Blood and Tissue Donation

[JMeganSnow]

Has anyone thought about the moral status of organ and tissue donation? What about blood donation?

To put this question in some context:

I work for a non-profit blood and tissue bank that takes blood donations and recovers bones, skin, tendons, heart valves, corneas, veins and a few other miscellaneous bits from cadavers. I think it is very appropriate that it is a non-profit organization because we don't offer any material recompense for a cadaver.

I once asked why at an organizational meeting and recieved a very pragmatic answer, namely that we don't offer a fee because we HAVE to be able to reject donors and the law regards such a practice as "discrimination" if we offer a fee.

A local plasma service (Aventis BioServices) DOES pay for plasma, but plasma, unlike red blood cells, can be processed and sterilized before it is used.

I think that my company has a firm moral standing: we don't pay (for the above reason) and our products are FAR less expensive than most because we charge cost (I think a LITTLE over cost, but not much).

Anyone else have some thoughts?

[Bryan]

Has anyone thought about the moral status of organ and tissue donation?  What about blood donation?

To put this question in some context:

I work for a non-profit blood and tissue bank that takes blood donations and recovers bones, skin, tendons, heart valves, corneas, veins and a few other miscellaneous bits from cadavers.  I think it is very appropriate that it is a non-profit organization because we don't offer any material recompense for a cadaver. 

Are there organ donation centers that do purchase organs from cadavers? Is there a greater demand for organs and tissue than there is supplied through donations? If so, would offering money for organs and tissues help satisfy some of this demand? If someone willed their body to their family after their death to sell the organs for profit, it would be a good way to help alleviate some of the costs related to death.

I once asked why at an organizational meeting and recieved a very pragmatic answer, namely that we don't offer a fee because we HAVE to be able to reject donors and the law regards such a practice as "discrimination" if we offer a fee.

A local plasma service (Aventis BioServices) DOES pay for plasma, but plasma, unlike red blood cells, can be processed and sterilized before it is used.

I think that my company has a firm moral standing: we don't pay (for the above reason) and our products are FAR less expensive than most because we charge cost (I think a LITTLE over cost, but not much).

Anyone else have some thoughts?

If your company doesn't pay only because it gives them the legal "ok" to discriminate, that really isn't a moral reason, it's a practical one. Does discrimination even apply to dead people?

Speaking strictly from an economic approach, if there was an open "organ market", it would function in the exact same way that any other free market functions. There would be a market-clearing price for a heart or liver, which would maximize profits based on demand for these organs.

As far as my personal body, I am an organ donor. I have no problem giving my organs away after I die because I am not aware of any economic benefit they could directly provide for the people that would survive me. If there were an economic benefit, I would demand in my will they sell my body for as much money that they could get for it.

[JMeganSnow]

I'm going to address your questions one at a time to the best of my knowledge, Bryan:

1.  Are there organ donation centers that do purchase organs from cadavers?

Yes. The tissue bank I work for has several for-profit partners that purchase grafts from us. If you specifically meant "do they pay the survivors for them?", no. I refer you to this website for futher details: it is, in fact, illegal to offer monetary compensation ("incentive") to surviving family members for cadaveric donations.

2.  Is there a greater demand for organs and tissue than is currently supplied through donations? 

Heck yeah. The worst deficit lies in the realm of organ donations; organs can only be procured from heart-beating donors, i.e. still on life-support. There is more demand than can be met for tissue grafts, also. This has led to tremendous innovation in the field of medical technology, with improved mechanical hip and knee replacements, and better surgeries that don't require the use of a graft. There's even artificial skin. There are up sides and down sides to using grafts or mechanical/artificial replacements, though, so what you get depends largely on your doctor's preferences and what's available (and the price, of course). There yet remains no such thing as artificial kidneys, livers, or bone marrow, though.

