Organ Donation

[softwareNerd]

Just spotted an ARI letter to the editor, in "The Economist" (March 25th, 2006):

People should have the right to harvest and sell their organs ("Organs to order", March 11th). IF the law recognises our right to give away an organ, it should also recognise our right to sell an organ (as long as there is no coercion involved). Those who could afford to buy organs would benefit at no one's expense but their own. Those unable to pay would still be able to rely on charity, as they do today. If the government upheld these rights, many of the thousands of people now waiting for organs would be spared hideous suffering and early death. How many? There is only one way to find out: set these people free.

[lex_aver]

I think it is bad idea to implement within the framework of any of the current governments. If they redistribute wealth, then what will stop them from redistributing organs "to the ones who need them most"?

[softwareNerd]

I think it is bad idea to implement within the framework of any of the current governments.

Implement what? Today, people can donate their organs. How will allowing them to accept payment -- as opposed to making free donations -- give the government the power to redistribute the organs?

[Qwertz]

I think I see.

If you make money off selling your kidney, the government could tax it. And if they can tax it, they can offer tax breaks based on the income bracket of the donee.

It doesn't really give the government the power to redistribute organs, but it's a certainty that any mixed government would try its hardest to exert an influence over the process.

Nonetheless I think it would still be a good move to implement organ saleability, even in a mixed economy.

-Q

[D'kian]

Governments could do all sorts of things. Taxing organ sales would be the least.

How about price caps? If those in power fairly foam at the mouth when gas goes up, imagine their reaction to organ "price-gouging." What's a fair price for a kdney? I don't think we can tell without an active market, but when has ignorance stopped a government before?

Laws could be passed regulating every tiny aspect of the organ sales process. From hospital care of the seller to his travel expenses, interstate sales, internet organ sales, etc etc. Sales by minors, sales to minors, sales by the poor, sales to the poor, should organs be covered by insurance, medicaid, medicare, and so on.

And let's not forget tissues. Early in the AIDS era sales of blood were banned. To be fair, most blood sellers were high-risk for AIDS, namely heroine junkies. These days I know sperm and egs can be sold, but I've no idea if other tissues are also legally commercial. Living people could sell bone marrow, blood, blood products (like platelets) pieces of a liver or pancreas, sperm, eggs, perhaps bits of cartilage, bits of muscles, stem cells and genes.

Of course the real outcry would be that organ sales would benefit only the rich.

[Lemuel]

Of course the real outcry would be that organ sales would benefit only the rich.

Are you saying they would only benefit the rich, or just that such would be the claim of critics?

[softwareNerd]

The WSJ of Nov 13, has an article about a physician campaigning to allow organ sales.

Two interesting pieces of trivia:

The federal ban on organ sales dates back to 1983, when Virginia physician Dr. H. Barry Jacobs proposed buying kidneys -- mostly from the indigent -- and selling them to whomever could afford to buy. His plan was met with widespread outrage. In Congress, then-Rep. Al Gore (D., Tenn.) introduced legislation banning the sale of organs. The bill became law in 1984. (emphasis added)

Iran is the only country with a government-sanctioned market.

HT: Freakonomics

Edited November 13, 2007 by softwareNerd

[Jon Pizzo]

I don't really have a fully formed opinion on this, as I have not done enough research to gather many thoughts on the matter. However, I don't see where the government has the right to forbid this. I also think that this should not be looked at as "Should the government let us do this?", but rather "By what right does the government say that we can't do this?". To me, rights do not need to be made legal, because they are there with or without government recognition. An example would be gay marriage. I don't think there should be a bill that proposes to make it legal, because I don't see how it should ever be illegal in the first place.

[JMeganSnow]

And let's not forget tissues. Early in the AIDS era sales of blood were banned. To be fair, most blood sellers were high-risk for AIDS, namely heroine junkies. These days I know sperm and egs can be sold, but I've no idea if other tissues are also legally commercial. Living people could sell bone marrow, blood, blood products (like platelets) pieces of a liver or pancreas, sperm, eggs, perhaps bits of cartilage, bits of muscles, stem cells and genes.

Blood sales aren't banned (or at least I was not able to find any information on the internet indicating they are). They were de facto banned by regulating the hell out of blood banks and enforcing non-discriminatory policies. Plasma can be bought and sold because you can put plasma through a manufacturing process that cleans it of disease-causing agents. So, there is still a plasma market. Red blood cells and platelets are destroyed if put through this same process. If you're paying donors, you aren't allowed to refuse to take their blood. So, in order to protect themselves blood banks can't pay for red blood cells and platelets.

Eggs and sperm, yes. You can sell and buy those legally at present. My aunt works in a fertility clinic where they do this, actually.

Muscle tissue is basically worthless: if you need to replace muscle, you need to eat steak, not get a donation. From what I understand there's basically no way to get foreign muscle to integrate into the body, anyway.

Bone marrow could *potentially* be valuable, but the market for that would be kind of weird because donors and recepients have to match with great precision. Not to mention the fact that it basically can't be stored, so the donor has to also be willing to have the procedure at a specific time. This is what is done now with the National Bone Marrow Registry, so I think the only change would be that you'd actually receive some compensation above and beyond having your medical bills paid.

Adult humans don't actually have stem cells to sell. Our cells are differentiated.

Cartilage, bones, and tendons will never be sold out of living donors. You can live without one of your kidneys and you can regrow most of your liver. Donate your achilles tendons and you'll never walk again. I don't even want to *hear* about someone donating their *femur*. However, it should be legal to sell them from cadavers.

