Economics, Exploitation

Of Course We Should Allow Kidney Sales

I’m participating in a debate, of sorts, in the Pan-Am Post. Drawing from Markets without Limits, I point out that most opposition to organ sales is about the how, not the what. Opponents complain about contingent features that could be removed or regulated away.

 

But markets in kidneys are illegal. The government sets the legal price of organs at $0, far below the implicit equilibrium market price. Thus, an economist might say: of course there is a shortage, whenever the legal price of a good is set below the equilibrium price, the quantity demanded will exceed the quantity supplied.

Many philosophers and economists thus think that markets in organs will eliminate the shortage. You aren’t kind enough to give away your extra kidney to a stranger, but you might do it for $100,000. Defenders of organ sales believe it will save hundreds of thousands of lives annually and will help make the poor richer.

Making kidney markets illegal is quite literally killing people.

Many people think that markets in kidneys would have certain undesirable or exploitative features, but these problems can be overcome by designing and/or regulating the market appropriately.

Consider this: some object that if markets in kidneys were legal, then the price of a kidney would be so high that only the rich could afford it. But, in parallel, some poor people can’t afford food. We don’t as a result forbid markets in food.

Instead, we subsidize the poor by issuing food stamps. We could issue means-tested kidneys stamps as well. Further, on a free market in kidneys, the price would likely be much lower than it is on the current black market.

Others object that the poor would be exploited by the rich. Even if so, this at best shows not that markets in kidneys should be forbidden, but that only people who are sufficiently rich — for instance, who make over $60,000 a year — should be allowed to sell kidneys.

Others object that people will rush to sell kidneys without a full understanding of the risks involved. But, again, at best this shows we should require would-be kidney sellers to be licensed. Before being allowed to sell, they must pass a test, akin to a driver’s license exam, showing they understand the costs and benefits.

In the end, some people feel that selling kidneys is just plain wrong, because it somehow violates human dignity or the integrity of the body. But this kind of disgust at kidney markets is quite literally killing people. There is no wisdom in repugnance.

Many things we now regard as normal or the hallmarks of responsibility — such as life insurance, anesthesia, or being willing to work for a wage — were once seen as undignified, or disgusting, or “commodifying life.” People’s lives are at stake here. It’s time to grow up and get over our primitive aversion to kidney markets.

Now, I myself prefer a free market in organ sales rather than a heavily regulated one. But that’s a secondary point. The question of whether we should have markets in kidneys is not the same as whether we should have unregulated free markets without governmental social insurance. You can be a social democrat and love kidney markets, or a libertarian and hate them.

Journalist Pedro García Otero offers a counterargument that is, I think, not persuasive:

From a recipient’s perspective, how much would a kidney be worth if he or she were dying? Priceless, no doubt. What about from the donor’s perspective? No sale would ever be voluntary. It would always be motivated, or more likely coerced, by desperate economic circumstances. This makes way for corruption.

To be frank, I’m not really sure what he’s getting at. Out of context, this passage is more clear than in context.

But one idea sort of hinted at here is that perhaps the market would be highly exploitative because buyers would be desperate and sellers would not be. People on the Left, and sometimes even on the Right, trot out this kind of argument. But it rests on a mistake.

Way back in 1817, David Ricardo asked us to consider a situation like this. Suppose Bob is desperate to rent land from a landowner. Suppose there are 50 landowners, none of whom is desperate to rent out their land, but each of whom can profit from doing so. You might think the landowners would give Bob a bad deal, since Bob is desperate and they are not. But, Ricardo points out, you’ve got things backwards. In this case, the landowners have to compete amongst themselves. Each can profit by outbidding the others, but offering Bob a better and better deal. Bob will actually capture almost all the bargaining space for himself. So, Ricardo reminds us, bargaining power isn’t just about desperation vs. indifference. Rather, it’s about competition. Bob has no competition (he’s a monopsony buyer of land rent) while the owners have lots of competition.

What happens, instead, if there is lots of competition on both sides? Well, then we get a normal competitive market.

People, especially those on the Left, often lazily argue against certain markets by asserting, without good evidence, that the market in question will be (behave as if it were) monopsonistic or monopolistic, and thus allow some to exploit others. (I’m looking at you, Marx. Read some real econ and take a shower while you’re at it.) Usually they have no evidence for this claim. But even in the uncommon cases where they do identify such monopsonies or monopolies, the solution isn’t obviously to forbid a market, but to do things to break up the monopsony or monopoly.

