We are developing the social individualist meta-context for the future. From the very serious to the extremely frivolous... lets see what is on the mind of the Samizdata people.
Samizdata, derived from Samizdat /n. - a system of clandestine publication of banned literature in the USSR [Russ.,= self-publishing house]
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Let us follow the righteous policy of Iran Postrel’s kidney lasted Satel 10 years. By the time her immune system rejected it, aged 60, she had found another donor. Satel is now on her third right kidney and is feeling fine.
She was fortunate – twice. But as a policy expert the experience left Satel deeply dissatisfied with a system that relies on luck and the kindness of strangers. The reason so few kidneys are available for transplant, she contends, is that under the National Organ Transplant Act of 1984, paying for organs is illegal.
The US is not exceptional – Iran is the only country that allows such transactions and it has no kidney shortage. Satel is not advocating an Iranian-style market for body parts.
But I am.
By the way, the “Postrel” mentioned as having given Sally Satel her first donated kidney is Virginia Postrel, whose writing will be familiar to many of you.
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Who Are We? The Samizdata people are a bunch of sinister and heavily armed globalist illuminati who seek to infect the entire world with the values of personal liberty and several property. Amongst our many crimes is a sense of humour and the intermittent use of British spelling.
We are also a varied group made up of social individualists, classical liberals, whigs, libertarians, extropians, futurists, ‘Porcupines’, Karl Popper fetishists, recovering neo-conservatives, crazed Ayn Rand worshipers, over-caffeinated Virginia Postrel devotees, witty Frédéric Bastiat wannabes, cypherpunks, minarchists, kritarchists and wild-eyed anarcho-capitalists from Britain, North America, Australia and Europe.
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This seems a no brainer to me. The idea that it is somehow unseemly to pay the donor seems to ignore the fact that everyone else gets paid — the doctor, the nurse, the taxi driver who brought the kidney, the guy who makes the box the kidney came in, the clerk at the insurance company, the receptionist who signs it in, even the guy who mops the floor in the operating room after the transplant.
The only person not getting paid is the person who makes it possible.
It is worth pointing out that this can be done at various levels. For example, and feel free to stop when your ick factor kicks in:
1. Market only renewable things like blood plasma, whole blood, bone marrow, or livers. Many places allow the sale of some of these, and most places allow the sale of things like sperm or urine.
2. Only allow the sale of the body parts of people who have already died (we take them in the gift economy so why not the trade economy?) One can only imagine the situation of some young person who died (young people’s organs being the most viable and valuable). Probably loss of a breadwinner or caregiver, leaving the family in bad financial straits. So an infusion of money at that time, at no loss to them, could be spectacularly helpful.
3. Allow future contracts on body parts: you can future sell your organs so realize their value now, and have the value redeemed when you die. This means you can realize the value now without the rather icky business of cutting vital organs out of living donors.
4. The sale of redundant organs like kidneys.
I am reminded of that oft screeched cry “my body, my choice.”
Just to play devil’s advocate . . .
We restrict the sale of body parts for the same reason we restrict assisted suicide.
Certainly we can come up with many scenarios where both practices are mutually beneficial, cause no harm, and serve our life purposes.
But we can also imagine circumstances in which horrible advantage can be taken of people who are not at their best at the time, and our laws are usually weighted to address just such a situation.
We can imagine “ . . . oh, Granny, you know we love you and love having you living with us, but, well, the pain is only going to get worse, and there’s really no cure, and you’re 88, and little Suzy could really use this bedroom for her own now that she’s a teen, and Dr. Death will be in the neighborhood next week . . . ” . . .
. . . and then we add “ . . . and, if we can sell your spleen, little Jimmy can go to college . . .”
Or even imagine, if we could sell the future rights to our colons, how many of the mentally ill drug addicts in San Fransisco are going to get a check that will pay for many many grams of heroin in exchange for a signature on the colon title transfer form, and imagine how many of them will suddenly, mysteriously, die of an OD in the next few months.
That’s the impetus for the prohibition. Find a way to solve the equation for those circumstances, and you’ll go a long way towards the legalization you seek.
I’m in favor of what you’re advocating – but only if we can address the taking advantage of people. Giving people a vested financial interest in someone else’s death can make for some undesirable motivations.
Certainly worked for Prohibition era kingpin Arnold Rothstein who used to insure his associates through his own captive insurance company, knowing full well that as members of the criminal underworld, their lives were likely to be a lot shorter than the actuarial tables suggested, especially if they had themselves…an accident…
Nice money laundering scam too, beats flogging fancy paintings for inflated prices.
bobby — I asked my Dad that exact question back when I was in my early twenties (When T. Rex was still the Main Man in the ‘hood).
