Monday, February 20, 2006

Buying and Selling Organs

I received an email request to discuss the issue of setting up a market for buying and selling organs as reported in this article.

Two doctors suggested legalizing the buying and selling of organs. According to the article attached to the email, "about 400 people per year die in the UK because they are left waiting for a donor."

I received this email about a week ago, but did not have time to write on the subject right away. Then, today, I saw another related article in which a 16 year old girl died while waiting for a liver.

There is a significant difference between donating a kidney and donating a liver -- a person cannot donate a liver and live. However, establishing a market for livers still might help to reduce the shortage. A substantial cash donation to the estate of those who become organ donors will help to ensure that surviving relatives make sure that the deceaced's wish to have those organs donated are carried out efficiently.

The main argument in favor is that it would save lives -- and that is not a bad thing.

The BBC article suggests that the main argument against is that such a system would exploit the poor.

I do not see any merit to this argument. Apparently, if I get your kidney, and you get nothing, you have not been exploited. If you keep your kidney and get nothing, and I die, apparently that is okay as well. However, if I get your kidney, I live, and you get a substantial amount of money that you can use to improve the quality of your own life, then you have been exploited, and we can't have that.

Like I said, I don't get that.

Now, I do not have any difficulty imagining a science-fiction universe where the poor are used as spare body parts for the rich. I can imagine in my mind a community of individuals -- half blind, with one kidney, with patches of skin missing and scars from a dozen surgeries to remove various types of tissue, who make thier living selling body parts to the rich.

That would not be good.

Yet, there is nothing about setting up a market for organs that would require that we take this particular route. There are a lot of options between a total prohibition on organ sales, and setting up a completely unregulated market for body parts on e-bay.

A moderate position between these two extremes can establish limitations that prevent this type of horrendous scenario. For example, concerning the donation of a kidney, the physicians mention in the BBC article suggested a price of $40,000.

If this seems exploitive, one of the ways we can avoid this is to increase the payment -- make sure that the benefit to the contributor is substantial. We could, for example, make it a payment of $100,000; plus 4 years' free tuition, room, and board at a university or training in some skill. With a high price, there would likely be a surplus of candidates, allowing the government to select contributors according to who it thinks will make the most use of the benefits provided.

Another possible limit would be to allow only the government to purchase organs, and to then distribute them to those who need new organs, rather than to those who have money. In this way, we will not be setting up a system where the poor become organ farms for the rich to harvest and use as replacements.

Finally, we could add the requirement that the person supplying a kidney were to have his sole remaining kidney fail, that he would be entitled to a new one for free.

With these types of safeguards, it would be difficult to argue that the system would be exploitive. It would certainly be less exploitive than the black market that currently exists. Indeed, such a system could drive the black market out of business, since the system will ensure that there is no demand for black-market kidneys.

I can understand the squeamishness that some people may experience when thinking about this issue. Yet, it is quite possible that this squeamishness is like the squeamishness some people feel at the thought of homosexual (or interracial) sex. It is a learned response acquired through social conditioning that actually does more ham than good, and we would be better off being rid of it.

Of course, I could be wrong. I am not averse to allowing some societies to keep things like this illegal for a while, while others that are comfortable with these sorts of changes experimenting, to see if it benefits these people or if it brings about the horror stories that some fear.

A person with a good imagination can probably imagine other horrors that may be associated with paying for organs. Yet, once the individual has put his imagination to work coming up with a problem, I would like to suggest putting that same imagination to work coming up with a way of dealing with the problem other than letting people die.

Ultimately, it saves lives, and with sufficient safeguards, such a system could give both the contributor and the receiver significant better qualities of life than they would have otherwise had. It is not so obviously wrong that I am forced to object to any society giving it a try.


Anonymous said...

Hey. This is Tony Sommer, who used to have a blog called atheist thoughts. I closed it because my xanga one is perfectly fine. Anyway, this article sounds a lot like those "freaks" back a couple decades ago that were in shows and people paid to see them. The shows closed down because people started to say that these people were being exploited, but the freaks themselves were the ones opposing these people the most since this was a place where they were excepted and they got good pay. I live in Kansas City, and my dad told me that the city is going to put in video cameras that will catch people running red lights. In exchange for putting the cameras in, the city pays the company a percentige of their profits from tickets. The catch is that if there aren't enough tickets, the company gets control of the light. So then the company sets it so the yellow light is shorter and more people run red lights, so the company can get more money. The city likes the deal because more people will be caught running red lights and they'll make more money. When my dad told me this I thought of you since this seems the type of thing you dislike so much.

P.S. I don't know if this posted the first time, so I'm trying again. If it comes up twice I apologise, I'm not use to blogger

Alonzo Fyfe said...

Well, I cannot speak strongly in favor of a social institution that not only permits but encourages people to view innocent but 'different' people with shock and horror. Yet, at the same time I do not think that the best option is one that throws these people into poverty either.

I did some quick research on your traffic light issue. It turns out to be valid, as reported in the Kansas City Star. Okay, I admit, I was suspicious that this was just another gross exaggeration when I first read your description.

I'll look at it, and see if I can find something in it that has more than a local interest.

If your posting comes up twice, I will delete one of them. But, it seems to have come up at least once.

Anonymous said...

Totally in favor of organ selling.

Actually I'm even in favor of people being allowed to sell organs they need to live if they like, as that should be thier choice to make not anyone else's.

Could be a good way to encourage folks on death row to sell organs in exchange for money for their families and perhaps they could even be forced to split it with victims/victims' families.

Plus the money could even be useful to the living, ala Joe versus the Volcanoe; here's a half million dollars Mr Terminally Ill, come see me in 6 months and we'll harvest your good organs.

Really it all goes back to freedom of choice in ones own body, which is why suicide, elective surgery and everything else in this vein should be legal.

Anonymous said...

Good theory but severely prone to abuse in practice. Consider an alternative: mandatory post-mortem organ extraction.

Multiply the annual death rate with the average number of organs that were functional to the very end (two or three in even the old and ill), and you get a number very close, if not exceeding, the number of people on the waiting lists.

The biggest problem with the current practice is lack of reciprocity. If you hope to receive an organ in case of serious illness, you have to become a donor. If you are not willing to give, you do not deserve to receive.

But people do not want to think of illness and death, so most never get a donor’s card. People who have nothing against having their organs removed after death, do not make their position known.

Upon ones death the doctors have to gain approval of organ extraction from the grief stricken family, and they must get it very quickly, or the organs become useless. Most of the time they do not succeed.

The current system presumes disproval, or lack of opinion at best. But what if it presumed approval? Unless one has stated, during one’s lifetime, in the presence of one’s personal doctor and lawyer, clear disproval of organ removal, the doctors would, upon one’s death, not only be allowed but required to extract all functioning organs from the deceased.

Not harvesting the organs would fall in the category of denying treatment to several patients, a severe fault that would merit revoking a doctor’s practice license.

This would remove the black market and exploitation by removing the need of selling and buying organs. Simple and less controversial.

General society could use praise and reprimand to ensure people do not to disprove the practice. It should start right now, not just by praising donors but buy presenting the general public with the issue of reciprocity.

“Do you want to die on the waiting list? If not – become a donor today.” Or to paraphrase it positively: “Would you like to be confident in the knowledge that you will receive an organ should you ever need one? If yes – become a donor today.”

BTW: In ten to twenty years time, when a method of activating the present but dormant regeneration-triggering gene is found, the whole transplantation practice will become obsolete.

Anonymous said...

I would sell one of my fully functional kidneys for $100,000 plus full transplant bill,O-pos.