I Would Give My Left Kidney to Prove I'm Right

March 15 (Bloomberg) — The reputation of libertarians is that they are selfish, and that the female of the species is the more selfish.

After all, libertarians insist on applying commercial paradigms to moral problems, which seems asocial and downright unfeminine.

Typical would be Sally Satel, a doctor-scholar at the American Enterprise Institute in Washington. Satel has shown sympathy in print to vendors of human organs. Sally is buddies with another libertarian, the blogging diva Virginia Postrel.

Postrel is ruthless. She has a post up right now mocking New York health authorities for regulating New York chefs and banning one form of gourmet fish preparation, sous vide cooking, as unsanitary. Where is this woman's concern for infant botulism?

It is intriguing then to find the same pair engaged in the most altruistic and intimate of interactions. Early this month on a Saturday at Washington Hospital Center, Virginia gave Sally a kidney. Though there is always the risk that Sally's body rejects Virginia's kidney, both women are recovering well.

This kidney story is interesting for the light it sheds on a political stereotype.

Late in the summer of 2004, Sally got the news that her kidneys had retired from life a few decades before she planned to. Sally faced a choice: a transplant or the "jail sentence" of dialysis.

Transplant Hurdles

But she shortly discovered that there was no easy legal way for her to get a kidney. The timorous American medical establishment, deeply influenced by Britain's national health system and left-leaning economists at the London School of Economics, has long sought to control organs and the market for them. A 1984 law, the National Organ Transplantation Act, named a single warm-hearted sounding entity, the United Network for Organ Sharing, as America's public organ broker.

Yet some 90,000 people languish on the waiting lists. Sally learned that the wait for kidneys can be five years. The same legislation outlaws the sale of organs, and violators can be punished with prison terms of the same length.

Satel had no family to supply a kidney. Officials from the American Society of Transplant Surgeons had spoken disapprovingly of private donations between unrelated parties. Social conservatives have qualms about organ transactions too.

Public Harm

After a lifetime of hypothesizing that public monopolies do damage, Satel had come upon an all-too-personal example of how this was so. She wrote a column in the New York Times about the problem, noting that an average of 18 people died every day waiting for organs. In a forthcoming article in the magazine In Character, she quotes nephrologist Benjamin Hippen as noting that this supposedly humane setup "degenerates into an equal opportunity to die on the waiting list."

Sally found a donor on the Internet through matchingdonors.com, but the arrangement fell through. This week she e-mailed me a happy description of what happened next: "Virginia heard of my health problem from a mutual friend in early Nov. and contacted me saying that if the Internet donor guy failed, that she would step up. And that is how she came to be!"

"We were friends, but not the knew-each-other-all-our lives-spent-every-summer-together kind," Virginia, recuperating in Dallas, told me yesterday.

It turned out that Virginia's kidney was a good match for Sally. Maybe it was their intellectual sisterhood. They joke that they even had the same blood type: Diet Coke. Virginia's Web site, dynamist.com, has a photo of Sally recovering from surgery with her favorite beverage.

Still, family, acquaintances and doctors alike urged the libertarian Virginia to think more selfishly about surgery.

'Really Bullheaded'

"I learned you have to be really bullheaded to give a kidney to a friend," she says. The pair planned the surgery for the Saturday after Postrel's husband Steve, a business school professor, finished giving an exam. The hospital caseworker noticed that Sally received more flowers than other transplant cases. Libertarians, it turns out, have lots of friends.

But was this a policy kidney? In a certain sense, yes. As a fan of biotechnology, Virginia recalls, she didn't have the "visceral" reaction that others might have to giving an organ. (Yes, she used that word). She looked up the risks of the donation and found that "we do lots of riskier things every day."

More Than Right

After spending so much time thinking renally, Virginia's husband Steve even came up with his own elegant little market solution to the fatal organ shortage. Citizens who give an organ get a holiday from federal taxes for a year. High earners pay lots of tax, and low earners pay next to none. As Postrel points out, the holiday idea is therefore less vulnerable to the usual criticism that organ dealing exploits the poor.

The kidney holiday sounds quirky enough to also appeal to the philanthropist, who tends to want two contradictory things: the satisfaction of giving and the sense that he really is getting something out of it.

Still, Virginia in the end gave not because she was Right, but because it seemed right.

"It was not as Virginia, the libertarian, but Virginia, the friend, that I was giving" Postrel says. "People who believe in markets do all sorts of non-market transactions."

Without thinking much about it, Postrel and Satel have made some important points. Well-intentioned policy can be fatal. Arch-conservatives can have big hearts, as big as any heart at the London School of Economics or at the Democratic Leadership Council. Market-orientation and charity are not opposites. Sometimes they go together. Public institutions can't monopolize morality, as much as they would like to. And they probably shouldn't be allowed to monopolize kidneys, either.

(Amity Shlaes is a Bloomberg News columnist. The opinions expressed are her own.)

© Copyright 2006 Bloomberg

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