His answer was the same as yours, except he left out the issue of The Streets of San Francisco, wherever they may be found. (But Karl Maulden was pretty good. *g* Still, things were different back then.)
Perhaps this is yet another case where one size cannot be made to fit all. So Oregon, Vermont, Hawai’i, California, and Washington (State) permit assisted suicide, at least in some cases; whereas New Mexico has repealed its permissive law.
There is no Federal law against it, and to my way of thinking, at least at the moment, that’s as it should be. After all, the States mostly retain their “police power” in deciding what cases of homicide fall into which bin, and how the bins should be dealt with. Also, I’m pretty strongly anti-abortion, but perhaps that’s also the best solution to the abortion problem … or not.
For those who are interested, see the interesting article “‘Death with Dignity’ Laws by State,” at
https://healthcare.findlaw.com/patient-rights/death-with-dignity-laws-by-state.html
Maybe more later … or not.
Let’s not forget, a heart was 3D printed in Israel a year, or more, ago. Soon kidneys should be mass-produced, so this is solvable from many levels.
bobby b
oh, Granny, you know we love you and love having you living with us, but, well, the pain is only going to get worse
But if it is a crime to convince Granny to do something that is not in her best interest (by someone else’s judgement) then an awful lot of things are going to be illegal. Just because a person is old doesn’t mean they give up their right to self determination, even if you or I decide that that is a poor choice. Maybe granny would rather little Jimmy goes to college than she spends a few more unpleasant years with her spleen, and I’m not exactly sure what business it is of yours or mine to overrule her decision.
Of course if granny is a bit gaga, that is whole different story — where the state allows someone else to take responsibility for the life decisions of others due to incapacity, that person rightly has an obligation to act in the disabled person’s best interest, by some objective standard. But if Granny is fully firing on all four cylinders I think it is kind of patronizing to suggest that she can’t make her own decisions.
Here, in the cold light of my rational mind, I know that if I were destined for some form of dementia that would poison my relationship with my kids and have them remember me as an ugly, unkind old man, I’d rather go early. And if I could toss a few body parts on ebay to help them out after I was gone then I’d certainly do it.
And, as with every government program, if all you look at is the exceptions where things might go wrong (and no doubt there would be some) then you ignore the trail of dead bodies of people whose lives could be saved were organs more readily available. In the USA approximately 8000 people a year die, while over 100,000 people wait, sick, terrified, on tenderhooks waiting for their lottery number to come up. Being put in the horrendous situation where they are on their knees praying to their God that some other soul might die so that they can live.
I think a pretty honest question is this: if one of your kids needed a kidney to live and, while you were in hospital you encountered a family who’s dad had just been killed in a car accident, are you really a felon for saying to that destitute family “I’ll pay for the funeral if, you give me that kidney that is going to be worm food otherwise.” On the contrary, I think it should be a felony to get in the way of such a life affirming transaction.
But you’ve just encapsulated the entire problem right there.
If there’s no undue influence going on – if an adult is making an informed decision – then, go for it!
We have the laws we have because we haven’t figured out a way to ensure that this is the case every time. That’s why I said, fix this issue and we can have organ sales.
I hate those “don’t walk on the grass” signs. My few light footfalls aren’t going to kill the grass!
. . .
If it were my kid, I’d probably be sitting next to the guy with a pillow suspended over his head in case he decided to draw out his expiration unnecessarily while his kids ran out to spend my money. But if we had such an ability, we’d wipe out any idea of a registry, and (here’s the part that’s blasphemy for a libertarian) organs would then always go to the highest bidder. Yeah, sure, that’s the way everything else works – but that strikes me as just too Hobbesian in this case. (Ever see the movie John Q?)
In my view of constitutional law, yes, they certainly should be a state-by-state issues – assisted suicide and organ-selling and abortion.
But I still end up on the same side of the argument – I’d just have to make it fifty times, I guess.
In the case of assisted suicide, I tend to favour the laws against in no small part because an informed able-to-consent adult, even if truly unable to do anything else nor see that state approaching in time to act, can go on hunger strike (and, I feel strongly, should have the right to refuse consent to taking nourishment). I am of the opinion that the act of taking their life can always be theirs, so the assistance of suicide to the point of actually killing justified by prior expressed consent is never needful. (Of course, this does not apply to some already long-recognised double-effect moral cases, e.g. the WWII resistance fighter’s “Shoot me or the enemy will capture me and torture me into betraying you”, or the WWI trench soldier’s “Shoot me; I’m going to drown in this mud inside a minute and I prefer a soldier’s death by bullet.”)
