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It costs an arm and a leg..or kidney: legalizing organ sales

Posted: Thu Apr 07, 2011 6:21 am UTC
by Save Point
Uniform Anatomical Gift Act wrote:SECTION 16. SALE OR PURCHASE OF PARTS PROHIBITED.

(a) Except as otherwise provided in subsection (b), a person that for valuable consideration, knowingly purchases or sells a part for transplantation or therapy if removal of a part from an individual is intended to occur after the individual’s death commits a [[felony] and upon conviction is subject to a fine not exceeding [$50,000] or imprisonment not exceeding [five] years, or both][class[ ] felony].

Link. (Most states have adopted the UAGA in one form or another.)

US Code wrote:(a) Prohibition

It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce. The preceding sentence does not apply with respect to human organ paired donation.

Link.

A while back, during a class debate, I found out I was a bit of a moral delinquent for generally favoring, though not entirely without qualification, legalizing the sale of organs for purposes of "transplantation or therapy." There are plenty of pros and cons, and I won't provide an exhaustive list of them all, but the simple fact is that there are lots of people in need of organs and a lot less people donating them, either because they are unwilling or ignorant of how to go about doing so (whether we're talking about becoming a living donor or deceased.)

There have been a multitude of proposals to remedy this, ranging from, but not limited to, an opt-out program to legalizing the sale of organs. I'm curious about your positions on the latter, from whatever perspective you prefer (moral/ethical, economic efficiency, whatever.)

So, (a) Should we legalize the sale of organs, and; (b) why or why not?

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 8:36 am UTC
by jules.LT
Putting organs on the open market increases the mortality in poor people because of the increased number of surgical operations and decreased number of functional kidneys in poor people.

The first thing to do in order to solve the organ penury is to make being an organ donor at death opt-out rather than opt-in.

Edit:
wikipedia wrote: Allowing or forbidding payment for organs affects the availability of organs. Generally, where organs can not be bought or sold, quality and safety are high, but supply is not adequate to the demand. Where organs can be purchased, the supply increase somewhat, but safety declines, as families and living donors have an incentive to conceal unfavorable information

This is not sourced, but it's convincing to me.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 1:19 pm UTC
by torgos
Iran has a legal kidney market; how has it worked out? Relevant paper(which I have not fully read through):
http://gsme.sharif.edu/~ffatemi/Researc ... an2010.pdf

A middle of the road option that sidesteps the usual qualms about selling kidneys is to create a Kidney matching market(albeit an option that will have a smaller effect on waiting times). There's currently one in New England. I don't know much about it, but the wikipedia page on Al Roth has some presumably relevant links:

http://en.wikipedia.org/wiki/Alvin_E._Roth

I support the idea of legal kidney sales, with the reservation that it should be carefully regulated; donors should be well apprised of potential health risks, and I'm inclined to ban people above a certain age from participating in the market.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 2:49 pm UTC
by Hedonic Treader
jules.lt wrote:Putting organs on the open market increases the mortality in poor people because of the increased number of surgical operations and decreased number of functional kidneys in poor people.

The first thing to do in order to solve the organ penury is to make being an organ donor at death opt-out rather than opt-in.

And the second thing? Is it really better to let people die than to allow the poor to sell them organs? The assumption that the mortality of the poor goes up might not factor in the increased quality of life and/or life expectancy from the additional income the poor could gain in a potentially open organ market. With sufficient financial compensation, this might out-weigh the risk for many who would consider making this decision.

wikipedia wrote:Generally, where organs can not be bought or sold, quality and safety are high, but supply is not adequate to the demand. Where organs can be purchased, the supply increase somewhat, but safety declines, as families and living donors have an incentive to conceal unfavorable information

Are there no objective medical ways to measure quality and improve safety?

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 6:53 pm UTC
by fr00t
jules.lt wrote:This is not sourced, but it's convincing to me.


I don't think that argument needs to be sourced, as it is a straightforward application of supply and demand. The government has placed a $0 ceiling on the price of organs, so no wonder there is a shortage.

jules.lt wrote:The first thing to do in order to solve the organ penury is to make being an organ donor at death opt-out rather than opt-in.