3.  If so, would offering money for organs and tissues help satisfy some of this demand?

Possibly, and the above cited site certainly seems to think so. However, there are more factors to consider. The statistics the site cites are almost completely useless. First off: tissue grafts must be procured within 24 hours of death. That right there rules out many potential donors. Cause of death plays a significant part, also. Frankly, the list of restrictions is so long that I would be AMAZED if the number of potential donors that get procured even APPROACHES 30%, much less the percentage that actually gets processed and used.

If someone willed their body to their family after their death to sell the organs for profit, it would be a good way to help alleviate some of the costs related to death.

This isn't actually a question, I know, but it is something I want to address. The family is the default "owner" of the body after death unless specific provisions are made by the deceased. In Ohio they recently passed a law to make the check box on the back of a driver's license acceptable as "first person consent" for organ and tissue donation. First person consent (rightfully!) outweighs the wishes of anyone else that potentially might have an interest. In theory this means that a tissue bank could take the cadaver regardless of the family's wishes. This is never used. All other considerations aside it would be a PR nightmare. Hence, the next-of-kin is ultimately responsible for the disposition of the cadaver.

4.  If your company doesn't pay only because it gives them the legal "ok" to discriminate, that really isn't a moral reason, it's a practical one. Does discrimination even apply to dead people?

I was using the term "discriminate" in its literal sense. The payment issue really only applies to the blood half of our organization for the reason I stated above. In order to provide the best quality products we must reserve the right to turn people away for any reason whatsoever, which we couldn't legally do if we offered money.

I'm sorry my first post contained so little information, and that this one is so long.

What I'm really wondering about is not the practical or economic factors, but the ethical and moral ones. I puzzle over whether the non-profit status of my tissue bank is irrelavant or moral. I puzzle over whether we ought to pay, if the above cited law didn't exist. These are the things I'm having trouble sorting through.

One last thing: the tissue bank where I work is positively RIDDLED with altruism. Our CEO/Medical Director proudly states that the reason most people like working there is that "we don't make widgets."

It annoys the heck out of me. We DO make widgets. We make SUPERLATIVE widgets. We'd be no use to anyone if we didn't.

[scottkursk]

My dad died after waiting to long for a new heart. I really wish we were able to have done something at the time other than sit and wait for the doctors to decide who got what organs.

In the US, you can gain compensation for certain tissues but not organs. Needles to say, if you need a kidney, you have are required by law to pretty much sit there and hope your number (literally) comes up before you die. Now, there is a market alternative.

There are a few companies that are offering organ transplants in India or some other Asian countries for a fee. For about 1/2 the cost of an organ transplant here, you can go over, get the transplant, and recover in a luxury setting. Given the power of the dollar, Indians are capable of doing the surgery in exclusive hospitals pretty much dedicated to foreign nationals. Plus, you get the best of surgeons that India (or whichever country you are in) has to offer. Mind you, you also encounter the risk in that the quality of the care you'll receive here is pretty much a known factor. Still, this is a good example of caveat emptor.

If I remember correctly, they do test locals to see if they are compatible and harvest organs from live local for a fee. Obviously, things like retnas and hearts aren't included since those come from someone who died. The families of the donors of major organs like hearts recieve compensation that would equate to a good life insurance policy here. Plus from when my father was on the list, you did literally have to meet a million criteria for an organ to match. It's amazing how hard it was to match up organs. Even if I died there was a s pretty decent chance my heart wouldn't have been compatible.

On a side note, in my father's ward he was the only American. Almost everyone else had come from Europe. Canada, or Quatar. They came here since the chances of them getting a transplant, as bad as they were, are still better than their socialized medicine systems.

[Bryan]

...

it is, in fact, illegal to offer monetary compensation ("incentive") to surviving family members for cadaveric donations.

...

That is the most foolish law I've heard all week. I can understand why people would uneasy to profit off of the death of a family member, but that is no reason to make a law preventing the sale of organs to people who literally need them.

There yet remains no such thing as artificial kidneys, livers, or bone marrow, though. 

As long as the irrational law makers don't get their way about banning stem-cell research and cloning perhaps this will change sometime in the near future. I’ve always thought this to be the most beneficial potential use of cloning technology, the ability to grow "test tube" organs.