Though I quite see the argument of danger of abuse applies also in the organ-selling case – IIUC such corruption is beyond-reasonable-doubt already happening in China – I do not see an equivalent of the argument I use above re suicide and I am not sure the “danger of abuse” argument can stand wholly unaided. You can take away a lot of freedom if your unwillingness to tolerate abuse is low enough. In these cases the dangers of abuse are great and I find it very revealing that precisely the people who justify power-grabs here, there and everywhere by feigning concern for statistically low risks of abuse should be so often indifferent to the risks of abuse here. But that does not solve the freedom issue – though it does tell us that the dangers of abuse are even greater than we might think because potential abusers will have narrative-controlling political allies.
And there I will leave my comment for now. I have thinking to do (and work 😐 ).
A lot to think about.
bobby b
If there’s no undue influence going on – if an adult is making an informed decision – then, go for it!
What does “undue” influence even mean? If your argument is that some people will make a poor decision that ends up deadly, therefore the government should take away their right to make that decision, then I think you should be extremely worried about the contents of your gun cabinet.
We have the laws we have because we haven’t figured out a way to ensure that this is the case every time. That’s why I said, fix this issue and we can have organ sales.
Are you in favor of other laws that prevent people from making poor decisions? For example, our government thinks that people will make a poor decision to not save for retirement, therefore the take a large chunk of your income, steal it, and call it “investing for your retirement”. They think you might make a poor decision to buy the wrong type of medicine, so they rob you of your options, and leave you to die. They think you will make a poor decision on how to educate your children so herd them all into dreadful schools that are so out of touch Laura Ingles would feel comfortable in them.
The very essence of a free society is the right to make decisions, good or bad, and suffer the consequences. For people who have some sort of mental disability we allow others to make that choice for them, and in so doing require them to make that decision in the best interest of the disabled person. Are people emotionally manipulated into poor decisions? Sure. I believe they call that “advertising”. But if we are to be a free society then that is the price we pay — you have to factor all things into your decision, including whether it upsets your scuzzy children, who you might have the misfortune of having to live with.
I hate those “don’t walk on the grass” signs. My few light footfalls aren’t going to kill the grass!
You are not seriously advocating that we should submit our individual wills to the greater good, are you? If it is my grass, then I get to tell you not to walk on it if I want to. Which is to say “get off my lawn”!
If it were my kid, I’d probably be sitting next to the guy with a pillow suspended over his head in case he decided to draw out his expiration unnecessarily while his kids ran out to spend my money.
You can’t seriously think there is no difference between killing someone for their organs and buying an organ from an expired person before it is put in the incinerator?
organs would then always go to the highest bidder
But here is the thing they you might be missing. In a market where organs are traded they probably wouldn’t be all that expensive. Probably one million people die in the USA each year. Not all of these people’s organs are suitable for transplant, but a very large percentage are. And most of them rot in the ground, or are burned in the incinerator. There is probably a market for about ten thousand organs a year (and remember one donor supplies many organs). So there is an over supply. My guess is a kidney would cost a few thousand dollars — which is probably less than the cost of the blood products used during a transplant operation.
In terms of the cost of a transplant operation, that kidney is statistical noise. However, for the family of the deceased, ten organs times $5,000 would make a very significant difference.
So the idea that Rockerfeller would get all the organs just doesn’t hold much water in my view. Markets are remarkably good at reducing the cost of things, or providing substitute goods.
The problem is that many people think that survival for the rich (who can afford to buy an organ) vs. death for the poor (who can’t afford) is somehow a bad idea. You shouldn’t be condemned to death just because you are poor.
So – maybe a system under which the Government pays for the organs and decides by lottery who gets the transplant? That would at least make more organs available.
We need also to distinguish between “live” donations (of kidneys) and harvesting of organs from the dead. That organs should be harvested from the dead, after paying families a good compensation – seems obvious, logical and correct. Why isn’t it done? What objections could one cite against this procedure? (of course – the family of the deceased needs to consent).
I heard there are some poor countries (like, say, India or the Philippines) where you can buy a kidney from a live donor. Rich people (mainly from richer countries) can arrange the transaction through intermediaries, including the transplant operation.
I’m not sure it’s fully legal, but it is done.
bobby and Niall, very good comments … but to my mind Fraser comes closest.
Not all problems we humans face have what can really be called a solution. Maybe Nicholas’s printed heart and similar innovations can work, but they have to be proven.
Fraser’s and bobby’s viewpoints are both correct, in some circumstances — but circumstances alter cases, and one size definitely does not fit all.
I really do think that as things stand, no compromise is possible between them. But if different States have different rules, some permitting and some prohibiting assisted suicide, at least some of the people facing imminent death, or the chance to save the life of a loved one, will have at least a theoretical possibility of pain-free death or of selling his or her organ(s) in order to achieve a value even higher to that person than his or her own live. (Mr. Galt, we recall, thought (foolishly, but it IS fiction) that if he took his own life, he would save Dagny, without whom his own life would be simply torment).