Exactly. I remember some TED video (not about organ donation specifically but cognitive bias' or something) where the US has something like 5% donor rates and some country in Europe has like 90%+. The only meaningful difference, according to the speaker, is that their form has them opt out instead of opt in. I.e. humans are much more inertial in their decision making than they think.

I just had a pretty good idea. Why don't they have some sort of "organ club" where those who have opted to donate organs upon their death will receive priority on receiving organs when they are alive? It would give everyone a non-monetary incentive to sign-up, increasing supply without the undesirable aspects of free-market organ trading, and those who are irrational enough to still not want to donate organs can simply be allowed to die.

edit: apparently that's a commonly suggested idea.. and there's a private club for it already (www.lifesharers.org) and Israel has adopted it nationally.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 6:58 pm UTC
by omgryebread
fr00t wrote:I just had a pretty good idea. Why don't they have some sort of "organ club" where those who have opted to donate organs upon their death will receive priority on receiving organs when they are alive? It would give everyone a non-monetary incentive to sign-up, increasing supply without the undesirable aspects of free-market organ trading, and those who are irrational enough to still not want to donate organs can simply be allowed to die.
It's a good idea, but sucks for people who can't donate organs, even if they wanted to.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 7:08 pm UTC
by fr00t
Ok, combine both solutions.

You have to specifically fill out some form to opt-out of organ donation (and wait in line at the dmv and have your name posted on a public list). If you opt-out you cannot receive organs should you need them. Distribution of organs after that is a separate issue (children first, mostly healthy first.. whatever)

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 7:29 pm UTC
by Izawwlgood
Distribution of organs by triage is the opposite of distribution for profit.

For what it's worth, read about how Steve Jobs got his new organ. Spoiler: It involved having the money to register at a bunch of different hospitals, and fly around the country for checkups. I.e., while you can't goto 'Spleens 'R Us' and pick one up for 20k, if you have more money, you're better able to get the organs you need.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 7:33 pm UTC
by Vaniver
Banning organ sales in any form is morally reprehensible. There are few issues I will rant about, but this is one of them.

The thought that the poor would suffer more with a legal organ market than they do now is murderous idiocy. Remember, about a dozen people on the kidney wait list die every day. There's more at stake here then posturing or envy.

When a kidney transplant happens, there's a chance the donor won't wake up. This is true for any major surgery. But if a kidney transplant doesn't happen, there is a 100% chance that the recipient won't wake up. Why, exactly, is it justifiable to trade a tiny mortality rate for a 100% mortality rate?

"But," some thoughtlessly cry, "kidneys would be expensive! The poor would be crowded out of the market!" To them I ask, have you heard of dialysis? The average wait for a kidney is 5 years. The average cost of dialysis is $50,000 a year. That "free" kidney costs, on average, $250,000. And you don't get a refund if you die before you get a kidney. If instead you could buy a kidney as soon as you needed one, then you wouldn't have to pay for dialysis for more than a few weeks- and if kidney prices settle at around $25,000, as expected, buying a kidney will only cost as much as 6 months on dialysis costs now (a tenth the current price). Studies also show, unsurprisingly, that the longer that you wait to get a new kidney, the less time you will survive afterwards- meaning our system not only kills those that don't receive a kidney, but also kills sooner those that do (as the system gives kidneys to the sickest matches on the list). And, by the way, for those who would sacrifice people on the altar of equality- your odds of surviving to get a kidney under the current system are better if you're richer. Without the wait, odds of surviving would equalize.

Note that I said "buy a kidney as soon as you needed one." In Iran, there is a waitlist for kidneys. The waitlist is to sell them. As soon as someone needs one, they can find buyers who match them, and, importantly, they can pick the healthiest buyer. The result is that people waiting to sell their kidney live better and get more medical checkups to improve the value of their organs. Not only does organ trading save those who need organs, it improves the health of those looking to sell their organs.

