Virginia Postrel, who recently donated an organ herself, writes:
Expecting people to take risks and give up something of value without compensation strikes me as far more blatant exploitation than paying them. I don’t expect soldiers or police officers to work for free, and I don’t think we should base our entire organ donation system on the idea that everyone but the donor should get paid. Like all price controls, that creates a shortage – in this case, a deadly one.
Further:
The issue of lost wages is a significant one, especially since kidney patients and their friends and families are disproportionately likely to be of lower socioeconomic status. In many cases, people who might be willing to serve as living donors simply cannot take the chance of financial ruin posed by losing a few weeks of pay (and that’s assuming their understanding bosses would give them leave).
The National Kidney Foundation is shamefully, unbelievably trying to put a stop to any discussion of the use of market mechanisms to reduce the national organ shortage. They even wrote a letter to the AEI, urging them not to hold a debate on the matter.
Virginia has also written a column for Forbes (not available online for free, sadly) about how some prominent hospitals are actually refusing to do kidney transplants for people who have found their donors online or through other media. Hospitals which are denying patients legal, nonexperimental, life-saving surgery for ideological reasons include Beth Israel Deaconess Medical Center, which is affiliated with Harvard Medical School. On her blog, Virginia writes:
The transplant establishment is, unfortunately, all too accustomed to managing the shortage rather than expanding the supply of organs. Too many powerful “experts” consider a donor who is moved by a particular stranger’s story to be a generic “altruistic donor,” for whom one stranger should be exactly the same as another. By their lights, favoring someone you’ve read about over whoever’s first on the list is “unfair.”
If you have ever seen the benefits of online conversation, through blogs or journals or message boards or chat rooms, think about that. The human kindness extended to you by another individual in that context, according to these hospitals, is somehow tainted.
I thought things were bad enough with the creepazoids who want to violate every human’s civil liberties at birth by reversing non-consent to make organ donation an opt-out rather than opt-in personal decision (“You think your body belongs to you? Think again, buster. It’s just government inventory…”). This outright hostility from hospitals and the National Kidney Foundation towards methods which would resolve the shortage and save lives is downright evil.
(Cross-posted to JackieDanicki.com)
Opt-in/opt-out is about your organs after you’ve died – your rights as an individual probably won’t matter to you so much then.
Compare that with forcing someone desperate for cash to sell their organs: “you want heroin? That’ll be a kidney”. I would feel even less secure in a society which felt that pawning body parts was a good thing.
If you want to own your own body parts, the current position in Britain – though overlaid with regulatory nonsense, sentimentality, and moral panic, seems still to be that laid down by Coke in the early 17th century: “there is no property in a body”. There’s a legal as well as an institutional and social barrier to be overcome.
I don’t think we should base our entire organ donation system on the idea that everyone but the donor should get paid.
For me, that’s the whole issue in a nutshell. We can carry out a further reductio. Giving a kidney is emotive to say the least, giving blood isn’t. I knew a US citizen who gave blood regularly (civic duty and all) except, in the context of US private healthcare, she was shocked when I pointed out she’d be invoiced for receiving a transfusion. Blood isn’t free and we shouldn’t pretend otherwise. Altruism and medical procedures won’t mix until doctors and nurses offer their expensively bought skills for free. By that time we can safely assume that polar bears will be gamboling across the immense ice-sheets of a place called Hell.
Do we have, in the current scheme, a mechanism where a voluntary organ donor is placed at the front of the queue, should they ever themselves need a replacement organ?
Or are they viewed as less deserving, as they have reduced life expectancy or probability of recovery, through their earlier act of donation?
Best regards
Speak for yourself. I do not intend to leave ANYTHING to the state after I snuff it, and that includes my remains. Your presumption is astounding.
Another example of self appointed know alls deciding the rules for all regardless of what anybody else thinks.
Care to give us a hint what the AEI is?
John Angliss, where does anyone suggest “forcing” anyone else to give organs?
“Opt-in/opt-out is about your organs after you’ve died – your rights as an individual probably won’t matter to you so much then.”
Perhaps not, but it will matter to my immediate family, who are the legal owners of my remains and will be charged with carrying out my final wishes – which is to be buried with the same bits that originally accompanied me during my arrival.
Attaching credit industry semantics (the garish “opt in/out”) to the matter of organ donation is what’s really creepy here.
U.S. Johnny
Albion,
American Enterprise Institute. As here. Though it is famous for its association with aggressive US foreign policy, it does do other things.
