The two women connected through the Paired Donation Consortium, which facilitates matching between living donors. So far, the Consortium has registered 80 pairs of donors and recipients, leading to 12 kidney swaps already in place.
James, who is a tax lawyer, reacted to the story as tax lawyers do. He immediately saw the tax issues. He wrote:
It would seem each women is "donating" a kidney to theI think James gets an A for describing the black letter law. The exchange is not a gift because they each get something in return. Each has a basis of zero in the exchanged kidney. Each has an amount realized equal to the fair market value of a kidney. The like-kind nonrecognition rules do not apply because it's not a trade, business, or investment activity. No other non-recognition provisions are relevant. There's no exclusion applicable to the transaction. The lack of cash is not an obstacle to the taxation of bartered exchanges. Though James didn't mention it, IRS rulings with respect to the sale of blood and blood products suggest that the income would be ordinary income and perhaps personal services compensation income. There's no charitable contribution deduction because no charity receives the kidneys. The substance over form doctrine treats the exchange as a swap of kidneys between the two women, each then making a gift to her husband. My guess is that there are medical expenses, which ought to be deductible to the extent they exceed the 7.5 percent adjusted gross income floor.
other's husband in exchange for a like donation. While the IRS may never dare raise the issue, could this create taxable income to each couple? They aren't gifts since something is expected in return. There isn't a like kind exchange since this isn't a business or investment type activity. Selling a kidney is illegal but swapping them seems ok.
Is it taxable? If it is taxable, would it be income to the wife or the husband? The husband gets something of value in exchange for something given up by the wife. Maybe they are constructive gifts to the husbands followed by an exchange?
That's the easy part. The tough question is whether the IRS would require taxation. What a heartless (ouch) approach to take. The IRS does have a track record in this area. So, too, does the Justice Department.
The first case is that of United States v. Garber, 607 F.2d 92 (5th Cir. 1979). Dorothy Garber learned, after the birth of her third child, that her blood contained a rare antibody useful in producing blood group typing serum. At the time she was one of only two or three people in the entire world with the antibody. A manufacturer of diagnostic reagents, Dade Reagents, persuaded her to sell to them blood plasma. The process involved withdrawing a pint of her blood, putting it through plasmapheresis to extract plasma by centrifuge, and returning the red blood cells to her body. Each appointment lasted from 90 to 150 minutes, generated a pint of plasma from two pints of blood, required injection of an incompatible blood type to increase the antibodies, caused pain and discomfort, and posed the risk of blood clots and hepatitis. Garber was paid on a sliding scale reflecting the strength of the plasma obtained in the particular appointment.
Eventually, other reagent manufacturers lured her away from Dade Reagents by offering higher prices for her plasma. She began selling both to Associated Biologicals and to Biomedical Industries. Both paid money for each extraction, and Biomedical also provided a salary, a leased automobile, and a bonus. At one point Garber was doing six extractions a month.
Although she reported the salary, Garber did not report the other payments as income, even though she received a Form 1099 from Biomedical. She did not receive such forms from Associated Biologicals. Consequently, she was INDICTED for willfully and knowingly attempting to evade a portion of her income tax liability by filing false and fraudulent income tax returns. She was convicted with respect to one of the years in issue, and sentenced to 18 months in prison, all but 60 days of which was suspended, placed on probation, and fined $5,000 in addition to her civil liabilities and penalties.
On appeal, the Fifth Circuit held that the trial court's refusal to admit the expert testimony of a CPA retained by Garber, after permitting the government's witness, an IRS agent, to testify that the transactions generated unreported income, was reversible error and remanded the case. The appellate court noted that besides the disagreement over the characterization of the transactions as performance of services or sale of products, there was disagreement in the latter instance over the valuation of the plasma. The court then made a total mess of its explanation by confusing basis and value and making some rather bizarre assertions:
The cost of Garber's blood plasma, containing its rare antibody, cannot be mathematically computed by aggregating the market cost of its components such as salt and water. That would be equivalent to calculating the basis in a master artist's portrait by costing the canvas and paints. No evidence of any original cost exists in the case of Garber's unusual natural body fluid.Sorry, but the basis in a master artist's portrait IS the cost of the canvas and paints. Moreover, setting basis equal to value makes no sense in the absence of taxation. Nor does setting value equal to the price at which something would exchange on the open market establish basis. And they wonder why I continue to insist that basic federal income taxation should be a required course. We're talking some very core concepts.
In such a situation it may well be that its value should be deemed equal to the price a willing buyer would pay a willing seller on the open market. [citations omitted] If this were the proper basis, the exchange would be a wash resulting in no tax consequences.
The concurring judge, though agreeing that the trial court's evidentiary decision was reversible error, stated, sensibly:
Because I conclude that the transactions under investigation constituted services and the income derived therefrom taxable under 61(a)(1), I should have preferred that the court say so in positive terms. The question would thus cease to be a novel one for those considering it in the future.The dissent, in which three other judges joined, concluded that there was gross income, pointed out that Garber had spent for personal purposes the portion of her fees that the payor had put into a savings account earmarked for tax payments, had not been told by the IRS that the payments were not income, and had not sought professional advice. The dissent agreed, though, with the concurring judge that the majority opinion did not provide appropriate guidance on the legal question of whether the payments were gross income. It pointed out, accurately, that if the payments were not gross income, the case should be reversed and the indictment dismissed, but that by remanding the case, the majority implied that the payments were gross income.