Then, of course, one can make appeals to liquidity and freedom, but it hardly seems necessary. Someone who sells their kidney can use the money to start a business or go to college or make some other improvement to their life. They wouldn't do it if they didn't think it was worth it, and once the backlog clears there won't be any reason to buy from someone who makes terrible life choices (I have been asked before, 'what about hobos who will sell their kidneys to fuel their addiction?', to which I reply, "who would buy their kidneys?"), so that undesirable trade will be self-preventing.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 8:54 pm UTC
by *bird
Vaniver wrote:Then, of course, one can make appeals to liquidity and freedom, but it hardly seems necessary. Someone who sells their kidney can use the money to start a business or go to college or make some other improvement to their life. They wouldn't do it if they didn't think it was worth it, and once the backlog clears there won't be any reason to buy from someone who makes terrible life choices (I have been asked before, 'what about hobos who will sell their kidneys to fuel their addiction?', to which I reply, "who would buy their kidneys?"), so that undesirable trade will be self-preventing.


I wonder though if there's an incentive to cheat in this system (hide information about bad lifestyle choices/health/etc). Aren't you assuming perfect information in this system?

Anyways, I think this will be moot in years since the technology to make organs is available already; it just needs refinement.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 9:18 pm UTC
by Silknor
Certainly there would be an incentive to try to cheat the system by pretending your organs are healthier than they are. But you don't need perfect information to stop this, only reasonably good medical tests to ensure an organ is healthy. I find it hard to believe we don't both have and use that ability already.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 9:23 pm UTC
by Glass Fractal
*bird wrote:
Vaniver wrote:Then, of course, one can make appeals to liquidity and freedom, but it hardly seems necessary. Someone who sells their kidney can use the money to start a business or go to college or make some other improvement to their life. They wouldn't do it if they didn't think it was worth it, and once the backlog clears there won't be any reason to buy from someone who makes terrible life choices (I have been asked before, 'what about hobos who will sell their kidneys to fuel their addiction?', to which I reply, "who would buy their kidneys?"), so that undesirable trade will be self-preventing.


I wonder though if there's an incentive to cheat in this system (hide information about bad lifestyle choices/health/etc). Aren't you assuming perfect information in this system?

Anyways, I think this will be moot in years since the technology to make organs is available already; it just needs refinement.


There must be some sorts of tests to establish if, at a minimum, the person offering the organ is healthy.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 9:34 pm UTC
by pizzazz
In even an average hospital in a wealthy, industrialized nation, standards of quality control for organ donations would be high enough to probably rule out addict organs altogether, and certainly would require numerous tests to assure accurate information can be given to potential organ receivers.

This topic was actually mentioned briefly in my Econ class this week (as a supply and demand application), and so it's easy to see why there's a kidney shortage. Although, the textbook described a different case: a mother wanted to donate her kidney to her child, but was incompatible, so she donated her kidney to someone else in exchange for her child moving to the top of the lift. This probably wouldn't completely eliminate the shortage, but it could make it much easier for relatives in a similar situation to effectively donate an organ.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 9:53 pm UTC
by Bubbles McCoy
Vaniver wrote:"But," some thoughtlessly cry, "kidneys would be expensive! The poor would be crowded out of the market!" To them I ask, have you heard of dialysis? The average wait for a kidney is 5 years. The average cost of dialysis is $50,000 a year. That "free" kidney costs, on average, $250,000. And you don't get a refund if you die before you get a kidney. If instead you could buy a kidney as soon as you needed one, then you wouldn't have to pay for dialysis for more than a few weeks- and if kidney prices settle at around $25,000, as expected, buying a kidney will only cost as much as 6 months on dialysis costs now (a tenth the current price). Studies also show, unsurprisingly, that the longer that you wait to get a new kidney, the less time you will survive afterwards- meaning our system not only kills those that don't receive a kidney, but also kills sooner those that do (as the system gives kidneys to the sickest matches on the list). And, by the way, for those who would sacrifice people on the altar of equality- your odds of surviving to get a kidney under the current system are better if you're richer. Without the wait, odds of surviving would equalize.

I agree with your conclusions, but there seems to be some serious number inflation going on here...

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Thu Apr 07, 2011 10:58 pm UTC
by Vaniver
Bubbles McCoy wrote:I agree with your conclusions, but there seems to be some serious number inflation going on here...
Unfortunately, that is because I'm using more recent data and things have gotten worse.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 12:38 am UTC
by KingofMadCows
People rely too much on their gut reactions when they make decisions about these kinds of policies. They just can't get over the potential for abuse. The fact that people can be coerced into selling their organs overshadows everything.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 2:31 am UTC
by slightlydead
china takes organs from the executed. Maybe we should follow them?

