Paying Kidney Donors, Football Players, And Boxers: Medical Risks

Yesterday, in If You Oppose Paying Kidney Donors, You Should Oppose Paying Football Players And Boxers Too, I introduced a new paper, written by Phil Cook and me, arguing that the case for paying kidney donors is much stronger than the case for paying participants in football, boxing, and other violent sports, and promising to follow up with subsequent posts outlining our arguments and evidence. 

Today, I’ll discuss the central argument in our paper: the medical risks to a professional career in football, boxing, and other violent sports are much greater both in the near and long term than the risks of donating a kidney. Injuries in such sports are common, and retired players are very often disabled by the long-term effects of these injuries as well the cumulative effect of thousands of blows to the body.

One challenge in making a meaningful comparison between the risks entailed in kidney donation and the risks entailed in participation in contact sports is that the latter may stretch out for many years and involve not one choice (donate or not) but rather a series of choices regarding participation. While it is difficult to quantify these effects in a way that provides a natural comparison with kidney donation, we provide some statistics that suggest that, for example, a man who signs a contract to play in the NFL for a year is consenting to be exposed to far greater medical risks than someone who volunteers to donate a kidney.

We focus our analysis on football, because the epidemiology of injury and disability is better developed than for fighting sports. It is worth noting, however, that there has always been concern about the risk posed by fighting sports, and that concern has accelerated in recent years, due to a better understanding of the long-term effects of head trauma. As a result of these risks, medical associations around the world, including the American Medical Association and various state medical associations, have called for limitations or bans on boxing and MMA.

As to kidney donation, we analyze both the post-operative risk from surgery and the post-recovery chance of death or disability resulting from loss of function of the remaining kidney. Both risks – while greater than zero -- are quite low, both in an absolute sense and in comparison to the typical risks of participation in violent sport. For example, post-operative complications (most of them minor, such as bleeding or wound infection) are present in 7.3% of cases, and donors face a higher cumulative incidence of end stage renal disease than nondonors – 0.31% versus 0.04%. While that risk is thus significantly elevated for donors, it remains very low in an absolute sense, representing an increased chance of about 1 in 400.

With respect to football, we discuss injury rates at the youth, high school, collegiate, and professional level. While that data is far too extensive to fully discuss here, I’ll provide a few highlights:

• In 2016, the 2,274 active players in the NFL experienced 2066 injuries during the preseason and regular season, 244 of which were concussions. That’s .073 concussions per player-season – about equal to the rate of surgical complications (most commonly, minor complications, such as bleeding or wound infection) in kidney donation.
• Official injury reports and survey information suggest that for a substantial majority of former players, injuries ended their career or contributed to the decision to end their career. Nine of 10 former players have nagging aches and pains from football when they wake up, and for most the pain lasts all day. For those age 30-49, the ability to work is impaired by injury.
• A recent postmortem study of a sample of donated brains of former NFL players found that 110 of 111 indicated either mild or (more commonly) severe CTE.

This last point requires some explanation, because the findings do not imply that 99% of former NFL players will have CTE. The brains in the study were voluntarily submitted for examination by family members who were often motivated by a desire to know the cause of their loved ones dementia or other neurological problems. But the 111 brains do represent 8.5% of the 1300 former NFL players who died during the period that these brains were donated. That places something of a logical lower bound on the prevalence of CTE. Presumably the true prevalence is much higher than 8.5%.

While it is not possible to do a precise “apples to apples” comparison of the medical risks associated with kidney donation` and the risks associated with a professional football career, it seems clear that the acute risk of injury and of long-term disability are far higher for the football player. As discussed above, most NFL veterans live out their lives following retirement with serious physical and mental disabilities. The vast majority of kidney donors lead entirely normal lives following recovery from the initial operation.

In other words, the ban against paying kidney donors cannot rest on the basis of medical risk when we pay professional athletes to incur far greater risks. This is just a short preview of the evidence on medical risk, so read the whole paper, If We Allow Football Players and Boxers to Be Paid for Entertaining the Public, Why Don't We Allow Kidney Donors to Be Paid for Saving Lives?

Prior related posts:

If You Oppose Paying Kidney Donors, You Should Oppose Paying Football Players And Boxers Too

Comments

[anon]

Wouldn't you agree that comparing the risk of injury in professional sports to the risk of injury associated with donating kidneys is a completely irrelevant, illogical argument?

YOur argument turns on the fact that objections to buying human organs from living persons turns on medical risk to those persons, and their donees.

In fact, however, as one is sure you know, the reason most people find the rich buying organs from the poor distasteful is because it is disgusting example of the privileged desperately attempting to justify ANY exploitation of the less privileged, in the name of capitalism and market theory.

Behind the veil of ignorance, you wouldn't propose such a thing.

[Deep State Special Legal Counsel]

Anon^^^^^

Your observations are correct. Whether its the Johnstown, Pa flood, the US Civil War, Vietnam, Iraq, Afghanistan, and now Trump Voodoo Economic Trickle Down, the rich always pay the poor to die for them.

[anon]

BTW, the notion that it is the rich exploiting the poor is self evident.

The rich have the means to buy organs, the poor do not.

The rich have no need to sell organs for money, the poor do.

And, if we are to use professional sports as a valid comparison (it isn't), let's do a study of the socio-economic class from which our gladiators at the greatest risk for physical injury are principally drawn (e.g., boxers, football, martial arts, etc.) The fact that the public enjoys (and the rich benefit financially) from exploiting the willingness to trade injury for money is not only irrelevant to the organ trade debate (expect insofar as the exploitation aspects are similar) but primitive.

The argument that professional sports is dangerous and therefore the rich can justify inducing the poor to sell their organs for money is, as stated above, purely disgusting.

[Deep State Special Legal Counsel]

anon,

Your argument is far afield here. Contact sports specifically and inherently sacrifice the human body (parts) for financial gain. That is why football and boxing are known as contact sports. Fighting in hockey is encouraged or at least not halted. The issue is intent.

Let's contrast that with driving a motor vehicle. Driving is the most dangerous activity most of us will engage in during our lifetimes. What you are essentially positing is that the mere act of driving to work at Walmart is in itself exploitive for financial gain and therefore analogous to paid organ donation.

[anon]

Have they legalized weed in Illinois?

[Deep State Special Legal Counsel]

No, we are working on it, however. Studying it... In Cook County, Coppers just write it as on Ordinance Violation.

[Brian Frye]

Interesting. How many lives is your distaste worth?

[Deep State Special Legal Counsel]

...and even if we legalize weed, I will not inhale.