Home Social Issues “Pay It Forward”—- Where’s the Profit in that?

“Pay It Forward”—- Where’s the Profit in that?


Today’s New York Times featured a front-page story about a 60-person chain of kidney transplants that began with one “Good Samaritan” donor who offered his left kidney to be transplanted to a complete stranger who needed a replacement kidney, simply because he thought it would be a good thing to do. Mr. Buzzamenti, who lives in Riverside, California, and is not, it turns out, an otherwise notably altruistic personality, thus triggered a chain of 30 kidney donations beginning on August 15, 2011 that zig-zagged back and forth across the United States, ending with Mr.Terry, who received a replacement kidney in Chicago 127 days later, on December 20, 2011.

What is remarkable here is the sequence that linked 30 people “who were willing to give up an organ to 30 who might have died without one,” and none of the 30 donors actually knew the person receiving their kidney. True, each donor after Mr. Buzzamenti had offered to give a kidney to a relative or friend in need, but was unable to do so because of incompatibilities which would have caused the operation to fail. Each donor had then agreed that, if someone else donated a compatible kidney to their intended recipient, they would donate their kidney to another patient, thus “paying it forward” in a life-saving chain, stranger to stranger. Chain 124, as it was called, is one of many that have been put together by the National Kidney Registry, the brain child of Mr. Garet Hil, a business executive whose own young daughter had needed a kidney transplant. It is a marvel of modern medical science combined with complicated computer algorithms which screen potential donors and recipients on many levels of immunological compatibility in order to find the best possible matches. After all the science, however, the entire system ultimately depends on trust.

Looking at the photos of donors and recipients one sees a diverse spectrum of America, which is to say men, women, young, old (one donor was 62), black, white, Oriental, beginning with Buzzamenti, a Caucasian Buddhist (converted from Catholicism) and, if names mean anything, what must have been Christian, Muslim, Jewish, and, who knows, no religion— but all in need of help or willing to give help. “The most worrisome risk was that donors would renege once their loved ones received kidneys,” a sentiment we all can recognize as “I’ve got mine, so long sucker.” That did not happen, although Mrs. Clark, a donor, who had to wait 68 days to donate her kidney after her husband received his transplant, admitted that during the long wait she did think about backing out, but resisted the temptation because “I believe in karma, and that would have been some really bad karma. There was somebody out there who needed my kidney.” Everyone in the chain trusted everyone else in the chain to follow through.

Nobody gets paid for donating a kidney, although of course hospitals and doctors are compensated for performing the transplants, the National  Kidney Registry covers its costs with fees paid by hospitals, and anyone receiving a kidney through their matching system must have health insurance (which eliminated one possible recipient in Chain 124 because he turned out to be an illegal immigrant). The monetary profit here is all in the surgery, mechanics, and administration, simply paying for services rendered. None of it would have happened without the uncompensated giving of a kidney—- uncompensated, that is, in terms of money. It can only be understood as trust and altruism, where the compensation is something else, call it immaterial, spiritual, or psychological, but nothing that can be considered in the “metrics” of the famous bottom line so beloved of the Market Theory of capitalism.

Only under the market theory does the human species insist on disseminating improvements and benefits only for personal profit. That has not always been the case: did anyone copyright agriculture or pottery-making? The invention of the wheel? How about the invention of money itself, or even the recent invention of the Internet?  The point here is that, while part of humanity’s success, the reason we have overrun the planet, may be due to having created ways of inter-acting non-violently outside the confines of our particular tribes, (like using money to exchange goods and services, replacing rapine and raid), the motives of altruism and charity may be every bit as basic to humanity’s success. There have been entire cultures built on gift-exchange, not on money profit. Even today we can see that the profit motive alone has not produced a universal health care system with good outcomes for all members of society.

Ironically, the Market Theory of capitalism (the secular religion of the Republican Party) under which the economy of today’s world operates, depends at bottom on trust and a certain degree of altruism, despite its pretensions of ignoring such “soft” sentiments. The theory (here condensed) holds that some prudent individual saves up some capital, invents an idea for a new or improved product or service, and then sells it to others for his personal profit. If there is no profit to be made, society will not get the product, not for long anyway. The foundation of the system is supposedly personal profit, but in reality  the starting point is not the profit, but the idea of the product, the idea, somewhat altruistic as it may be, of something better, followed by the trust of the entrepreneur that people will indeed pay him for it, and the trust of the buyer that the product is as advertised. Take away the altruistic idea or the trust of either party, and the system breaks down, no matter how anxious the entrepreneur may be for a profit.

This is not to dismiss the profit motive, but only to de-value its divinity.

As Elizabeth Warren, candidate for the U.S. Senate in Massachusetts, has said so well, no one really succeeds all by themselves. Even the most hard-driving entrepreneur has depended on the infrastructure of society to help him, an infrastructure built up and paid for by others before him, and he has an obligation therefore to help others coming after—- to “pay it forward,” in other words. Maybe we really are all in this together.  


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