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 2:43 am UTC
by Tirian
KingofMadCows wrote:People rely too much on their gut reactions when they make decisions about these kinds of policies. They just can't get over the potential for abuse. The fact that people can be coerced into selling their organs overshadows everything.


I don't think the alternative is any prettier, that we acknowledge that organs have tremendous value and then decide that we're too morally superior to pay for them. I'd like to believe that we take this position because we honor the bodily integrity of the poor, but then I notice that the rich man is getting his transplanted kidney for free instead of having to pay a poor man's estate for it. It's not like anyone else in the health care industry is doing their work for free just because saving lives is its own reward and it all comes around in the end.

I'm similarly critical of changing organ donation to being opt-out. I don't doubt that we'd be able to save lives by tricking lazy people into giving their organs away, but that leaves a sour taste in my mouth. Again, if something has financial value to you and you can't find enough people giving it away to satisfy your needs, then I think it's immoral to work out strategies other than paying for it.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 3:01 am UTC
by KingofMadCows
Tirian wrote:
KingofMadCows wrote:People rely too much on their gut reactions when they make decisions about these kinds of policies. They just can't get over the potential for abuse. The fact that people can be coerced into selling their organs overshadows everything.


I don't think the alternative is any prettier, that we acknowledge that organs have tremendous value and then decide that we're too morally superior to pay for them. I'd like to believe that we take this position because we honor the bodily integrity of the poor, but then I notice that the rich man is getting his transplanted kidney for free instead of having to pay a poor man's estate for it. It's not like anyone else in the health care industry is doing their work for free just because saving lives is its own reward and it all comes around in the end.

I'm similarly critical of changing organ donation to being opt-out. I don't doubt that we'd be able to save lives by tricking lazy people into giving their organs away, but that leaves a sour taste in my mouth. Again, if something has financial value to you and you can't find enough people giving it away to satisfy your needs, then I think it's immoral to work out strategies other than paying for it.


I think people generally use the more negative potential consequences to argue their point since it's more emotionally salient. It's like the arguments people have made against a beta blocker that helps degrade encoding of memories. The idea is to give the drug to people who have experienced traumatic events so that they can forget about those events, preventing the development of psychological problems. The critics argue that it can be used for things like date rape and by criminals who want to erase their memories of crimes.

As for organ donation being opt-out, there are some more legitimate arguments against it since there are certain religious beliefs that are against organ donations. I believe Jehovah’s Witnesses, Christian Scientists, and the Shinto Buddhists are against it. It could be argued that making organ donations opt-out violates the religious freedom of these faiths.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 3:13 am UTC
by Magnanimous
slightlydead wrote:china takes organs from the executed. Maybe we should follow them?

This would be the opt-in default that everyone's talking about, essentially.

There are certainly religious conflicts with an opt-in default, but I wouldn't think they would be that hard to get over. A lot of people in the US have declared a religious preference (though I don't know how formal this is). If nothing else, there could be an official organ declaration on your Nth birthday (with the option to declare at any time); we already have a lot of rights associated with birthdays.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 5:02 am UTC
by Glass Fractal
KingofMadCows wrote:As for organ donation being opt-out, there are some more legitimate arguments against it since there are certain religious beliefs that are against organ donations. I believe Jehovah’s Witnesses, Christian Scientists, and the Shinto Buddhists are against it. It could be argued that making organ donations opt-out violates the religious freedom of these faiths.


It's not enforced donation, it's opt-out. They can, you know, opt-out if they want to.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 5:07 am UTC
by alexh123456789
Tirian wrote:I'm similarly critical of changing organ donation to being opt-out. I don't doubt that we'd be able to save lives by tricking lazy people into giving their organs away, but that leaves a sour taste in my mouth. Again, if something has financial value to you and you can't find enough people giving it away to satisfy your needs, then I think it's immoral to work out strategies other than paying for it.


