You trudge along the Huron, absorbed in wonder at what the miracle of compound interest is doing to your college debt. Suddenly, a splash, a cry. A man flails in the water. He can’t swim; you can. “Please, help me!” You (1), plunge in and do your best to rescue him, or (2), cup your hands and inquire: “What’s it worth to you?”

Michigan men and women would choose Option One. But why is it the right choice? No need to invoke scripture or catechism where Kant can explain: “[T]o help others where one can is a duty.”1 In a rescue situation, if we have the special competence and unique opportunity, we have the moral obligation to aid a neighbor in need.

The present kidney shortage is a situation in need of rescuers: more than 5,000 of our neighbors will die this year awaiting a transplant. However, proposals to legalize compensation for kidney donors are the moral equivalent of Option Two: “What’s it worth to you?”

What’s-it-worth is official policy in Iran.2 In an attempt to eliminate their shortage of kidneys for transplant, the government guarantees kidney-sellers a base fee of $1,200. Patients then meet privately with seller-candidates to negotiate an add-on price, usually many times more. If the parties cannot agree on “what it’s worth”, the seller walks. If the patient has enough cash, they make a deal.

Iranian sellers are not blameworthy. They are desperate people being treated like means. Eighty-four percent are poor. The state doesn’t monitor their post-sale health. Reflecting on their ordeal, 76 percent think kidney sales should be banned!3 The true culprit is a regime that has legitimated trade in body parts.

Iran is the poster child for those who advocate compensating kidney donors. Yet Cash-for-Kidneys hasn’t achieved its putative goal of eliminating the shortage of transplant organs.4 Officials admit they don’t know the full extent of national need, and many Iranians with renal disease go undiagnosed. Hundreds who do need a transplant but can’t pay the added fee languish on the wait list for cadaver organs.

Doubtless a US kidney-sale system would be more sensitive than Iran’s. Seller and patient would be kept apart. Third parties – certainly government, maybe insurers – would pick up the entire tab. Yet the program we would establish in law would be the equivalent of the Iranian Cash-for-Kidneys program.

Well, why not? Paying for kidneys may be distasteful, but why is it wrong?

The first principle of practical reason directs us not just to pursue the good but to avoid evil.7 Commodifying kidneys is an evil because it reduces the human person to a means.8 It depersonalizes us, literally renders us an object with a market price.

Pricing kidneys reduces constitutive parts of the human person to the status of pork bellies.9 Moral laws apply universally. We can’t bracket ourselves. If it’s wrong to treat a human being as an object, and you’re a human being, it’s wrong to treat yourself as an object. It’s wrong also for others to collude in the extracting and selling – surgeons, technicians, bureaucrats, lawmakers, taxpayers.

The Iranian state has chosen a path that we must reject.5 The logic of supply and demand is relentless. Just think “outsourcing.” Reduce the kidneys of US citizens to a commodity and soon enough we will be importing cheaper organs sold in desperation by the world’s poor. We’d probably draw the line at kidneys from executed Chinese prisoners.6 But if a healthy human kidney is just another spare part bought at a market price, why squirm?

Your body is not a building inhabited by the real, unseen “you”. Properly understood, you are your body. A human being is a substantial unity of a material and a spiritual principle intrinsically self-integrating and self-directing.10 Some human beings once had a market price slapped onto their chests, but we fought a civil war to put an end to that injustice. Owning a whole human being is wrong. Paying for parts of human beings is similarly wrong. Our living bodies, along with the fundamental goods that we pursue and which fulfill us by actualizing our basic potentialities – life, health, friendship, marriage, knowledge of truth, self-integration, worship – do not have a market exchange value. They are incommensurable goods beyond supply and demand.11

But, to rescue a neighbor, we may give as a gift that which we may not sell. Donation of a kidney, whether in life or at death, is a gesture of the deepest friendship. The grammar of the deed affirms: “You are not alone, I stand with you.” We gift something of our very self. Ideally, the gesture evokes a response equally generous. This is how, concretely, we build a culture of solidarity.12 If these gestures by living donors are few, no wonder: they are acts of heroism. Yet even the least heroic of us can do something bold: sign the “anatomical gift” commitment on the reverse of our Michigan drivers’ license.

The market economy is a valuable human invention. It enables us to allocate scarce resources efficiently, but we choose the ends to pursue. We are not obliged to subject human kidneys to market mechanisms. In fact, we are obliged to resist that temptation.

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