Frankly, the list of restrictions is so long that I would be AMAZED if the number of potential donors that get procured even APPROACHES 30%, much less the percentage that actually gets processed and used.

A friend of mine works at a "call center" for organ donations and he has told me the same thing. The selection process is very stringent for potential donors, which is understandable considering where these donated organs/tissue go.

I was using the term "discriminate" in its literal sense.  ...  In order to provide the best quality products we must reserve the right to turn people away for any reason whatsoever, which we couldn't legally do if we offered money.

It would be insane not to discriminate given the nature of the business. Considering that fact that people that die are in poor health it would be very hard to find usable organs to go into living bodies.

I'm sorry my first post contained so little information, and that this one is so long. 

Thank you for the lengthy reply

What I'm really wondering about is not the practical or economic factors, but the ethical and moral ones.  I puzzle over whether the non-profit status of my tissue bank is irrelavant or moral.  I puzzle over whether we ought to pay, if the above cited law didn't exist.  These are the things I'm having trouble sorting through.

I think the non-profit status is irrelevant, especially given the current legality of the business and what a touchy issue it is in general. It obviously would not be immoral if it were a for-profit business, and appears that it does provide a lot of people with gainful employment.

[DavidOdden]

I think that my company has a firm moral standing: we don't pay (for the above reason) and our products are FAR less expensive than most because we charge cost (I think a LITTLE over cost, but not much).

I think there's no moral question at all. It is perfectly acceptable for a person to try to enrich themselves by selling body parts, but by no means mandatory. If your company were somehow pressuring you into working at the parts-plant for free (or crappy wages) and used a putative obligation to help the needy as a claim on your life, that would be immoral, but they aren't and so that's that. If theye were to hawk their wares as being "self interest-free" goods and thus were claiming moral superiority over a new improved Aventis which pay people for parts (skipping the legal issues), that would be a moral issue. The question, put really simply, is whether people are destroying value, rather than preserving value. IMO, money, while valuable, is not the highest value.

[the tortured one]

I give blood as often as I can

...

for the free cookie, of course

But if I could sell it, heck, I'd make some money. I've already done so selling Platelets.

[JMeganSnow]

I'd donate blood, too, but I can't. I lived in Europe between 1988 and 1992 and I'm a geographical risk for Creutzveldt-Jakob disease.

I did manage to donate for a potassium study at one point, though.

[JMeganSnow]

My dad died after waiting to long for a new heart. I really wish we were able to have done something at the time other than sit and wait for the doctors to decide who got what organs.

I'm sorry to hear this, Scott. If we could get more donors, we would. The company where I work is expanding so fast it's not even funny; we just recently got larger facilities, and we'd overfilled them before we even moved in. We're acquiring new branches and contracts all the time and we STILL have more demand than we know what to do with.

[scottkursk]

I'm sorry to hear this, Scott.  If we could get more donors, we would.  The company where I work is expanding so fast it's not even funny; we just recently got larger facilities, and we'd overfilled them before we even moved in.  We're acquiring new branches and contracts all the time and we STILL have more demand than we know what to do with.

One thing it did show me was how important it was to be an organ donor. After all, when I'm dead, I don't need my heart or kidney etc anymore. However, I know my loved ones would get pleasure out of the idea that someone was breathing with my lungs, seeing with my retinas, etc.

[DavidV]

I don’t give blood anymore because the government has outlawed a market in it, but I have signed up for organ donation because the possibility of saving someone’s life outweighs the value of boycotting a socialist system to me.

How does one go about donating one’s body to science? It’s way too early for me to be worrying about that, but I would like to do that, if only as a protest against the “funeral industry.”

[scottkursk]

I don’t give blood anymore because the government has outlawed a market in it, but I have signed up for organ donation because the possibility of saving someone’s life outweighs the value of boycotting a socialist system to me.

You can also donate blood and "bank" the donation (in a limeted sense). So if you become sick you can make a withdrawl. Usually, people do this if they know for sure they are going to be having a surgery that will require transfusion. You don't necessarily get your own blood back but it does make securing a donation easier.