The way I imagine it'd work is similar to being an organ donor today, except you check the little box to opt-out. In this scenario, you aren't tricking anybody, and even if they somehow misunderstood, you would be saving thousands of lives at essential no cost; dead people have no need for their organs.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 5:16 am UTC
by Magnanimous
Glass Fractal wrote:
KingofMadCows wrote:As for organ donation being opt-out, there are some more legitimate arguments against it since there are certain religious beliefs that are against organ donations. I believe Jehovah’s Witnesses, Christian Scientists, and the Shinto Buddhists are against it. It could be argued that making organ donations opt-out violates the religious freedom of these faiths.


It's not enforced donation, it's opt-out. They can, you know, opt-out if they want to.

You can't opt-out if you're dead, though. And most religions are particular about what you do with the deceased.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 5:18 am UTC
by Glass Fractal
Magnanimous wrote:
Glass Fractal wrote:
KingofMadCows wrote:As for organ donation being opt-out, there are some more legitimate arguments against it since there are certain religious beliefs that are against organ donations. I believe Jehovah’s Witnesses, Christian Scientists, and the Shinto Buddhists are against it. It could be argued that making organ donations opt-out violates the religious freedom of these faiths.


It's not enforced donation, it's opt-out. They can, you know, opt-out if they want to.

You can't opt-out if you're dead, though. And most religions are particular about what you do with the deceased.

You can't opt-in if you're dead either, yet we still get organs under the opt-in system so I assume this is a decision one can make while alive.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 5:29 am UTC
by CorruptUser
Sorry, opt-out implies that the government/society has a right to your kidneys that you are allowed to deny, not a right you grant. It might not seem like much, but it is huge philosophically.

What needs to be done (among many, many things) is the media should pay more attentions to obvious cases of rich people bribing the hospitals to give them organs. Remember how quickly Steve Jobs got that new liver?

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 6:40 am UTC
by Bubbles McCoy
Vaniver wrote:Unfortunately, that is because I'm using more recent data and things have gotten worse.

Poking around a bit, you appear to be quite right... hot damn this is a money waster, that's about three times as expensive as I thought it was (at which point it still seemed like quite the deal to allow payment for organs).

Tirian wrote:I'm similarly critical of changing organ donation to being opt-out. I don't doubt that we'd be able to save lives by tricking lazy people into giving their organs away, but that leaves a sour taste in my mouth. Again, if something has financial value to you and you can't find enough people giving it away to satisfy your needs, then I think it's immoral to work out strategies other than paying for it.

I guess I don't quite see this as just tricking people. Everyone will still have to ask themselves the question at the DMV, it's just a matter of how the question is phrased - asking "will you refuse to donate your organs in the event of your death" versus "will you allow your organs to be donated in the event of your death." I don't know if it's a matter of trickery so much as trying to force people to confront the implications of their decision a little more directly.

CorruptUser wrote:Sorry, opt-out implies that the government/society has a right to your kidneys that you are allowed to deny, not a right you grant. It might not seem like much, but it is huge philosophically.

It doesn't intrinsically mean anything philosophically. As-is, there are laws on the books concerning how your material possessions are split in a disposition after dying; if your internal organs are defaulted to the medical institution you died in there's not much of an ideological shift, only a specific religious custom no longer being assumed by default.

And I don't quite get why we should prioritize investigating organ-based bribes is what most "needs to be done." Someone's devised a system that would likely eliminate shortages for everyone, and you're more worried about rectifying an inequality that would completely cease to exist if this effort is successful? Why bother?

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 7:19 am UTC
by KingofMadCows
Bubbles McCoy wrote:It doesn't intrinsically mean anything philosophically. As-is, there are laws on the books concerning how your material possessions are split in a disposition after dying; if your internal organs are defaulted to the medical institution you died in there's not much of an ideological shift, only a specific religious custom no longer being assumed by default.


But do you think that'll stop people belonging to religions against organ donation from fighting such a policy?

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 7:28 am UTC
by Bubbles McCoy
Probably not. But I'm not sure if there'd be much of a fight, we're literally just looking to change the wording on a box on a DMV form. I don't know if anyone can muster up much of an organized opposition to something like that.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 8:27 am UTC
by jules.LT
People who find it important enough can sign the opt-out form for their kids at birth if they like, so "you can't opt-out when you're dead" isn't a strong limitation: it only depends on how important it is to them.