Published on:
Author: Jason Brennan
  • TheBrett

    In the case of kidneys, my main concern is that you might create a big illegal market in unethical kidney harvesting funneling kidneys into a legal market. You’d need a very good registry system to exclude kidneys that weren’t gathered by licensed harvesters, and checks on those harvesters to make sure they’re following the rules as well.

    That said, I think we should definitely allow the offering of money to the relatives of just deceased people for organs, if the deceased offered to be a donor.

    • Libertymike

      The licensing / registry system you propose is, itself, far more likely to create problems than the “big illegal market” boogey man you envision.

    • TracyW

      Or just require the donor and the donee to be in the same operating theatre.

  • stevenjohnson2

    I hope the David Ricardo example is misreported. The notion that there are fifty landowners but only one would be farmer is so extreme as to be absurd. This can only make sense as part of a discussion that includes realistic examples.

    The analysis of “kidney markets” is also incorrect. There is a market for kidney transplants procedures, which very likely is highly monopsonistic, and in many towns, monopolistic. The claim there is going to be an increase in the supply of kidneys if kidney sales were permitted is not justified without an examination of the real markets of hospitals and physicians. It’s not clear how economic analysis that neglects elasticity of demand qualifies as an analysis rather than a piety. Also, the long term costs of kidney donation are pretty much unknown at this point in time. The costs have been more or less wished away by deeming it an act of charity.

    It seems to me that this is possibly the clearest example yet that markets without limits are an idee fixe, not a sensible program.

    (And by the way there are issues of tissue matches that may make the donors the monopsonists/monopolists, in which cases a free market will raise problems of how to subsidize the poor who need kidneys. Should subsidies pay a monopolists rates? )

    • John Halstead

      Iran is the only country in the world which legally permits kidney sales and the only country in the world without a shortage. It is absurd to say that compensating for kidneys won’t increase supply.

      • stevenjohnson2

        Everyone who needs a kidney transplant gets one? This is such a remarkable assertion it needs a little more documentation.

        Of course if your assertion was really nothing more than “Everyone in Iran who has the money can get a kidney transplant,” then it is unclear how it is different from the situation right now, when everyone who can afford the black market can get a kidney.

        • urstoff

          Those may be radically different scenarios given that the price under an open market may be much, much lower than the price under a black market. Plus, there are tons of non-financial deterrent to using a black market that don’t exist in open markets.

    • Jason Brennan

      It’s a thought experiment.

      Why you’re at it, you should email Einstein’s heirs and explain to them that there are no perfectly smooth elevators falling at constant rate of acceleration.

      • Libertymike

        We all have experienced too many uncomfortable, seemingly interminable, elevator rides, haven’t we?

      • stevenjohnson2

        Here’s a thought experiment then: Competition among kidney sellers drives down prices for kidneys, but in almost all areas of the country, the costs of the tissue matching service and the transplant surgery itself is a monopoly of the largest medical center, raising the price of the procedure. As a result, the same people who could have bought a kidney on the black market can now get one cheaper, while people with no or limited insurance, still don’t. How does the advent of a free market in kidneys do anything but lower the amount of money given to the people who sell kidneys?

        Whining about thought experiments doesn’t help. The point is whether the thought experiment actually illuminates principles or obscures them. I don’t think the OP is up to snuff, and is just libertarian piety about free markets.

        • TracyW

          How does the advent of a free market in kidneys do anything but lower the amount of money given to the people who sell kidneys?

          At the moment people are banned from selling kidneys, kidneys can only be donated for free. If the amount of money given to kidney donors is lowered under a free market, then your argument implies that under a free market kidney donors will be charged for donating their kidney. Or am I misreading you?

          • stevenjohnson2

            Yes, you are omitting the existence of black market prices for kidneys.

          • TracyW

            So, assuming that there’s a functioning black market for kidneys already, then all the “real market” effects you handwave about are already in existence. How is legalisation going to make monopoly/monopsony effects worse than they are in the black market? Are you arguing that hospitals and surgeons are less likely to work in a legal market than in a black market?

