketplace really the arena where we as a society want medical decisions made about who will need to wait for a transplant and who will not?  Is the health of some inherently more valued than the health of others simply because they have the creativity, connections, and financial resources to promote themselves as a more worthy recipient than the other poor guy stuck on the public waiting list?  Will the creation and expansion of a privatized exchange for organ donations blunt the larger effort to reduce the waiting time for all through a more robust commitment across our society to make organ donation normative and frequent?

An article in the AMA Journal of Ethics in 2005, noting the emergence of this advertising trend, objected to the practice:

“Media campaigns are an unfair practice that undermines the values of distributive justice that the Organ Procurement and Transplantation Network [established by Congress] was created to champion.  Autonomy and utility arguments cannot defend the practice successfully because they are outweighed by the potential harm to the larger community of recipients, to donors, and to society.”

I am not naïve about the fact that we already have a multi-tiered system of access to good medical care in this country based on ability and willingness to pay.  Hospitals are building concierge floors for their VIP patients willing to pay a premium.  Doctors are establishing boutique practices offering special access for a hefty annual fee.  Medicaid patients wait longer, have less choice or access to tests, treatments, and medicines than most private pay individuals.  Plans available on the insurance exchanges vary dramatically in what health care services one can access.  In a nation where accelerating income inequality allows the few to opt out of all kinds of public spaces established to promote a more egalitarian, fair, democratic society, it’s no surprise that health care should follow suit.

But at the very least I’d ask the question, “Should a major university proud of its schools of medicine and divinity and of its traditions of critical ethical inquiry be in the business of promoting this kind of practice?”  I don’t think so.  And while I harbor no illusions about the impact of a little protest from me, I’ll be writing the Yale Alumni Magazine with a copy of this blog and a request that my name be removed from its mailing list. 

                       John H. Thomas

                       November 12, 2015

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