The benefit to society is so huge that this really shouldn't be stopped for the sake of those who think it's important but won't bother, as long as the form is reasonably available.

Only after this massive increase in supply can you evaluate the cost of a donated kidney as compared to the cost of a sold kidney.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 2:04 pm UTC
by Tirian
alexh123456789 wrote:
Tirian wrote:I'm similarly critical of changing organ donation to being opt-out. I don't doubt that we'd be able to save lives by tricking lazy people into giving their organs away, but that leaves a sour taste in my mouth. Again, if something has financial value to you and you can't find enough people giving it away to satisfy your needs, then I think it's immoral to work out strategies other than paying for it.


The way I imagine it'd work is similar to being an organ donor today, except you check the little box to opt-out. In this scenario, you aren't tricking anybody, and even if they somehow misunderstood, you would be saving thousands of lives at essential no cost; dead people have no need for their organs.


Someone upthread makes the point that the registration rates in Europe are grossly higher than registration rates in the United States and conjectures (accurately, I think) that the difference is that a relatively small proportion of people can be bothered to find and check a box no matter what the box says. My opinion is that this is foolish ignorance, since for very many people the most valuable asset they own is their body. But it's understandable at the same time, since medical ethics from ancient times have declared that life is priceless and therefore we can't be attaching monetary values to things that save and preserve life. Except, of course, that that's a load of hogwash in modern times because insurance companies place value on life all the time and pharmaceutical companies extract maximum profits as well as they can.

It's just you and me who need to pay large amounts of money if we need a unit of blood at the hospital but can't make money by selling our blood into that same pool. Organs are the same. Let's say a healthy man dies unexpectedly. I agree that he doesn't need his liver (although some religious traditions will disagree with us), but it's just as true that his widow and children just lost a significant source of income and his organs are worth a non-trivial amount of money to someone. I think the right decision is to negotiate a settlement that is beneficial to both of these parties, and frankly I do consider that it is a nasty trick to simply take his organs for free after noting that he failed to check off such and such a box when he renewed his driver's license.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 3:04 pm UTC
by Zamfir
Tirian wrote:It's just you and me who need to pay large amounts of money if we need a unit of blood at the hospital but can't make money by selling our blood into that same pool. Organs are the same. Let's say a healthy man dies unexpectedly. I agree that he doesn't need his liver (although some religious traditions will disagree with us), but it's just as true that his widow and children just lost a significant source of income and his organs are worth a non-trivial amount of money to someone. I think the right decision is to negotiate a settlement that is beneficial to both of these parties, and frankly I do consider that it is a nasty trick to simply take his organs for free after noting that he failed to check off such and such a box when he renewed his driver's license.

Are you now discussing sales of organs after death or by living people? They seem to me to be very different cases, with very different aspects from both a practical and an ethical point of view.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 3:52 pm UTC
by jules.LT
The point is that the only people who check the box are those for whom it's very important that their organs not be used to save other lives because of their personal values.

Talking about opportunity cost when your dead loved one's organs are being used to save lives is obscene. Next thing you'll choose to let the organs rot just because the potential buyers are too poor.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 3:55 pm UTC
by LaserGuy
Zamfir wrote:
Tirian wrote:It's just you and me who need to pay large amounts of money if we need a unit of blood at the hospital but can't make money by selling our blood into that same pool. Organs are the same. Let's say a healthy man dies unexpectedly. I agree that he doesn't need his liver (although some religious traditions will disagree with us), but it's just as true that his widow and children just lost a significant source of income and his organs are worth a non-trivial amount of money to someone. I think the right decision is to negotiate a settlement that is beneficial to both of these parties, and frankly I do consider that it is a nasty trick to simply take his organs for free after noting that he failed to check off such and such a box when he renewed his driver's license.


Are you now discussing sales of organs after death or by living people? They seem to me to be very different cases, with very different aspects from both a practical and an ethical point of view.


I think the issue he's asking is this:

Suppose that organ sales by living people are legal. If I were to sell a kidney, then it mean that I could provide, say, $25,000, to help support my family. If I die before I have a chance to tell, do my organs become part of my estate, so that my family can sell my organs? Or do they become property of the state for free? I would think it would have to be the former.