There is no field that I know of in which one solution is always the just one, nor even the “fair” one, nor even the one desperately wished for even by someone who is wedded to the idea that people (mostly, except for truly hard-core libertarian or other no-wiggle-room types) “should” not be allowed by others (“society”) to control his own end, provided safeguard are in place to protect the dupes or the gullible.
My husband and both of my mother’s parents died of cancer. Because their doctors and nurses put the patient’s, the individual, instant patient’s, none of them suffered the final pain accompanying death via cancer. This practice has been accepted by most doctors and nurses (“don’t ask, don’t tell”) since at least the Catholic Church eased up a bit, practically speaking. (In Grandma”s case. the Doc was a practicing Catholic.)
For many of us, maybe most of us, what we fear is not death itself but the loss of control over our own bodies, among which is the loss of our ability to control pain even with the help of meds, the loss of our ability to perform even the most basic physical functions without either pain or undignified, non-self-sufficient help, the ability to find so few moments free of pain physical or psychic (not that I see that much of a difference — Granny Smith and Winesap apples are both apples, unlike as they are in flavor).
It’s astonishing the allegedly intelligent people cannot see how a pay-for-organs market would be immediately taken over by predators who would take full advantage of those with less than ideal capacity for imagining the consequences.
When I reworked this post as a Quora question, a self-declared person who lived in Iran stepped up and declared that it’s not legal in Iran.
Who thought trusting the BBC was a good idea?
@Julie near Chicago
But if different States have different rules
Federalism is a wonderful thing, and I could not agree more. One of the biggest poisons in our system of government is the constant sucking up of all decisions to the federal level so that the competitive power of federalism can’t solve problems. Competition in government is almost as powerful as competition in commerce.
There is no field that I know of in which one solution is always the just one, nor even the “fair” one
Life is indeed not fair, but the least we can do is to leave people the hell alone to decide which of the unappealing options available to them is the least unappealing.
Doesn’t America operate the “kidney exchange“, a sort of half-way house that falls short of organ sales.
Fraser, +(10**20) or some larger figure.
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Runcie — thanks for the article. Amazing the solutions people can come up with, if allowed. :>))
There IS one concern about organ transplants- personality changes. Heart transplant patients really do take on some of the characteristics of the donor, such as changing their tastes in music. Nobody knows why, so we can’t say that kidney transplants won’t have other effects. (My reliable source for this- Fortean Times Magazine!)
FYI, Julie, I’m about 80% in favor of Fraser Orr’s viewpoint. Ever since watching some friends a decade ago, I’ve made certain I possess sufficient morphine sulfate to handle what may come, plus no one with access to an internal combustion engine need ever fear an ugly death. But, because some people might not have my clarity of mind (!?) I have misgivings about the “assisted” part of the equation. (See Grandma.)
Similarly, I’d sell a kidney in a heartbeat for the right amount of money, and I’d donate one directly to the right person. But, again, the prospect of setting up a market in which people with poor judgment or personal pressures could be taken advantage of gives me pause. (Again, See Grandma.)
Find some way to safeguard those situations, and I’m all in.
Oh, and, Yay, federalism!
bobby, clarification greatly appreciated! 😀
But prohibition laws never in themselves prevent black markets. So there will always be those with the intent of doing Granny in, whether she agrees or no; and there will always be those willing to do it, for the right price. [“Granny” is a mere 25, and her husband is 26. Why wait to inherit her fortune and resume his unfettered lifestyle? He can do the deed himself (the price is the risk he takes of getting caught, plus nerving himself up for it and figuring out how to go about it, plus possible subsequent lifelong remorse, which is at least theoretically possible); or else he can hire it done. Also, insofar as we are libertarians still vaguely in touch with reality, we go a long long way to avoid prohibiting people from making bad decisions, so hubby may even talk his young wife into the very good reasons for being dead — See Jim Jones — and after all, there is no downside to death itself, unless the living person thinks so.]
Just as gun prohibition does not prevent “gun” crime, nor the prohibition of alcohol prevent speakeasies.
Nor flat-out abortion prohibition prevent abortions (would that they could!, with the one exception of likelihood of the mother’s loss of a serious part of her normal human functioning) — yet as I said, I am in favor of returning the “police power” to the States, so that it would be legally available in some states, with such restrictions as their citizens (on the whole) think necessary and justifiable.
Etc.
However, I still look forward to your popping down here in the Lamborghini or the fancy-schmancy RV, as long as you don’t forget the mead or the dog. 😀 Um, you do have a dog, yes? If not, we can split the difference and you can bring your cat. 😀 😎