Akst on Organ Buying and Selling

Daniel Akst has some good questions:

It's illegal in this country to buy or sell organs for transplant. This is an unjust law made and enforced by people who desperately need neither organs nor money. It condemns kidney-disease sufferers to death and potential organ donors to poverty. It's a law that I will unhesitatingly break if one of my children needs a kidney, and I hope you will have the decency to do the same if a member of your family is in a similar situation.

…The unearned piety of those who condemn these transactions strikes me as outrageous. If someone has the right to abort her own fetus, why does she not have the right to sell her own kidney? By what authority does the state tell me I cannot save myself or my family members by paying money I earned to a willing seller of a surplus item?

Comments

The belief that healthcare is different than consumer goods? The belief that internal organs are categorically different than consumer goods? The belief that we should be able to stay alive even if we can't afford high priced kidneys, etc.? Fear of stolen kidneys or coerced sales?

Money is not the only currency. If you want to donate a kidney to procure one for an incompatible spouse, you could donate a kidney to someone else and create a domino effect that frees a compatible one for your spouse.

http://www.sciencedaily.com/releases/2006/07/060730134033.htm

http://surgery.about.com/od/beforesurgery/ss/LRDonationTx_4.htm

Unless you're a physician you don't get to decide who is in the most urgent need of your kidney and you should not.

If your child can live for months or years on dialysis and someone else will die tomorrow it should be obvious to any rational person who comes first. The donor lists remove the emotional component from the system.

A free market in organs removes rationality and awards the organs to the highest bidder - if a wealthy individual outbids you for the compatible kidney (or removes the kidney from consideration before you even knew it was available) where are you then? At least with the current system you have a chance - in the free market this is diminished.

That doesn't even begin to talk about what people will do to themselves for a few thousand dollars.

@alison
Chains are easier to create and maximize then loops. In practice these chains start with an altruistic donor that donates even though they do not have a loved one in need. The question is how to get more of these people who can set off those chains.

If each member of the chain pays a fraction of the cost for the one organ, and the final one goes to the person at the top of the waiting list, what's the harm?

The kidney thing is a great litmus test. Opposing their sale is abominable—to do so, you have to hate/misunderstand freedom to such an extent that you'd suffer some 90,000 Americans per year to die.

I am an adult human being, in full control of my faculties.
I own myself. It's my birthright.
Since I own myself, wherefore the objection to my sale of a patch of my own compatible skin to a burn victim in need of that tissue? Or, the sale of a compatible kidney to a victim of kidney disease (or accident) in need of that organ?

@joshua
Would it be OK if there was regulation ensuring that only people above the poverty line would be allowed to donate?

How about if instead of directly buying and selling organs, we passed a law so that anybody who donated a needed organ would no longer have to pay taxes?

When you specified your money, you should specify money you paid tax on. The USA. Just want to control the earth and every one in it. Off topic- the USA wants every other country to play by the rules and standards the USA sets in place. If you don't like it and don' t comply you can't play.

Unless you're a physician you don't get to decide who is in the most urgent need of your kidney and you should not.

Oh? On what moral authority?

This may be the most savagely immoral thing I have yet to read in an MR comment. Shame on you, sir.

"It's a law that I will unhesitatingly break if one of my children needs a kidney"...

If one of your (adult) children desperately needed cash, would you be happy for them to sell a kidney for a few thousand bucks? Why stop at kidneys? Should poor parents be allowed to sell off all their vital organs, so that the money raised can be spent on sending their kids to college?

This law - like laws on gambling - exists to prevent poor people from making rash short-term decisions.

Unless you're a physician you don't get to decide who is in the most urgent need of your kidney and you should not.

SMA, this is probably false. I'm not a doctor but I've seen many news articles about one relative donating a kidney to another. It's a safe bet that the relative would not have made the donation if he seriously thought the kidney would be intercepted by a doctor and given to an anonymous stranger thousands of miles away.

The rest of your post assumes that the current scarcity we have in terms of organ donations would continue. Which leads to the question of why you are concerned about people selling their organs on impulse. You can't simultaneously believe in serious organ scarcity and scare stories of people selling their kidneys to pay rent.

@Joe - Take that to it's logical conclusion. Imagine a regulation requiring organ recipients and their families to have significantly lower net worth and income than the organ sellers. It's hard to imagine, because such a market would dry up and cease to exist. Which underscores the fact that the market is one of exploitation.

Chris,
Very, very true. My wife works in lung transplants, and from her descriptions of median survival and quality of life impacts, neither of us would consider ever getting a lung (nor most of the other transplants). It always amazes me to see the loops people go into to get on the list. Ironically, I suspect most of the staff would choose not to recieve a transplant, but many of them (except the doctors) are donors.