          • stevenjohnson2

            Here’s a thought experiment then: Competition among kidney sellers drives down prices for kidneys, but in almost all areas of the country, the costs of the tissue matching service and the transplant surgery itself is a monopoly of the largest medical center, raising the price of the procedure. As a result, the same people who could have bought a kidney on the black market can now get one cheaper, while people with no or limited insurance, still don’t. How does the advent of a free market in kidneys do anything but lower the amount of money given to the people who sell kidneys?

          • TracyW

            I don’t follow. If the transplant is a monopoly, why would the monopolising hospital sell things cheaper to rich patients? Profit-maxisimising companies would surely try to raise their prices, and price-discriminate so as to charge more to customers who could pay more.
            Also, I think that a lot of people concerned about the not-rich here are failing to recognise how expensive dialysis is. The NHS estimates dialysis costs them £15,000 to £35,000 a year and each kidney transplant saves around £200,000 for the NHS in net present value (so this is not-even-counting the benefits to the recipient.) In the USA, the federal government covers dialysis, and thus financially benefits from each kidney transplant. Similar things for other countries: poor people can even less afford kidney dialysis than they can’t afford transplants, so whomever is paying for their dialysis could pay for a kidney and the operation and still have money left over. As you say, we should look at real-world medical systems and in every real-world system I know of, these distributional problems are not a concern.

    • TracyW

      In support of Steve Johnson’s argument about the market power of hospitals, it is noticeable that right now the only person who doesn’t get paid is the brave soul who is actually risking their life.

  • reason60

    “Making kidney markets illegal is quite literally killing people.”
    Isn’t this the “if it saves just one life” argument?

    • urstoff

      It’s more the “stop ignoring the real costs of prohibition” argument. The fact that kidney markets will save a lot of lives is a huge positive that has to be weighed against whatever negatives there are. It may outweigh, for example, the fact that some sellers may be exploited (whatever that means).

      • reason60

        I agree with you, sincerely.
        The idea that human I life is sacred and compels us to preserve it wherever possible is exactly the argument used in favor of helmet laws, seatbelts, worker safety regulations and environmental laws.

        • Libertymike

          No, helmet laws, seatbelts, worker safety regulations, and environmental laws are pretexts for the state’s privileged purveyors of violence to harm human life.

    • John Halstead

      On a lot of moral theories if you coerce thousands of people and thereby kill them, then you need a really good justification. Critics of kidney markets have weak points, obviously surmountable points, and hand waving.

    • Jason Brennan

      Since the best argument the other side has is “It’s yucky and it offends me,” one life will do it for me.

      • reason60

        And you wonder why we find your argument unpersuasive.

        When the core concept of the sancity of the human body is contemptuously dismissed, a reasonable person has to recoil at the prospect of what sort of outcome you find desirable.

        There is in fact a persuasive ethical argument for compensation to organ donors. But it earns persuasion by engaging the moral framework of those it targets.

        All you have demonstrated so far is that you prefer your intuitions to mine.

        • Libertymike

          Okay, who is contemptuously dismissing the core concept of the sanctity of the human body? Check thy premises.

          • Jason Brennan

            If respecting the sanctity of human life means watching people die because we can’t sell human kidneys, then I think the sanctity of life is a crappy and bad thing.

        • TracyW

          If the core concept is sancity of the human body then all kidney donations, or at least all living donor donations are morally wrong. So is your position that the law should ban kidney donations given for free?

          • reason60

            If I were a fundamentalist, maybe I would think so.

            But I am operating from a more catholic, ecumenical framework, which holds a more holistic view of the human condition, meaning that there are many variables at play, with the overall goal of fulfilling the human person and building community.

            So donating of organs can be a loving and beneficial act, depending on the circumstances.

            I only noted this comment since there seems to be an odd cherrypicking notion of what is sacred.

            That is, human life is sacred, but the body isn’t; autonomy is important, but solidarity isn’t.
            The same holistic view of the human that causes me to hold that all human life is sacred, is the very same one that causes me to view the human body as sacred- they can’t be divorced from each other.

            Or maybe better to say, Jason hasn’t shown how he manages to do so.

          • TracyW

            So donating of organs can be a loving and beneficial act, depending on the circumstances.

            Indeed. As can selling a kidney.

