Kidneys for Sale

A young alum thinks money is the key to increasing kidney donations.

November/December 2012

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Kidneys for Sale

Photo: Jayne Patterson

You might say Alexander Berger, ’11, put his kidney where his mouth was. Last December, Berger wrote an op-ed for the New York Times advocating a seemingly ghoulish idea—allowing people to sell a kidney.

His point was simple. The need for donated kidneys vastly outstrips supply. By offering a set price, say $50,000 (paid by insurance carriers and Medicare), and maintaining current need-based distribution systems for the purchased kidneys, more people could be enticed to offer up an organ that could improve someone’s life with little chance of harm to themselves: “The procedure is safe and relatively painless,” he wrote.

Berger, though, wasn’t just spouting rhetoric. He was days away from making such a donation to a total stranger for no benefit other than the satisfaction of having helped.

Berger is now a research analyst at Give Well, a non-profit that rates charities. Stanford caught up with him to see if he feels the same way about the issue now, one year and one kidney later.

Have you always been someone who is out there helping strangers? Are you the type to donate blood?

The funny thing is, the only time I’ve ever given blood was in order to find out my blood type so I could donate a kidney. I’m not a big fan of needles.

So how does a guy who is afraid of needles end up donating a kidney to a stranger?

There have been a couple of New Yorker articles about altruistic kidney donors before and I always thought they came across as kind of crazy people.

Then my junior year, I was taking the Ethics in Society honors seminar and we read this great thesis by [Joe Shapiro, '03] about the ethics of kidney markets, especially in the developing world.

It mentioned something off hand that I hadn’t known, which was that donating a kidney in the United States is an extraordinarily safe process. The statistic that gets thrown around is that the risk of death for a healthy altruistic kidney donor is about one in 3,000—and that puts you in the same ballpark as a woman over 35 giving birth.

So that set you on the path to an operating table?

My first thought was, “Wow, that’s surprisingly easy. Maybe that’s something I have to do.” My next thought was, “Well, it’s nice and all to donate a kidney, but people live on dialysis, so it’s not like it’s necessarily life-saving.”

Then I went and looked at the data to try and figure out how much a kidney actually benefits somebody. It turns out that, on average, relative to dialysis, receiving a kidney gets you about 10 more years of life. And that made me think, “Well, that actually is pretty important and close to saving someone’s life.”

So the summer before my senior year, I filled out a form on the National Kidney Registry website, I went to my doctor and got a physical and I talked to my parents. In approximately that order.

How did they react?

Somewhat shockingly, they didn’t say “No, you can’t.” They said, “We really wish you would . . . wait longer. Why the rush? You could do this when you’re 30.” But they were really supportive and I appreciated that.

And your friends? You wrote that some thought you were off your rocker.

The more I talked to people, the more reactions I got saying, “this does sound like a really good, relatively easy way to help somebody a lot. Why don’t we see more people doing this?”

As your piece in the Times argues, you think donors should have the ability to be paid. What led you to publicly advocate that position?

I was talking to [Professor Rob Reich, MA '98, PhD '98], who I was close to, and I was saying that as much as [altruistic donating] is a remarkable opportunity to really help somebody, I wish it didn’t exist. I wish it weren’t a problem that people who need kidneys can’t get them and so have to rely on charity from strangers, which is inadequate.

He said: “You know, Alexander, you could try and change the policy.“ He encouraged me to start thinking about that and ended up playing a key role in helping me find the right people to get in touch with at the Times.

What was the reaction to the piece?

I was pleasantly surprised by the amount of coverage it got. I heard from a few people [for whom it changed their mind.] So that was great. Being public was worth it for that reason, but it wasn’t an easy decision. You end up with a lot of random bloggers commenting about you [and not] much control over that.

In the Times piece, which you wrote before you had the surgery, you called the procedure “relatively painless.” Was that your experience?

I was on narcotic painkillers for a week—and I wanted them. They would ask how bad the pain is on a scale of zero to 10 and [I’d be at] a seven or an eight. That was for a very short period of time. It was not outrageously painful.

So what happened to your kidney?

It started a six-kidney transplant chain. It got on a plane (in San Francisco). It flew to Pittsburgh. It was implanted in a woman. Her husband then donated on her behalf. His kidney [went] to Wisconsin. There’s an internal Wisconsin switch, then (another kidney) goes back to UCSF and [the last] ends up at Riverside (Calif.).

Have you had contact with the woman who has your kidney?

She sent me her family Christmas card with a note about who she was, and we’ve exchanged some email since then. She’s a ninth-grade math teacher. She has two young sons. It was neat to hear about.

So nearly a year later, minus one kidney, how is life different?

I still rock climb. I still exercise. I think I can do more sit-ups than I could do before. It has not materially affected my [life] in that regard at all. Literally the only thing I shouldn’t do is martial arts, where people might punch me in the other kidney. I feel like it was totally the right decision; I am really glad I made it and I would do it again. But it hasn’t had any sort of transformative impact on my life and it’s not something that I think about often. To your knowledge, has anyone followed your example? I’ve talked to three or four people who have been at the exploratory stage and all of them said, “I talked to my mom about it and she wanted me to wait.” And these guys are in their 30s. It’s still a pretty major thing.

Interview has been edited and condensed.

Sam Scott is a senior writer at Stanford.

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