Another, maybe dicier issue: do you have the right to sell organs that will invariably result in your death? Can I sell my heart?

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 4:25 pm UTC
by jules.LT
This finishes to convince me that organ sale shouldn't be allowed. It would make people much less likely to accept that their organs be given away for free at death, and therefore decrease supply rather than increasing it.

Also, euthanasia when you're incredibly ill is a tough subject already, so the chances of it being legal to sell your heart when you're healthy enough for it to be valuable are remote at best. But pig hearts are the future anyway.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 7:44 pm UTC
by Tirian
LaserGuy wrote:Suppose that organ sales by living people are legal. If I were to sell a kidney, then it mean that I could provide, say, $25,000, to help support my family. If I die before I have a chance to tell, do my organs become part of my estate, so that my family can sell my organs? Or do they become property of the state for free? I would think it would have to be the former.

Another, maybe dicier issue: do you have the right to sell organs that will invariably result in your death? Can I sell my heart?


I don't particularly have a stake in the issue you raise. My layman's understanding is that organ donation requires the specific wishes of the donor (before his death) and the goodwill of the estate, and if you were missing either of those then you're in rough waters. But in theory, it really shouldn't be so much different from the settlement of my life insurance policy which doesn't happen during the policyholder's life either.

The issue that I was raising was more basic, which is confronting the attitude that my organs should be free when I die because "I don't need them anymore". My point was that, as true as that is, we do honor the dead by respecting the wishes they have for settling their estates and furthering the causes that they want to persist and benefit. I mean, when I die I don't need my house anymore either, but that doesn't mean that the government should seize it without compensation and give it to a worthy homeless family. Even if I don't need my kidneys, I may have a child with a college fund and I don't see why my organs should be separate from any other tangible assets of my estate if that is my wish.

I think that the question about a living person selling their heart is mildly absurd. It would be a gross violation of medical ethics for a doctor to remove a heart from a living patient, since that is a course of action that would unquestionably end the patient's life. I suppose that if we threw in enough caveats like my suffering from the advanced stages of an incurable disease that I could enter the hospital of the intended recipient, refuse medical care for my own condition, and have them perform the surgery immediately after my natural death, that that would be the sort of thing that happens nowadays from time to time without too much fuss.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 7:59 pm UTC
by torgos
jules.lt wrote:This finishes to convince me that organ sale shouldn't be allowed. It would make people much less likely to accept that their organs be given away for free at death, and therefore decrease supply rather than increasing it.


What?

They can still give their organs away for free if they want to, and in the one place where kidney sales are legal, organ supply dramatically increased.

If you mean 'there will be a decrease in the supply of free organs', that's possible.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 10:01 pm UTC
by Save Point
Sweet, wasn't expecting so many responses.

jules.lt wrote:Putting organs on the open market increases the mortality in poor people because of the increased number of surgical operations and decreased number of functional kidneys in poor people.

That that poor will be disproportionately affected in a negative way applies to a myriad of other markets, but our initial response isn't to outright ban them. Rather, we impose regulatory and oversight mechanisms designed to surgically root out the less desirable behaviors that mar what can otherwise be a perfectly legitimate, voluntary system. If our concern is poor people being exploited, we can just as easily set a salary floor - a minimum income - for organ donors. We could similarly impose other restrictions: you must have a college degree; you must be currently employed, or employed for a certain period of time; and so on and so forth.

It is also worth noting that, due to their poverty, people in lower socioeconomic classes are not in very good health, whether due to lack of medical access or simply indulging in drug and alcohol abuse which is more prevalent within poorer circles. While this is generally lamentable, in terms of organ donation, this already trends towards disqualification for organ donation. There is a standard set by medical practitioners and by those who are seeking organs which requires the donors to meet minimum health criteria. This, too, functions as a more natural hurdle towards the poor becoming organ farms for the wealthy.

As for the concern over the wealthy dominating the demand market, the question here is acquisition, not allocation. We can impose a good many ways to distribute these organs. We could, for example, let the state purchase the organs at a given price, and then distribute under any other kind of criteria. Some examples: market, lottery, egalitarian -- just to name a few. (See: Lloyd Cohen's body of work.)