Interesting that transplant surgeons do not think accepting (quite a lot of) money for their services makes them any less caring.
I work in a large NHS trust which has an excellent renal department. I was in their offices when involuntary cadaver transplants were mentioned. Everybody in that dept. is dead set against it. They said forcing people to give up parts of their bodies was wrong and would set many against donating. Most of the people working with renal patients would rather the public were better informed about voluntary donation.
I’ve also had conversations with doctors and nurses who argue that transplants have hindered research on working on the organs to enhance their performance through either surgery or drugs.
Although we like to see outselves as rationalists, at some point there are actions that just plain give us the creeps, no mater how we analyze it. To some extent organ “donation” hits a lot of people this way. This is why the medical establishment has tried to downplay the financial aspects of the practice. If enough people think the system is being gamed by the rich or powerful or well-connected, they will turn against donation of all sorts.
A rich person acquiring a kidney from a poor Indian trying to save his family from starvation looks not like a reasonable commercial transaction but rather total exploitation. When the power ratio between the two actors is so unequal, a strictly libertarian approach seems untenable. The current distribution system based on medical necessity is designed to avoid even the appearance of a conflict of interest, which might prevent future donations. I would see donations to the most pitiable patient appearing on television in that light. Who says the cute little blonde child has a better right to an organ than old Ken Shabby?
Basically this is too emotional a topic to go all Randian on it. This is not to say that some form of compensation for the donor can’t be worked out. However, if it is seen by the public as organ trading just for cash by the poorest of the poor, the backlash will hit like an earthquake.
“A rich person acquiring a kidney from a poor Indian trying to save his family from starvation looks not like a reasonable commercial transaction but rather total exploitation.
If the poor Indian must give his kidney to the rich man for free then that is less exploitative? What if the Indian man decides not to give his kidney, his family starve and the rich man dies? Is anyone left better off by that?
Perhaps Randians should get emotional when people are allowed to die so the unafflicted can feel morally superior.
To argue against organ-ownership, by analogy with the recent gun post here, you have to assert that a man starving to death with two kidneys is somehow better than a funded and thriving small businessman with one.
I must agree with mark adams for the most part.
Except when the poor guy with an extra kidney is purposefully denied a happier alternative to giving up a body part. Denying someone a better alternative to give up something with such value as a part of their body just to survive is immoral. This type of deceit is something that would be encouraged by a open market that is too ‘open’.
I do feel differently about blood though, because it is a renewable part of the body that helpls a lot people whereas body parts usually don’t grow back. I currently do see a problem in reimbursing donors for blood. It would likely only add like 5% or so to the cost for the patient.
Sorry, this had a typo. should be …do not see a problem …
Actually, by paying donors to give blood you might reduce the cost of blood to the end consumer since the donors would have more incentive to turn up as required rather than just when they feel like it.
Will Judd,
Who is suggesting that the poor Indian guy’s alternatives were being crushed by the rich guy? If someone destroys a prospective donor’s income in order to force him to sell his kidney, that would be vile beyond measure, of course, but the same would be true if the poor man’s valuable possession was an antiquity that had been held within his family for some time, or if the aim was to persuade the chap to cease being a hold-out opposing redevelopment.
It seems incredibly unlikely that the scenario you propose will ever take place.
Unless, that is, you mean that it is immoral to live in a world where there is poverty. Is that what you mean?
Petronius’s excellent comment of June 5th at 05:16PM encouraged me to look further at what has actually been said by the National Kidney Foundation (NKF). Having done so, I am not convinced that they deserve the strong condemnation given.
The quoted bragging by CEO John Davis (sroll to second item) is here:
Due to a successful advocacy effort by NKF, this bill does not include demonstration projects to determine if financial incentives would increase non-living organ donation. Many transplant societies and organizations supported demonstration authority but we remained steadfastly opposed believing the payment for organs undermines our values as a society.
An extract of letter (a part not quoted in the referenced article) of 25 May 2006 to the AEI from the NKF is here:
The [April 2006 Institute of Medicine] IOM report is a thorough, thoughtful and balanced analysis of the public policy dilemmas raised by proposals to increase organ donation. It was developed, at the request of Congress, by an independent panel, with members from a variety of backgrounds. The IOM committee concluded that any kind of remuneration in connection with the decision to provide organs for transplantation, even in the form of assistance for payment of funeral expenses, would raise indefensible moral issues, could affect patient safety, and, ultimately, would not reduce the national organ shortage. The National Kidney Foundation endorses the recommendations from the IOM report. NKF is unwavering in its long-established opposition to any innitiative that makes organs a commodity and its aversion to any scheme for buying and selling organs.
