Putting A Price On The Ineffable

Organ donation, surrogacy, & other quandaries of money and morals

This week’s episode of This American Life covers the story of a woman who wanted to donate a kidney to a dying friend. Because she mentioned over the phone during one of the many screening conversations with overseers that the friend was willing to help compensate her, if necessary, for loss of income over the time that she would need to take off work to heal, she was rejected. That would be seen as trafficking, the screeners told her.

For lack of a kidney, her friend sickened and died.

That’s One Way to Do It | This American Life

The nation of Iran has developed a system whereby people are allowed to sell their kidneys to people who need them, even “haggling” over prices, though the process is still administrated and overseen by experts; and the woman was so intrigued by the idea of a mediated marketplace for organs that she went to see it in action. She described some of the troubling and inspiring aspects of what she observed.

The segment raises some fascinating questions. Would we really, as a society, rather have a person die than let him make some kind of even nominal exchange of money for a vital organ? Right now, it seems that we would, yes; that’s where we are as a culture. Even allowing him to offset his donor’s costs is unacceptable. We think that the principle is sacred, the principle that a person should not sell off parts of their body.

But what, then, about surrogacy? Is that really so different? We do, at least in certain states such as California, allow women to carry children for other people in exchange for pay, with remarkably little regulation or oversight. Michelle Goldberg recently wrote for Slate about one particularly tricky case in California, wherein a surrogate is now suing for custody.

According to [Cook’s] lawyer, Harold Cassidy, she’d found it to be a rewarding way to supplement the salary she earned at her office job. “Like other women in this situation, she was motivated by two things: One, it was a good thing to do for people, and two, she needed some money,” Cassidy says. … In May, Cook signed a contract [with C.M., a single 50-year-old man she had never met] promising her $27,000 to carry a pregnancy, plus a $6,000 bonus in case of multiples.*

Her doctor implanted her with three embryos, not expecting that all of them would take, but the multiples clause in the contract proved prescient: Cook is now carrying triplets, which is more than C.M. wanted or, according to his emails to Cook, could afford. He’s not rich; he’s disabled and lives with his elderly parents. Virtually all of his savings went into this late-in-life quest to have a son.

C.M. asked Cook to abort at least one of fetuses. She refused.

According to Cook’s lawsuit, before the embryo transfer, C.M. assured her via email that he could accept responsibility for all the children that might result. But while C.M. had been prepared for twins, he didn’t want triplets. Indeed, her suit says, soon after her pregnancy was confirmed, it became clear that C.M. had exhausted his savings, and wasn’t sure he could care for more than one baby.

Cook offered to adopt one or more of the children she’s carrying. That would, one might think, solve everyone’s problems, but instead, it’s sparked a lengthy, costly lawsuit between two people, neither of whom have much, materially, but both of whom are invested — psychologically and biologically — in the fates of these unborn kids.

Cassidy says Cook sympathizes with C.M., but she doesn’t feel she can turn over the children to him. She wants custody of one of them — the one that C.M. wanted her to abort, referred to as Baby C in the complaint. And she’s seeking a hearing to determine the best interests of the other two, whether that means living with their father or with her.

I’m curious about the egg donor, too, about whom we seem to know nothing. Was she paid? How does she feel? Doesn’t she want in on this drama?

As Goldberg summarizes, “[This story] illustrates some of the thorniest issues plaguing the fertility industry: the creation of high-risk multiple pregnancies, the lack of screening of intended parents, the financial vulnerability of surrogates, and the almost complete lack of regulation around surrogacy in many states.” It also illustrates one of the quintessential American paradoxes: we are all about individual freedom, autonomy, and commerce, except that we are also often quite conservative and moralistic when it comes to what individuals are allowed to do with our bodies.

Support The Billfold

The Billfold continues to exist thanks to support from our readers. Help us continue to do our work by making a monthly pledge on Patreon or a one-time-only contribution through PayPal.