There is also the issue of black markets. The poor, unfortunately, receive the short end of the deal in virtually every arena in which they participate, and black markets are no joke. Far better to legalize organ donation and let individual donors of every stripe receive the medical and safety regulations, as well as compensation, for their organs than let them definitely be exploited in the underbelly markets.

I realize this raises a follow-up question, so allow me to attempt and address it now: if behavior in black markets is purportedly so corrosive, why should we legalize it? Perhaps it would be better to continue creating incentives against engaging in this behavior.

The distinction here is that it is the illegality that deters "good" people (for lack of a better word) from engaging in this kind of transaction. Most people do not want to break the law, and these are the kinds of people who have the ethical framework that makes them desirable and safer with which to work. Market liberalization encourages these honest and conscientious agents to enter the market and work within the legal framework. Moreover, the visible repeated interaction with these businessmen and women creates the incentive to engage in good business practices. I am not saying that this creates a market in which angels operate, merely that it encourages typically honest middlemen and brokers to work in a market that is otherwise left to rogues - the sort who would deign to work underground on exploitative terms - and likewise results in visible behavior that is subject to sanction if one behaves as a deviant.

As for my own opinion, there is a point I don't think I've seen brought up yet. Currently, organ acquisition largely operates under the rule of capture, meaning that whatever hospital harvests the organs gains dominion (property rights) over them. However, they cannot sell these organs to other institutions, so the only real way for hospitals to benefit from this acquisition is to transplant these organs themselves. It sounds good in that it creates professional opportunities for those involved, but it also creates the incentive for hospitals to hoard organs rather than share them with those who have more need for them. Taking a more liberal approach to the organ market would more closely align this need with supply.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Fri Apr 08, 2011 11:20 pm UTC
by Vaniver
jules.lt wrote:This finishes to convince me that organ sale shouldn't be allowed. It would make people much less likely to accept that their organs be given away for free at death, and therefore decrease supply rather than increasing it.
NO. Do some goddamn research when lives are at stake. The total supply will almost definitely increase, the total cost of receiving a kidney will almost definitely decrease. Even if you're just interested in there being the same number of uncompensated donors (why is this more important than saving lives?), in Iran, the number of uncompensated kidney donations has not significantly decreased (since, typically, they're given from a family member to another).

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Sat Apr 09, 2011 12:43 am UTC
by Bubbles McCoy
Vaniver wrote:NO. Do some goddamn research when lives are at stake. The total supply will almost definitely increase, the total cost of receiving a kidney will almost definitely decrease. Even if you're just interested in there being the same number of uncompensated donors (why is this more important than saving lives?), in Iran, the number of uncompensated kidney donations has not significantly decreased (since, typically, they're given from a family member to another).

Indeed. Look back to Vaniver's numbers - if you could eliminate the kidney shortage today by increasing supply, then you'd save $250,000 in medical services per patient, meaning that giving to the family $500,000 would be a break even (not counting the health benefits of not spending five years on dialysis). If giving tens of thousands of dollars to the family of the deceased (regardless of whether they would have done so for free or not) means that enough kidneys could be acquired to eliminate the shortage, improving health and saving money for everyone.

Re: It costs an arm and a leg..or kidney: legalizing organ s

Posted: Sat Apr 09, 2011 5:28 am UTC
by sourmìlk
Vaniver wrote:
jules.lt wrote:This finishes to convince me that organ sale shouldn't be allowed. It would make people much less likely to accept that their organs be given away for free at death, and therefore decrease supply rather than increasing it.
NO. Do some goddamn research when lives are at stake. The total supply will almost definitely increase, the total cost of receiving a kidney will almost definitely decrease. Even if you're just interested in there being the same number of uncompensated donors (why is this more important than saving lives?), in Iran, the number of uncompensated kidney donations has not significantly decreased (since, typically, they're given from a family member to another).


Vaniver, you have pretty much convinced me. The only thing I'd add is that I'd like to see how making the organ-donor option and opt-out one would affect supply. If we have sufficient livers and kidneys and such after organ donation becomes an opt-out, I'd prefer we not allow organ selling under the principles discussed above. If it's not sufficient, then I think people's right to bodily autonomy trumps my privilege not to be slightly disturbed.