The “Report brief” (3 page PDF) by the independent IMO “Organ Donation: Opportunities for Action” can be found at this URL. [The full report seems not available free of charge on line.]
Though not definitive, my current view is that the NKF have a principalled position. Though one that is not obviously correct, it has its points. It is certainly anti-libertarian; however, there are risks in allowing a free market in organs.
The original posting seems to me to be objecting, having just lost the argument. Then insisting that the issue be reconsidered (presumably repeatably until the “right” answer is obtained). I could not help thinking of the EU Constitution.
Best regards
Can someone explain how a voluntary arrangement between adults can be considered exploitation? Anyway, some people seem to find the idea of someone selling body parts while alive unbearably offensive. But is this so different from other occupations where people take risks with their lives? Soldiers risk body parts or even give their lives for pay and for the good of others. Is this also a total exploitation?
Isn’t there a strong utilitarian case for allowing payment for organs? Market forces could surely create a far more efficient and well supplied system than one supplied only by charity and centrally controlled. I suspect that overall many more lives could be saved. The cost of avoiding some difficult scenarios may be the unnecessary loss of many lives.
I think care is needed in separating out certain issues.
Firstly, there is the issue of use of body parts of those who have died (suddenly, were not too old and were in good health prior to their sudden accidental death). At least part of the issue is the payment to their relatives to allow their organs to be used, which might lead to agreement to switch off life support when not necessary, or sooner than prudent.
Secondly, there is the issue of paying healthy, usually young, adults for their organs. This is with their agreement. There is the risk to society in general, if not to the individuals given the payment, that the gain in total lifespan (and quality/utility of life) might not exist, or is certainly somewhat difficult to judge as definitely beneficial. The person giving up an organ might not properly appreciate what they are giving up, especially if the amount of money seems very attractive. Society (eg through health insurance of the donor becoming ill later through donorship) might have to pick up the tag. Would, for example, a potential donor be more likely (to the greater benefit of society) to give their organ to a young poor person offering say £500 than an old rich person offering say £50,000. There is also the risk of a criminal market developing in stolen organs; on this, I recollect seeing an interesting fictional film (but currently do not recollect its title).
Thirdly , there seems to be less objection to assistance with travel expenses and loss of earnings for live donors. This is different from payment for the organ.
In general, society nowadays provides laws to protect individuals from some of the unwise decisions that they are at risk of making (eg when desperate taking out inappropriately large loans on seriously unreasonable terms). I reckon the organ donor issue should be looked at in a similar way.
Best regards
In general, society nowadays provides laws to protect individuals from some of the unwise decisions that they are at risk of making (eg when desperate taking out inappropriately large loans on seriously unreasonable terms).
Yes, and this is completely abhorrent and should be reversed. That you endorse the further nannification of individuals speaks volumes.
Concerned Citizen writes (WRT me): Yes, and this is completely abhorrent and should be reversed. That you endorse the further nannification of individuals speaks volumes.
Presumably the “volumes spoken” go beyond clear statement of my opinion, to my being wrong.
My view is that one can draw lines of decision between a totally libertarian view and a totally statist view. Where one draws them depends on the issue. I believe that I am broadly to strongly libertarian in where I draw my lines, but presumably Concerned Citizen thinks otherwise.
Taking Concerned Citizen’s view as totally pure, there would be no laws except that of strongest wins. This leads, in my view, to all of us intellectuals who are not physically strong having to survive by service to a chosen strong guy, and probably also hoping we have chosen the right one. Personally, I doubt Concerned Citizen actually goes that far.
In a world with 2 or more people, there must be some decisions that need to be made, where there is a difference of opinion. In such a case, one should argue one’s corner and then accept the overall view (by consensus, voting, whatever).
On organ donation, I see both sides. I’m content, at the moment, to go with the view (in the USA) of the IOM; I think that that particular going-with would be true, no matter what they decided (within reason as follows). I believe they are the appropriate expert body to consider all the issues and come to the best compromise decision (or rather advice to Congress). If anyone thinks truly that they are not the legitimate body or that their decision process was flawed (too fast, inadequate consultation, faulty logic), let them speak. That might change my mind; just saying we disagree, no matter how forcefully, won’t do it.