How does one go about donating one’s body to science?  It’s way too early for me to be worrying about that, but I would like to do that, if only as a protest against the “funeral industry.”

Easy, just contact a local medical school and they should have a program. They will give you what amounts to a living will/directive that says when you die what to do with the corpse. You don't have to pre-register for that any more than you have to donate organs. Your loved ones can choose at the time of your death to donate your whole body or harvest specific organs. Premortem registration just makes it easier for the medical personel in case of objections from family members. The only advantage of whole body donation is there would be no funeral costs if they accept your body.

[JMeganSnow]

I don’t give blood anymore because the government has outlawed a market in it, but I have signed up for organ donation because the possibility of saving someone’s life outweighs the value of boycotting a socialist system to me.

How does one go about donating one’s body to science?  It’s way too early for me to be worrying about that, but I would like to do that, if only as a protest against the “funeral industry.”

You could donate plasma to a company like Aventis.

If you want to donate your body to science all you really need to do is to make a provision in your will or discuss it with next-of-kin. Some things you can do (if you get a chance) to ensure that the process runs smoothly:

1. Research what tissue/organ procurement agencies operate in your area and choose one that you like.

2. Choose a funeral home that supports organ and tissue donation. Some funeral directors don't like it, oddly enough, and make a huge hassle for the procurement agency.

3. If you intend to donate to science pick a specific institution. My company doesn't do much research on its own but some of our partners do. Generally anything that doesn't get used by the tissue bank automatically goes for research.

[JMeganSnow]

You can also donate blood and "bank" the donation (in a limeted sense). So if you become sick you can make a withdrawl. Usually, people do this if they know for sure they are going to be having a surgery that will require transfusion. You don't necessarily get your own blood back but it does make securing a donation easier.

This is called an autologous donation. Red blood cells expire after 56 days, platelets after 5. Some doctors don't like it because they think it weakens the system (something you don't need immediately prior to surgery). Plasma lost through donation is generally replaced within 24 hours (it's mostly water, after all) and I think the red blood cells are completely replaced within two weeks if your system is working normally.

If you make an autologous donation you AUTOMATICALLY get your own blood back. (If you need blood, that is.) The FDA would make MINCEMEAT out of us if we messed that one up.

I think you're referring to what my company calls "directed" donations . . . if you donate and indicate you'd prefer that your blood be used for a specific purpose. It's not as restricted as an auto donation. With an auto donation, if they don't use it for you they throw it out (it doesn't get tested as strenuously as normal donations, I believe). Whereas directed donations go through the whole process, so if it can't be used for the intended purpose it can still be used for something else.

As we like to say, the best way to make sure there's blood available for you is to donate regularly.

We do autologous tissue grafts, too, generally skull flaps for brain surgery patients.

[scottkursk]

This is called an autologous donation.  Red blood cells expire after 56 days, platelets after 5.  Some doctors don't like it because they think it weakens the system (something you don't need immediately prior to surgery).  Plasma lost through donation is generally replaced within 24 hours (it's mostly water, after all) and I think the red blood cells are completely replaced within two weeks if your system is working normally. 

If you make an autologous donation you AUTOMATICALLY get your own blood back.  (If you need blood, that is.)  The FDA would make MINCEMEAT out of us if we messed that one up.

I think you're referring to what my company calls "directed" donations . . . if you donate and indicate you'd prefer that your blood be used for a specific purpose.  It's not as restricted as an auto donation.  With an auto donation, if they don't use it for you they throw it out (it doesn't get tested as strenuously as normal donations, I believe).  Whereas directed donations go through the whole process, so if it can't be .

Thank you for the clarification Megan. I was confusing the two donation types. Also, I didn't realize with the autologous donations you actually got your own blood back. Very interesting. And I was impressed the dry cleaners always manages to get my shirts back to me. That is a logistical nightmare.

[JMeganSnow]

And I was impressed the dry cleaners always manages to get my shirts back to me.  That is a logistical nightmare.