You don't own your genes, as in the particular sequence of ATGC that means you as opposed to someone else. Otherwise you'd wind up with people suing their identical twins for copyright infringements. So selling genes = silly. You can sell the cells that contain the genes and the buyer can make use of them to a greater or lesser extent depending on which cells you sell. But the genes should belong to whoever spends the time and effort to dig them out of the cells they inhabit.

I don't think pieces of pancreas (or even the whole pancreas) have any medical use, and you don't regrow pancreas like you regrow liver (I think), so donating this would kill you anyway.

Any other questions?

[softwareNerd]

I don't know anything about this organization, called LifeSharers, but the idea sounds like a decent one given the context of not being able to sell organs. The idea is that people sign up to be donors, and agree that other donors will get first dibs on their organs.

(Though, their FAQ says that "live donors are already moved up the waiting list". If that is true, I'm not sure what is different about this organization. I don't understand what they mean by the following: "This is already being done for live organ donors. LifeSharers helps make sure it's also done for people who promise to donate when they die.")

Edited May 19, 2011 by softwareNerd

[softwareNerd]

The good folk at the Institute for Justice are trying to fight the ban against payment for bone marrow transplants.

Here is a related story from Bloomberg.

[softwareNerd]

The good folk at the Institute for Justice are trying to fight the ban against payment for bone marrow transplants.

Kudos to the IJ for winning this case. Compensation is now legal for bone-marrow donation.

[brian0918]

I guess it's time to join to the registry and hope some millionaire needs my help.

[brian0918]

I'm not real clear on how they planned on contacting the donor directly in order to pay them, since the NMDP keeps the information confidential.

[softwareNerd]

I'm not real clear on how they planned on contacting the donor directly in order to pay them, since the NMDP keeps the information confidential.

Good question, I wonder if there are some other laws that have to be undone before usage is widespread. For instance, I'm not sure if this win also means that a person can jump the queue by paying a donor who is otherwise not going to donate.

[Snow_Fox]

I have very mixed feelings on this. On one hand I believe people should have the right to do what they want with their own body.

On the other..

I start to wonder about people who get in the situation they are in due to a lifestyle they know is destructive to begin with.

If I had a child and for some reason I couldn't give them my organs.. I would want to be able to buy them an organ.. I would try to in a heart beat if possible.. On the other hand.. I watch my parents drink, smoke and wreck their bodies nightly.. And the idea that they could just buy another organ to wreck is really well.. disgusting.

[Nigel]

So I was thinking about this recently--before ever seeing this thread. My thoughts were that, by and large, selling your organs while living raises some ethical questions. The potential for future health complications versus the value of your life would have to be fully analyzed (the bone marrow example is far less severe than giving up a kidney for example).

On the other hand, donating organs upon death is a whole different ball game. In my opinion, no doubt about it, if my organs are to be used after my death, I want my family to be compensated. Why should organs be free? To the recipient, a new organ is the gift of life, the value of that is, to many, unmeasurable however, I feel a monetary value can be placed on organs. Lets face it, hospitals potentially stand to make a fair sum of money on an organ transplant. If its my organ being transplanted, I (or my family/estate) should share in that money since with the transplant is not possible without the donor. Its like life insurance, but without a premium. For this reason, I will not donate my organs freely, my body should not be exploited as a means for others to make money. In regards to value, I am thinking on the order of tens of thousands per organ depending on the organ and the situation. Obviously a heart is worth more than a kidney, and the older you are and quality of health when you pass has some baring on value. The point is, I am 100% against the free exploitation of my organs after death.

[Leonid]

Recently in South Africa number of medical professionals have been prosecuted and sentenced for heavy fines and suspended prison terms for performing completely legitimate medical procedure-kidney transplant. From the medical point of view the procedure was flawless; doctors’ crime was against the world-wide acceptable ethical rule-under any circumstances the recipient of the organ shouldn’t pay to the donor. Never mind that such a rule directly collides with the fundamental principle of medical ethics which is a principle of autonomy.

“The principle of autonomy stands for the proposition that an adult with capacity to decide has a full and perfect right to determine what may be done to his body.1 This is a right recognized in ethics, medical practice, and law. “

http://xnet.kp.org/permanentej...

Medical ethics therefore recognize and accept the principle of one’s ownership on one own body which means that one can do whatever he pleases with any part of his body-he can donate or sell it if he whish. However, despite that organ donation from the living donor considered to be a great act of moral virtue, voluntary selling of organs is immoral and constitutes a criminal offense. The most cited reason for that is “the exploitation” of the poor and promotion of the organ’s black market, which is a killing of people and harvesting of their organs. But these arguments cannot withstand even brief examination. Organs’ black market is indeed a crime and should be treated as such. However nobody in his right mind would advocate the prohibition of money or any commodity because criminals kill people for them. In regard to the poor, if anything, blood or organ donation for money can only improve their condition. The real implicit and often explicit reason for the prohibition of organs’ selling is that such an action is selfish, for profit and therefore contradicts the “noble” altruistic nature of selfless organs or blood donation. The other reason is that free market for organs would eliminate the government monopoly on the organ transplantation as it stipulated by the National Organ Transplant Act (Congress 1984) which outlawed the commercial trade of organs. Government also established the "United Network for Organ Sharing," as the country's monopoly provider of organs. In other words, government took on itself the power which previously has been ascribed only to omnipotent God-literary the power to control life and death. The last but not the least reason is egalitarianism. The argument is that only rich people could afford organs on the free market and the poor, therefore will be discriminated. In other words, if everybody cannot be saved, then it is moral and just that we all rather should perish together. Such an altruist morality is really to die for.

Edited December 27, 2011 by Leonid