            That is, human life is sacred, but the body isn’t;

            This seems like a very sensible approach. I think Catholics would agree that if someone loses a limb or an organ, or has a hip replacement, or the like, their life is still just as sacred and as valuable as ever.

            autonomy is important, but solidarity isn’t.

            I don’t see how you get from “solidarity is important” to “we should never pay kidney donors”. I’ve never heard anyone argue “solidarity is important so we shouldn’t pay the surgeons.” Or are you the first?

        • Jason Brennan

          If you want to see my sympathetic, careful response to the “sanctity of human life” argument, see this paper just published in Ethics:

          http://econ.as.nyu.edu/docs/IO/35350/Brennan_MarketsSemiotics.pdf

          • reason60

            Yes, thats where you attack the Mere Comodification argument.
            You use the example of markets in pets or art as examples of markets in things valued for non-instrumental purposes.

            Which works against your argument.

            We see often pets involved in divorce cases, where one side may legally hold title to the pet- but the other has enormous emotional investment, and the resulting anguish. Or the case where someone buys a beautiful historic building and demolishes it, and the resulting horror and trauma to the cultural stakeholders.

            We don’t ban the markets in these things because we recognize the larger value in them, but they do demonstrate that once something is commodified, it loses the ability to be judged by the norms of sacredness. Our laws don’t do a very good job of distinguishing between a pet or a toaster, even though we believe that one is property and one is near-human.

            You also try to conjure up a vision where we can have markets in body parts, but somehow treat them with respect and honor. And there does exist the possibility of this- in the same way that we craft special laws regarding gravesites and embalming for example.

            But then what you are really calling for is a method by which we have a “Schmarket” as you call it, a market that doesn’t behave strictly like the market in toasters.

            This is what I mean by your handwaving of culture- “we sell dogs, why not human parts” argument. You ignore the “whole person” view of human relations in favor of a “cafeteria” theory, where you can pick and choose which aspects you favor.

            My point here is not to convince you that my moral intuition is correct- my point is to explain why your argument holds little persuasive power.

          • Libertymike

            Your position lacks persuasion as it is premised, at least in part, upon the fallacies that (1) Jason is contemptuously dismissing the core concept of the sanctity of the human body and (2) that a free market in the purchase and sale of kidneys, per se, constitutes contempt for the core concept of the sanctity of the human body.
            If anything, one who opposes a free market for the purchase and sale of kidneys demonstrates his contempt for the sanctity of the human body for to hold otherwise is to spit upon all those who would benefit therefrom such a free market. What about the sanctity of the human body of the would be recipients who would otherwise perish?

          • Jason Brennan

            Well, I’ve presented this about 15 times, and gotten quite a few, “Oh, crap, your right” responses. So, hey, can’t convert everyone, but can convert many.

          • TracyW

            So you would favour a “schmarket” in kidney organs?

          • reason60

            Maybe!

            In order to determine the moral validity of an act, we need to do more than assert that there is some sort of benefit- like I pointed out below, nanny state regulations have saved perhaps more lives than any organ market, but I doubt anyone here would use that as a sole justification.

            If our goal is to produce the highest flourishing of the human spirit, promote solidarity and well-being among us, relieve suffering, and a long list of other abstract goals, I can see compensation being possible.

            But that sort of larger, “whole person” analysis is what’s lacking here.

          • TracyW

            I have never seen a larger ‘whole person’ analysis done for any type of surgery. While obviously this in itself is an argument from ignorance, if we assume, hypothetically that no such analysis has been done for say, hip replacements or open-heart by-passes or what-not, would you then be, hypothetically, in favour of banning these surgeries?

          • reason60

            “Whole person” is to you and I, what water is to fish. Its the normal way decisions get made since forever.

            I am not proposing anything of my own devising- I’m just restating bog standard European/ American Christian social justice thinking.

            Basically, the notion that the correct methodology to moral determinations is moral intuition/ revelation, examination of cultural tradition, and reasoned debate and negotiation.

            Notice that this lends itself to an open ended sort of process- there isn’t any way to determine in advance of how the outcome will go, and involves negotiation and mediation and compromise. Yes, even theologians like the bishops and rabbis negotiate and compromise, within their frames of reference.

