By now, you’ve probably heard the story of the Long Island surgeon who is suing his estranged wife for the kidney he donated to her. If it can’t be returned, he wants the $1.5 million dollars he believes it is worth.
For most of us, this is just tabloid fodder, but in her latest Doctor and Patient column, Dr. Pauline Chen says the case is representative of the “extent to which money has become enmeshed with medicine.” She writes, “Many of us reading, listening to and even writing about the story, myself included — accepted the premise long enough to wonder how (they) came up with that high a figure or if it was even physiologically possible for him to take back the kidney.”
Dr. Chen goes on to describe her first kidney transplant operation with a living donor, and how difficult it is to place a value on the transaction.
The experience was nothing short of extraordinary. And like the very act of donating an organ, the kidney itself was hardly glamorous, demanding nothing in return for its miraculous work. It was a sturdy organ – pink, firm as a small rubber ball, and shaped much like the kidney beans you’d find at a restaurant salad bar…. It was, I remember thinking that morning, a gift of life. But it’s a gift, according to some, that can be assessed for as much as $1.5 million or as little as $20,000 or less.
For more, read the full column, “Putting a Price on Compassion,” and then join the discussion below.
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From 1 to 25 of 79 Comments
I don’t find it morally reprehensible that this man wants money for his donated kidney.
To donate a kidney entails real risks to the donor for the rest of his life. The surgery itself to remove the kidney is risky. Living with one kidney is simply less efficient to the body than living with two. Moreover, if his remaining kidney fails, he is in grave danger. Putting the price of the kidney at $1.5 million seems entirely reasonable.
Without knowing details of the case at hand, it seems that this man donated the kidney to save someone he loved and expected to remain with for the rest of his life. When that relationship failed, he wanted to be compensated what he thought was his fair share. I don’t think he actually expects her to give the kidney back, but he does want the equivalent money. That is fair.
— ShanaDo you not understand the meaning of the word “donate”, Shana? You keep refering to the kidney as donated, but say you think he should be compensated!
The contention that he should receive any compensation is ludicrous.
— BarbaritaFinances and medicine are… I don’t know what. Our family doc knows a lot about the business end of his business because he does his own book-keeping, mostly ’cause he’s a computer geek on the side. Should he have to know the details of what is covered to what extent by different insurance companies? Does that push medical info out of his head? It’s hard to argue against having awareness of cost/reward issues though.
— HardyWThe NEJM article refers to “application of business practices to medicine with the goals of improving efficiency, restraining expenses, and increasing quality.” So far none of these goals are even on the horizon, especially restraining expenses. Medicine-as-business is more interested in creating the illusion of quality than providing quality itself, as any hospital ad illustrates. Ratings of quality by government agencies or insurance companies become dumbed-down indices of performance which have little relation to quality. Physician reimbursement is a counterproductive system of perverse incentives whic does nothing to promote these goals. Do we really want medicine to follow the business model where profit is the goal, with quality and performance as secondary considerations? Unless people pay out of pocket for medical care, competition will not be the driving force that it is in other markets. As for the price of a kidney, malpractice lawyers and juries have been deciding this for decades. Maybe the market should be allowed to set the value, in keeping with the business model. I would prefer to remove the profit motive altogether and just run medicine for the public good.
— Ohio MDThis is the farthest thing from fair! Presumably, she needs the kidney for survival, whereas he just wants it back to be spiteful, not for a medical reason. Even if that wasn’t the case, this is so ridiculous and mean-spirited and reeks of revenge. I’m disgusted.
— AshleighO, I don’t know. I am not sure how closely the human body and its organs should be tied to monetary values, in the sense that absolute materialism increasingly gains the upper hand with our ever increasing knowledge leaps at the macro and micro biological level. We may be enthusiastic about the human body as a machine, but I have never been entirely comfortable simply seeing myself as a rather convoluted chemical program–something of a metaphysical sense still resists, despite disposable embryos and genetic screenings. Don’t we devalue the human spirit if flesh is a mere commodity?