Interesting that end-of-life issues have not been raised. I remain very concerned about the prospects of an organ donor market because of exploitation concerns, not merely of the poor, but also of the dying. We have people running around talking about a "duty to die" for some people. What happens when you combine that ethic with a (wink, wink, nudge, nudge) regulated market for organs? "Bring out your dead!" My concerns on this matter are so great that I have for this reason refused to list myself as a donor.

I am also very concerned about the fluid nature of whatever regulatory regime that is created. Specifically, you make a very strong case for kidneys. But I know better than to believe that we could create a market for kidneys without all other transplantable organs being added to the list. You suggest a $50k regulated minimum price for a kidney, and anticipate a surplus. I agree that this would be the result. I do not agree that you would continue, in such a circumstance, to support the $50k floor. The market would press hard for the equilibrium. Or would it?

As a regulated market, the political players are the ones that matter. My observation is that the insurance companies are well-versed in that regard. And insurers (ESPECIALLY the government) all push for lower rates of reimbursement. How long before we import almost all of our transplants--or trade them for immigration rights?

Joshua Allen - I don't follow your comparison at all. Why should the utility from donating kidneys be at all equivalent to the utility men get from having sex? If our ancestors failed to have sex, we wouldn't be here, meanwhile even the technical possibility of donating a kidney is less than a century old, so I would expect the biological drive to have sex to be far stronger than that to donate kidneys. And I have never seen spam telling me to "click here for hot kidney donation stories! True stories!". You claim that reality proves me wrong, but to do so you're going to have to convince me that your analogy is relevant, at the moment I find myself entirely unconvinced.

And how is organ selling much worse? When did improving other people's quality of life for pay become much worse than having sex, with or without pay? Are you saying that the doctor who prescribed an effective treatment for my (maddening) eczema is morally *worse* than a hooker? I mean, I'm no puritan, but I'm jolly well grateful for the medical treatment I've got through my life, I don't see anything bad at all about it.

Right-wing nut:
What happens when you combine that ethic with a (wink, wink, nudge, nudge) regulated market for organs?

Doctors and nurses are essential for all medical care, why haven't we seen the introduction of forced labour from them?

But I know better than to believe that we could create a market for kidneys without all other transplantable organs being added to the list.

Are you willing to share why you know better with us? Why for example would people not see a moral difference between organs that can be transplanted without killing the donor and organs that can't be transplanted?

How long before we import almost all of our transplants--or trade them for immigration rights?

So you are so opposed to imports or immigration rights that you are willing to let people waste away years on dialysis, or even die, rather than trade for those organs?
How about the way that the US imported penicillin from the scientists who had done the necessary work at Oxford, UK. Was that an evil act because it relied on the dreaded imports? Would you have preferred letting hundreds of thousands of people die rather than import such knowledge?

Tracy:
> Doctors and nurses are essential for all medical care, why haven't we seen the introduction of forced labour from them?

It _is_ under consideration. Look at the way that medicare/medicaid reimbursements work. Under Hillarycare, doctors would have their specialty directed from Washington.

But I think that your response is a nonsequiter to my concerns. I am specifically concerned that the creation of such a market, especially one regulated to force prices to be high, would influence decisions toward ending a life rather than seeking to cure the the condition. You appear to have missed that part of what I was saying.

>> But I know better than to believe that we could create a market for kidneys without all other transplantable organs being added to the list.

> Are you willing to share why you know better with us? Why for example would people not see a moral difference between organs that can be transplanted without killing the donor and organs that can't be transplanted?

Because I'm not refusing the evidence right in front of me? There has been a scandal in my own county where they were taking eye lenses without permission. "Kidney donations only" is not politically sustainable because there is no difference in the public mind between kidney donations and other types. You support paying for kidney donations. Your question implies that you might not support paying for donations of essential organs. Is this the case? (No one has mentioned this so far.) In the event that a patient has already died, does your position change? More generally, what are the conditions under which you believe that donors should not be compensated for their part in the transaction? Since I am concerned about a slippery slope, the political viability of your reasoning is crucial.

>> How long before we import almost all of our transplants--or trade them for immigration rights?

> So you are so opposed to imports or immigration rights that you are willing to let people waste away years on dialysis, or even die, rather than trade for those organs?

I'm opposed to exploitative markets. I did not think I needed to remind those present that the Chinese government has executed political prisoners in order to provide their organs to someone else for money. I have 0 confidence that our market would remain domestic, or that the third world participants would play by our rules--whatever they end up being.