            Contrast this with Jason’s article- he uses the legal approach of laying out a thesis, presenting evidence, drawing conclusions.
            There isn’t any doubt or ambiguity here, and none is intended. It is a purely dualistic framework- the goal is to confront and crush an opposing argument, leaving no way of escape.
            You either surrender to Jason’s point of view, or find superior arguments in opposition.
            Its difficult for me to envision this leading to a just outcome, even if his logic is sound.

            As to the specifics of your question, this process has in fact been done- the medical community has drawn up guidelines for physicians as to when these procedures should or should not be done, regardless of the customer- er, patient’s desire.
            The process was largely as described above, a meeting of different moral and ethical cultures and positions, negotiation and discussion, and compromise.
            So, as a far as I can see, these things are being done with the requisite care for the whole person.

          • TracyW

            I note that you didn’t answer my question. I was quite explicit that I was talking about hypothetically.

            As for “bog standard European/ American Christian social justice thinking”, that’s the stuff that has given us eugenics, imperialism, child-sexual-abuse cover-ups, stolen – generations of Aboriginal children in Australia and Canada, etc. I see no reason to privilege that line of thinking.

          • reason60

            Yes, it has. Fallible people produce ambivalent outcomes.
            And so you think a fundamentalist approach would yield a better quality of of justice?

          • TracyW

            So, as a fallible person producing ambivalent outcomes, in a hypothetical world where no one had done a larger, ‘whole person’ analysis of open-heart bypass surgery, you would favour banning the surgery, then?

            And so you think a fundamentalist approach would yield a better quality of of justice?

            False dichotomy. Also I have no idea what you even mean by a fundamentalist approach. I do notice, however, that you’re not even attempting to defend bog-standard European/ American Christian social justice thinking as a useful metric. I take it therefore that I have convinced you that said thinking has sucked bigtime.
            (In a final addition, I have carefully repeated your adjective of ‘bog-standard’. It is possible that somewhere out there is a system of social justice thinking not subject to the faults of the bog-standard approach.)

          • TracyW

            Basically, the notion that the correct methodology to moral determinations is moral intuition/ revelation, examination of cultural tradition, and reasoned debate and negotiation.

            I’d like to point out that there’s a long Western history of rejecting the moral revelation and negotiation parts at least of this notion. To quote for example Winston Churchill: “Never give in. Never give in. Never, never, never, never—in nothing, great or small, large or petty—never give in, except to convictions of honour and good sense.”
            Which I think is often a good thing: I see no reason to negotiate my moral determinations with racists or rapists or slavery-defenders.

            And, while I certainly often disagree with bog-standard European/American Christian social justice thinking, and think such traditions have often been actively harmful, I must say in their defence I hadn’t noticed them being particularly prone to negotiation over moral determinations. Of course, this may be a reflection of my ignorance, you are welcome to try to convince me to lower my opinion of bog-standard social justice thinking even further.

  • Jerome Bigge

    A good example of (not allowing a market to develop) is giving whole blood. We do sometimes hear that there is a “shortage” of blood. This of course is due to the fact that the donation of blood is performed as a charitable act. The donor gains little but perhaps the sense of helping someone else for all their “trouble”. With a free market where people do get paid for donating, the supply of whole blood would be considerably larger than what it is now.

    • kelly

      hello i want to donate one of my kidney i live in Nigeria and iam 30 years old so

      if you are interesting your can text me on +2348169909182 or email me

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  • Jan Masryk

    Suppose Brennan knows the correct economic theory. Then either his comments are de trop or there is an information asymmetry in the market which he can gain a rent from- in which case we would know in advance that anything he says is disingenuous.
    Suppose, on the other hand, that he does not know the correct economic theory. Then anything he says is not ‘Muth rational’.
    He’s just adding noise to the signal for a meretricious purpose.
    Who can honestly say this isn’t true?

    • Jason Brennan

      I don’t get it. Please elaborate.