Marriage ceased being a guarantee as soon as no-fault divorce became commonplace. If this ex is a surgeon he knew the risks, and if the divorce was otherwise fair, this feels like a highly uncomfortable gimmick to me. Did he have to give her the kidney? Was her life in jeopardy or was this a matter of impatience over waiting on a donor list?
I think he should just move on, regardless of why the marriage failed.
— JoanneA great part of the pressure to make medicine into a business model comes from the health insurance companies which have assumed control over most consumer payments for medical care.
Armed with this capital and staffed by various actuaries, accountants and sundry MBAs these folks are remodelling medicine to make it an efficient mechanism. Efficient, that is, if you consider the goal to be increased profits for the health insurance companies.
The process is quite similar to the process that turned craft workers into industrial labor in the 19th century and to the process that is transforming college professors into itinerant lecturers today.
Actual health care providers need to work together to preserve their humanity and professional standards. I would suggest that large multi-specialty medical groups - doctors cooperatives - might be part of the answer.
— Wonks AnonymousHe offered to do donate his kidney to her out of love. They no longer love each other and they are getting a divorce. Obviously neither one can turn the clock back to the time where he had the kidney still inside of him. Asking her to compensate him makes sense in a very objective way but in real life it’s cold and conniving. If he wins this every person who receives an organ from a live donor will have to worry about being asked to compensate the donor should he do something that causes the donor to regret giving up a piece of an organ or an entire organ. Is that what we want to happen?
— hen3ryTwo thoughts-
-This is why doctors must all be on a salary so they can be driven by their love of their profession
- Conversely there is no place for pathological martyrdom in medicine. That means no doctor or nurse need put their patients needs before their own pathologically.We need a healthy healthcare worker workforce which should screen out and exclude those who believe in martyrdom
Thanks
— Dr. Rick LippinI don’t think that compensation for organs is always a bad thing, I think Levitt has some research claiming allowing organ sales would save a lot of lives.
That said, this was a donation. A gift. There was always a chance that the marriage would fail and that was inherent in the risk the donor took. I think allowing terms for a donation to be renegotiated after the fact is a dangerous precedent.
— AlWhen you compare the 1.5 Million he is asking to the usual outrageous sums sought for pain and suffering in malpractice suits I think the 1.5 million is pocket change.
— TerranceDid he have to go through a psychological assessment before donating?
“My first priority was to save her life,” Batista said at a news conference in Garden City. “The second bonus was to turn the marriage around.”
Moral of the story: if your marriage is in trouble don’t donate your kidney thinking it will save it.
A gift is a gift. He is not entitled to any compensation.
I know nothing about divorce economics but presumably her increased earning power due to his donation will already be taken into account in other ways.
— m.a.It’s real simple.
It is immoral to put a pricetag on human flesh and human souls
If we do we have lost what makes us human in my opinion.
That said ,there must be a national values discussion about the age old dilemma about the common good verses the welfare of any single individual. We cannot maximize both.
— Dr. Rick LippinMonetary values have always been attached to body parts - in fact, there continues to be ongoing debate among experts regarding the pros and cons of the U.S.’s absolute ban on payments for organ donations. I’m also not afraid that this case will having a chilling effect on organ donation, as people in love always believe that their marriage is the one that will beat the 50% failure odds. And although I feel strongly about our country’s refusal to unequivocally state that access to health care is a basic human right (not an economic one), I find the more interesting issue in this case to be the rising level of narcissism in our society. This man’s lawyer admitted that he created this issue in order to apply financial and emotional pressure re: alimony and child custody. In other words, “you owe me”. We have a God-given right to be rewarded for everything we do, and a God-given right to make someone else pay for our every unhappiness. And in America, every reward and punishment can be fairly represented by the appropriate dollar figure. This case is simply a particularly odious example of the “everything has its price” attitude that pervades every aspect of our society.
— AnneDonors are given rigorous health checks to ensure they are fit enough to donate and they do not incur risks for the rest of their life. e.g. A 40 year old follow up study of US veterans from WW2 who had had a nephrectomy concluded that they were no more likely to end up with end stage renal failure as a result of having a kidney removed. The whole rationale of living kidney donation is based on “you only need one” as long as your kidney function exceeds a high threshold.