> Sounds like a great deal for the immigrant.
So long as they're not victims of fraud. Some mistakes are harder to recover from than others.

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BTW, what is the rejection rate? Interesting that the number is not immediately available.

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As for those of you who prefer to sneer at me from the cafe at the edge of Godwin's law, I would respond first that I would prefer to actually discuss matters, and second that as a believer in liberty, I am quite used to that sort of accusation.

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Who is willing to take on my argument that insurance companies or the government itself will inevitably drive the price below the rate of the domestic market?

> As for your other argument, is there any evidence that could convince you that insurance companies or the goverment itself, wouldn't drive the price below the rate of the domestic market?

I'm talking about the rent-seeking behavior of the insurance companies. I am quite willing to concede should it stop. I'm talking about the reimbursement rates for medicaid & medicare. The monopsony-like behavior of these programs is well documented, and I would love to concede should it end. But all my money is on the opposite in each case.

"Free to leave the profession." I guess we have different ideas of "free". That looks to me like a very high cost.

I'm not talking about doctors being paid, I'm talking about them acting on the growing "duty to die" ethic, or the "quality-adjusted life expectancy" ethic to the detriment of the dying patient. My "bring out your dead" quote was the lead in to the more famous "I'm not dead yet" line from the Monty Python skit. The terminally ill patient is quite a burden to the rest of us. Adding a benefit to the actual death of the patient make the patient's situation that much more tenuous.

Are you aware that some coyotes abandon their "employers" in the middle of the desert? I'm thinking about up-front schemes and dishonest middle men. In particular, while I agree that we probably could sustain a regulation requiring that the removal occur in the States, I doubt that we could communicate this well enough to prevent con men from presenting otherwise.

I interpret the oft-wept low rate of people marking their "driver's license" for organ donation as a distrust of the slippery slope. While I don't spend time researching the issue, this is the first time that I've seen kidney donations as an issue separable from donations in general.

I guess there is a form of payment that I could support. If someone donates, they have a donation credit that they could use to move themselves or a non-compensating friend to the front of the line. This would be like a chain, but the links could actually move back and forth in time. In the limit, this is subject to the same abuses I have already mentioned, but I expect the mechanism for abuse would be slow-enough acting that the political process would likely right it.

But please, PLEASE pay a lot of attention to the slippery slope and the terminally ill. Learn about substituted judgment and what exactly a medical guardian can do. My family decided to put a DNR on grandma. The way it ended, it was absolutely right. But I fear that the mere existence of an organ market can and will poison the process. The Shiavo case was just the tip of the iceberg of what can happen.

I expect to die someday. I've been in the military. I'm not afraid to die for someone else. I just want to have a fighting chance in the matter.

I was against kidney sales until I had this idea:

As part of the donation agreement have the buyer (a firm) commit to supply the seller with a free kidney transplant if his/her remaining kidney should ever fail. This would happen so rarely that the incremental cost would be nominal, and it removes the "kill yourself for money" element of the transaction. Once the kidney market develops, it would easily provide enough "backup" kidneys that noone's safety is really threatened.

Right now, most purchased kidneys come from other countries, but that would probably change once the market took hold. Most people in developed countries (the likely buyers) would probably prefer a kidney from their own area...

If the organs of the living would turn into assets, wouldn't the same thing apply for the organs of the dead? Wouldn't this be a rather bizare situation?

Or would the government decide that the organs of the dead are public assets, if they are to be donated?
If they do this, wouldn't this be viewed the same as if the government stole assets worth tens of thousands of dollars without paying?

If some of the organs of the dead could be traded, shouldn't the same apply to all organs?

I am 22 years old, male, married, Indonesia, healthy, want to donate the one of my kidney. My blood group is O+, I'm not drink, not use drugs, and never have any kidney deseases. I want to donate my kidney for the exchange just for US$25,000.00 for my kidney, because I have a financial problem and I must gift lived for my wife and my daughter for they further. If you want to get your life back, so do I. I just want to fix my life further with my family. I hope u can help me. I am serious and if you don't trust me, you can come to my country or pick up me for the transplant in other country. If you interest, please feel free to contact me at my private e-mail : kidneyforsell@hotmail.com or contact me on +62 838 5838 199
Thank you...

nb: you pay the expence of the HLA test (Pre-transplant test), because now I've nothing for pay that.

The belief that healthcare is different than consumer goods? The belief that internal organs are categorically different than consumer goods? The belief that we should be able to stay alive even if we can't afford high priced kidneys, etc.? Fear of stolen kidneys or coerced sales?

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