Yes, yes it is. I think I could say that 90% of our business is logistics to make sure that only good products are released and probably be completely correct.

[Adleza]

Can't seem to make the quote function work right, so:

"It annoys the heck out of me. We DO make widgets. We make SUPERLATIVE widgets. We'd be no use to anyone if we didn't."

That's awesome!

There are regular blood donation runs on my campus by the local blood center, and I donate if I am feeling well and if my iron is high enough. The reason I donate might be a little round-a-bout... I figure I might need blood one of these days, and I hope it is there for me. I know that I am not directly affecting my future by donating blood now, but it would make me uncomfortable to expect my lost blood to be replenished unless I had already done something "in return".

What makes me crazy though, is there is a strong feeling (sometimes people come right out and say it) that if you don't donate blood when you are able to, you are a morally bad person. Fear of needles? Screw that. Faint when you donate blood? Suck it up. So I wear a long sleeve shirt on the day I donate and refuse to wear the I Donated Blood sticker. Your own blood is your own to decide what to do with, and shouldn't be pressured out of you any more than money.

[JMeganSnow]

What makes me crazy though, is there is a strong feeling (sometimes people come right out and say it) that if you don't donate blood when you are able to, you are a morally bad person.  Fear of needles?  Screw that.  Faint when you donate blood?  Suck it up.  So I wear a long sleeve shirt on the day I donate and refuse to wear the I Donated Blood sticker.  Your own blood is your own to decide what to do with, and shouldn't be pressured out of you any more than money.

I read an article in TIME stating that donating blood can actually be good for you physically . . . regular donations reduce your risk of heart disease! A study done found that part of the reason that heart disease spikes in post-menopausal women is that they aren't *ahem* losing blood on a regular basis anymore. Apparently having a pint or so sucked out of your body encourages your regenerative cells to kick it into high gear.

There are also medical conditions that require "theraputic donations" . . . most notably one where your body doesn't get rid of the iron left behind when red blood cells decay (which they do, very rapidly) and it just builds up in your body until it poisons you. Individuals with this problem have to donate their iron-rich blood FREQUENTLY. AND (if I remember this right) places that do these theraputic donations are required to throw it away . . . otherwise it screws up the patient's insurance in some way and they actually are FINED for DONATING HIGH-QUALITY BLOOD. ARRGH. I would have to check on that before I could tell you absolutely, though.

So, if it bothers you to demonstrate that you donated, just write on the sticker ". . . because it's good for MY health!"

[pinknomad]

Has anyone thought about the moral status of organ and tissue donation?  What about blood donation?

To put this question in some context:

I work for a non-profit blood and tissue bank that takes blood donations and recovers bones, skin, tendons, heart valves, corneas, veins and a few other miscellaneous bits from cadavers.  I think it is very appropriate that it is a non-profit organization because we don't offer any material recompense for a cadaver. 

I once asked why at an organizational meeting and recieved a very pragmatic answer, namely that we don't offer a fee because we HAVE to be able to reject donors and the law regards such a practice as "discrimination" if we offer a fee.

A local plasma service (Aventis BioServices) DOES pay for plasma, but plasma, unlike red blood cells, can be processed and sterilized before it is used.

I think that my company has a firm moral standing: we don't pay (for the above reason) and our products are FAR less expensive than most because we charge cost (I think a LITTLE over cost, but not much).

Anyone else have some thoughts?

I was wondering if it's possible for blood to be donated after a person has died. Say a person has just died and their blood type matches with another person's (who happens to need blood) and this dead person was a donor. Is it physically possible to transfer the blood out of the freshly dead person into the other living person and have it still work?

[JMeganSnow]

No, Pinknomad, because blood starts to break down IMMEDIATELY. I happen to know this because it's often difficult to get blood samples for disease testing for Tissue after someone has died. Also, people that have died are frequently ill, on some kind of medications, seriously injured, etc.

In order to get useful blood, it has to come from a healthy person, essentially, and dead people don't count as "healthy" by any stretch of the imagination.