Yes this woman needed a kidney because her life was in jeopardy. Survival on dialysis is trial by endurance from which there is only release via a transplant or death. In the UK, I waited on the transplant list for 3 years and was finally released by a living kidney donor. The waiting list is a misnomer because patients never know where they are in the queue and there is no orderly queue. Too many of us die waiting in vain.
Advances in drug therapies for transplant patients mean that its possible for anyone to give to anyone else as long as their blood and tissue type are compatible. It’s no longer necessary to get the closest match.
I dont see why in a well regulated health system such as we have in the UK that donors should not be compensated in some way for the great gift that they give recipients. The donors go through an operation which is not necessary for them. They get pain relief and recover swiftly but still have to suffer the inconvenience and pain however short term it is.
I am interested in knowing how (what parameters) the lawyers quantified the value of the kidney. To the patient the kidney and their life is priceless.
— Helen RambautThis is disgusting and should be thrown out of court without a second glance. They have three children together, what do you think the price should be for use of her body for purposes of incubation. Sounds ridiculous? So does this idiot!
— Aftercancerhttp://aftercancernowwhat.blogspot.com
The day your doctor performs his hammer and chisel surgical procedure will be the day the Messiah comes to take us all to a wonderful place beyond this material world.
Until that day every single touch, stitch, suction, nick, perforation is yours alone. Sorry.
— lusciousbobbyDr. Chen brings up a broader question than the one regarding the specifics of the particular case cited. Where is the balance between commerce and care? Certainly a physician is in business, but where to draw the line in practice?
In order to gain efficiency does “good enough” become the goal? I’m not talking about bad outcomes – but rather less than optimal. Permanent damage to a sensory nerve that could have been avoided by taking a little more time, for instance. Efficiency calls for doing more in less time. The surgeon is producing his/her widget more efficiently. Overall quality suffers, but the factory is making more money for its shareholder of one.
This ties back to last week’s topic about finding a quality physician. As the balance of medicine tips more towards business the more the “clients” will want to be able to evaluate their “service providers” based on quality and price. And how is quality measured? The details will matter.
— EWBDid anyone ask if this is a counter suit? Maybe the estranged wife is suing for 50% of the families net worth. The 1.5 million may just ensure that the surgeon has some money left.
— andrea archerShana, pay attention: paying for organs is illegal. end of story. why this is even an issue is completely puzzling. you’re right, it WAS his kidney. he wasn’t forced to give it up; he CHOSE to. he didn’t have to save his wife from ESRD, in fact he couldn’t have been forced to help her if he didn’t want to. if i were to donate a kidney, and then the my other one failed, i can’t ask for the first one back. it’s no longer my kidney.
i respect dr. chen greatly, but come on. this isn’t even an issue in the US. we don’t pay for organs. why it even matters how much he thinks an organ is worth is beyond me. besides, isn’t the price of a life-saving organ pretty much priceless?
— future MDMaybe she should charge him for every time they went to bed together.
— Liz WIf you could sell a kidney for $1.5 million, a lot of people would do if. Frankly, I would probably do it. I need $1.5 million a lot more than I need one kidney! For that matter, why shouldn’t I be able to sell a kidney for $1.5 million? It is my kidney, right?
— SusanShe should take a page out of The Merchant of Venice - Go ahead, take your kidney back - here’s the knife.
— KKWhat is your point? That money is the source of evil? That we all think an organ is worth a certain amount of money?
— bdocA possible example of what #4/Ohio MD mentions is Aetna Aexel program… or what I call the hidden network w/in the network I pay for. The day after my shoulder surgery Aetna informed me that my surgeon was not part of the hidden network. AMA analysis of this program is here: http://www.ama-assn.org/ama1/pub/upload/mm/368/aexcel_chart.pdf
As for the Batista case, I hope it will not tighten future live donor screening processes. It’s bad enough what this case is doing to everyone involved. It would be **really** bad if he ruins it for needy recipients by causing donor screening to become more stringent.
signed,
— JPWpotential future (liver) donor