Best regards
A brilliant rejoinder, Mr. Sedgwick.
Nigel Sedgwick wrote:
Taking Concerned Citizen’s view as totally pure, there would be no laws except that of strongest wins. This leads, in my view, to all of us intellectuals who are not physically strong having to survive by service to a chosen strong guy, and probably also hoping we have chosen the right one.
Oh my, that has been refuted so many times already. Laws develop on the free market like everything else, based on the already existing economic laws of human action and the physical restraints of reality. If law enforcement is needed then on a truly free market there will be several enforcement agencies available to choose from. The market is the best provider of “checks and balances” against abuse of power. The only obstacle why it isn’t happening yet is the current belief of so many people that a state is necessary to control this or that.
In a world with 2 or more people, there must be some decisions that need to be made, where there is a difference of opinion. In such a case, one should argue one’s corner and then accept the overall view (by consensus, voting, whatever).
Why should I accept laws I don’t agree with? Truly legitimate laws need to be based either on agreement or else must be inherently valid to all persons regardless of culture or epoche (like e.g. the law of self ownership). In the case of organ donation no state-imposed law is able to suppress the black market if there is a demand. Such state-imposed paper laws only increase the price on the black market. No good effect can be expected from such laws.
Morken wrote; and I disagree.
However, as I find each of his statements inconsistent within themselves, there is a problem.
The problem is, I believe, that words mean different things to me than to Morken. Response, therefore, would lead to pointless and irresolvable argument.
If anyone else can help, that would be appreciated.
Best regards
Nigel Sedgwick wrote:
Morken wrote; and I disagree.
However, as I find each of his statements inconsistent within themselves, there is a problem.
The problem is, I believe, that words mean different things to me than to Morken. Response, therefore, would lead to pointless and irresolvable argument.
That is interesting, I believe you are right in this. The meaning of several words for different people is very probably defined in different ways, and additional to this English is not my native language. A long-time solution could be to define words before engaging in discussions.
I don’t know, Morken. What you said made perfectly clear and consistent sense to me.
I think the confusion boils down to a difference in philosophy. Some people believe that government is a given. That is, something that exists of its own right and is obligated to serve people well.
Others, like me and apparently you, think that government is a contract between people. While a government that I accept may do things that I would reject if taken individually, I accept them as a part of the government I have chosen to ally myself with. But this is not, by any interpretation, to mean that I believe in democracy as a moral source of authority. My acceptance of government acts that I disagree with is predicated on my voluntary acceptance of the sum total of that government. A government that breaks its (constitutional) contract with its constituents loses moral authority. Even if it is acting with a democratic majority.
Midwesterner wrote:
I don’t know, Morken. What you said made perfectly clear and consistent sense to me.
Thanks Midwesterner, my English is apparently then not as bad as I shortly thought it is.
I think the confusion boils down to a difference in philosophy. Some people believe that government is a given. That is, something that exists of its own right and is obligated to serve people well.
Maybe a bit offtopic, maybe not:
When I first heard about the Pledge of Allegiance and that it is recited in public schools in the US I always wondered why this unamerican national socialist poem is recited in schools and not rather a passage from the Declaration of Independence which would be far more appropriate. But I guess it is brainwashing in action.
That is a very good question, Morken. I think you guess right.
“Basically this is too emotional a topic to go all Randian on it.”
It’s too important in issue not to.
As to the poor Indian gentleman selling a kidney on the spot to some modern-day robber baron in order to eat for the day, this is a typical, and probably intentional, underestimation of what free markets can do.
Nobody can predict for sure what a free market for organs would look like, but one mechanism that might be found is something like reverse life insurance. Some agency pays me now, while I’m still kicking, for the rights to my organs should I die in, say, the next 5 years (while they can still be fairly confident of the quality). They then resell these organs once they have them in hand to the highest bidder.
That’s just one possibility, I’m sure some clever businessman will come up with better, but it just goes to show that it only takes a few minutes’ thought to improve on having to choose between a kidney and a bowl of rice.
Folks who need a kidney sometimes have a willing living donor, but they are the wrong blood type. Programs like the New England Program for Kidney Exchange solve that problem by matching two pairs of recipient-donors who face the same problem of a willing donor, but wrong blood type. This is the type of innovation that will really help solve some of these issues. website at NEPKE