      • Jan Masryk

        John Muth is a name you are familiar with. He’s an American hero- to be played by Kris Kristofesson!- Academica destroyed him, he drank a bit. But his univocal, wholly American- and therefore Universal- answer to RAND’s Arrow’s puzzle about the bureacratization of Democracy- the deontic death by a thousand cuts of almost infinite delegated legislation- in a word, the impossibility to have algorithmic, effectively computable, Liberal solutions UNLESS the correct economic theory is also gorgeously mimetically prescriptive- ah! Jason, it is rational for you to go back to your home brew.
        Economics says you are silly. But with a blonde wig, you could still wow them on Fox News.
        It’s bone structure- so I’m told.
        To elaborate. Econ is ergodic or not at all. There is a free market in kidneys for those free from repugnancy or reputational effects. But those repugnancy and reputational effects are closely related to the possibility of suffering horribly and dying.
        Essentially, above a certain threshold, nobody does not ‘regret minimize’ because the menu is robust.
        Muth Rationality, applied to Repugnancy markets, militates for canalisation such that there is increased interaction within a population sub-set.
        A bit like your writing silly books.

  • TracyW

    Wow your debate opponent really really sucks at logic.

  • Christopher Ritchie

    Once again I think it obvious that Brennan’s argumentation rests on an acceptance of a consequentialist ethical paradigm(and can perhaps be adjusted suitibly to a Deontological one). That in an ethical argument he atempts to deride ethical objections on the basis that people are merely objecting to something being ‘yucky’ is demonstrative of an underlying weakness. If you’re opponents are required to already concede the point in order for your argument to have merit…

    But sure, lets give the benefit of the doubt here; his principal point seems to be this, that the net results of generating a market in kidneys would be better than the status quo. There are several problems here. Who gets kidneys now? Who gives them now? Who would get them under this imagined market? Who wouldn’t that presently does? Are we comfortable by the reality that a market in kidneys would result in poor young people who presently get kidneys on the basis of medical analysis would loose out to older richer people? Would the market correct for this? No indication that it would. The Market values teh capacity to pay into the market, not how many years of life a new kidney is going to give you. We have a system now that implicitely values the life of the rich over that of the poor, do we want that system to be explicit? Ah! But the objection stands that we can than regulate that market for preferred outcomes. But doesn’t that just suggest we would than have a black market again? Your primarily objection to the functioning of the present system. Would a regulated market, regulated to avoid the outcomes we want be better than the present system? The OP does not suggest that it would be.

    • TracyW

      What your analysis misses is that kidney dialysis is very expensive. Whoever is paying for the kidney dialysis has a strong direct financial incentive to pay for a kidney and the transplant operation.

    • urstoff

      I think it’s true that one of the major arguments (and the best in my mind) for kidney sales is consequentialist, but aside from the occasional very committed philosopher, you can’t just throw up your hands and say “I’m a deontologist, therefore your consideration holds no weight”. Normal moral discourse is a hodge-podge of different types of moral considerations, some consequentialist, and some not. Really strong consequentialist considerations will defeat weak deontological (or whatever) considerations and vice-versa. That definitely seems to be the case with kidney markets.

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  • rahul

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  • Dr David Gray

    Are you interested in selling your kidney to overcome all your financial problem, Welcome to DAVIDGRAY HOSPITAL INC. We offer free, no obligation assistance to international patients to find world class medical treatment in India, Malaysia, Canada,United Kingdom UK, Turkey, USA. we specialize for top class medical treatment like Heart Surgery, Cancer Care, Spinal fusion surgery , sleeve hysterectomy surgery , and other major surgeries. DAVIDGRAY HOSPITAL INC offers an unmatched cost and quality advantages because it has world class hospitals and globally trained and experienced surgeons across every specialty. Whether you are considering cervical disk replacement surgery, brain tumor surgery in India, heart valve replacement surgery, or prostate cancer treatment in India,kidney treatment, we offer support and services to facilitate the care you require and also sell Kidney as well. We can help you find the best Kidney donors hospital in India, IVF hospital in India, you want to sell your Kidney in India or any were in the world, contact us now via: davegrayhospital@gmail.com, Blog:http://davegrayhospital.blogspot.com .

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  • Primussuper Specialityhospital

    Hello everyone , Primus Super Speciality Hospital is urgently in need of kidney donors with a good awarded amount of $500,000.00 We are located in Malaysia, Canada, South Africa, India , UK , Turkey and all over UAE. Interested person should kindly contact us immediately for more information.
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  • Dr. Micheal Varghese

    Are you interested in selling one of your kidney for a good amount kindly Contact us now as we are looking for kidney donor, Very urgently who are B+ve , O+ve and A+ve. Donor should be 18 years or above. Interested Donor should contact us now.
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  • Perry A Levi

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    Apollo Hospital