The good news: After the remand, the government dropped the prosecution. There's no record of whether Garber paid the unreported tax.
A year later, the Tax Court addressed the deductibility of various expenses by another plasma donor, Margaret Cramer Green. Green v. Commissioner, 754 T.C. 1229 (1980). In this case, Green was paid by Serologicals, Inc. for generating plasma through plasmapheresis. Green reported the amounts she received as gross income, offset by claimed business expense deductions. The court's analysis is most interesting, especially in light of the Garber opinions issued a year earlier:
Both parties to this case base their respective arguments upon the implied assumptions that petitioner realized income upon receiving payment for her plasma and that this income should be characterized as ordinary. Although these assumptions may seem obvious, since this case presents some novel legal questions, we feel compelled to lay a firmer foundation for our conclusions herein.So is there any difference between the extraction of plasma and the extraction of a kidney? In both instances, the taxpayer "performed no substantial service."
Clearly, petitioner realized income. Section 61 states that "gross income means all income from whatever source derived.4 Such sweeping language must be broadly interpreted to fulfill the intent of Congress to implement a comprehensive income tax. [citations omitted] Congress intended "to use the full measure of its taxing power." [citations omitted] Fulfilling this intent, the well-settled test for income is that enunciated in Commissioner v. Glenshaw Glass Co., 348 U.S. 426, 431 (1955), which looks for "undeniable accessions to wealth, clearly realized, and over which the taxpayers have complete dominion." The Fifth Circuit, to which appeal in this case would go, has followed this test as a search for lasting economic gain realized primarily by the taxpayer personally, [citations omitted] See also the Fifth Circuit's general discussions of this and other matters as they specifically relate to blood plasma sales in United States v. Garber, 607 F.2d 92 (5th Cir. 1979), revg. and remanding, on rehearing en banc, 589 F.2d 843 (1979), a criminal fraud case. All of these gains are taxable, unless specifically excluded. [citations omitted] Petitioner received the payments for her plasma directly, without any conditions subsequent which might require repayment of the funds or might control her use of the funds. The payments were not subject to any exclusion from income. [footnote omitted] The payments were gross income to petitioner under section 61.
Next, we must determine the character of the income realized by petitioner for her plasma. This income was not capital gain. Capital gain involves the sale or exchange of a capital asset. Section 1222(1) and (3). If petitioner's activity is viewed as the sale of property held for sale to customers in the ordinary course of business, petitioner's blood plasma, the property held for sale, is not a capital asset. Sec. 1221(1). On the other hand, if her activity is viewed as a service, her blood plasma is an integral part of that service and is not part of a sale or exchange. [citations omitted] Therefore, regardless of how the activity is viewed, it is not the sale or exchange of a capital asset and the income realized therefrom is not capital gain.
Nevertheless, the identification of the activity as either the sale of a product or the performance of a service is important in determining gross income and the deductibility of certain items in the calculation of adjusted gross income and taxable income, which is the general issue before us. Under the facts of this case, we find that petitioner's activity was the sale of a tangible product. From petitioner, who did little more than release the valuable fluid from her body, the plasma was withdrawn in a complex process by the equipment of the lab. Petitioner performed no substantial service. She was paid for the item extracted by the lab. Except for the unusual nature of the product involved, the contact between petitioner and the lab was the usual sale of a product by a manufacturer to a distributor or of raw materials by a producer to a processor. A tangible product changed hands at a price, paid by the pint.
The rarity of petitioner's blood made the processing and packaging of her blood plasma a profitable undertaking, just as it is profitable for other entrepreneurs to purchase hen's eggs, bee's honey, cow's milk, or sheep's wool for processing and distribution. Although we recognize the traditional sanctity of the human body, we can find no reason to legally distinguish the sale of these raw products of nature from the sale of petitioner's blood plasma. Even human hair, if of sufficient length and quality, may be sold for the production of hairpieces. The main thrust of the relationship between petitioner and the lab was the sale of a tangible raw material to be processed and eventually resold by the lab.
Not only do these cases affirm what James Butler and I think is the black letter law result, they suggest, at least to me, that the IRS probably would require reporting of the gross income by the kidney-swapping women. Are the cases different? If one tries to distinguish Garber and Green by characterizing them as motivated by economic gain, one can treat each kidney-yielding woman as motivated by economic gain, namely a kidney for her husband. If one tries to distinguish the kidney-swapping women by portraying them as altruistic and generous despite the kidney being received in turn, one can note that Garber and Green endured discomfort, pain, and risk in order to help all those unidentified individuals who benefit from medical science's use of the rare plasma.
If the IRS does so proceed, the outcry might be overwhelming. In that case, Congress can amend the Code if it so chooses, to provide an exclusion. The IRS should not arbitrarily add an exclusion to the tax law simply because it might be a good idea.
It is doubtful that the kidney-swapping women would be permitted to claim trade or business deductions. Unlike Garber and Green, who had been undergoing plasma extraction for years on a continual basis, the kidney-swapping women were engaged in a one-time transaction. It is highly unlikely the one-time transaction would rise to the level of a trade or business.
I wonder if the kidney-swapping women have consulted their tax advisors. If they did, I wonder what the tax advisors told them. I am most curious. If you were their tax advisor, what would you tell them?