Markets in Everything: Bone Marrow

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Markets in Everything: Bone Marrow

Postby Vaniver » Mon Nov 02, 2009 4:58 pm UTC

Quoted article from here.

Megan McArdle wrote:I'm a big fan of the Institute for Justice, which fights the good fight on issues like economic liberty and eminent domain. Today they're launching what may be their biggest case ever: a fight to allow compensation for bone marrow donors.

For reasons that aren't entirely clear, the 1984 National Organ Transplant Act forbids people to sell their bone marrow, as well as their kidneys, lungs, and so forth. By which I don't mean that the ban is merely stupid; I mean there's apparently some reason to believe that Congress simply did this as a mistake, adding bone marrow into the bill at the last moment without really thinking things through.
Donating bone marrow is a lot more like donating blood than it is like donating a kidney, because of course, your body just makes more marrow to replace what you give up. These days, they don't even have to stick a big needle into your pelvic bone, as they used to; instead, they give you a drug to stimulate blood stem cell production and filter the cells from your blood, using the same apheresis machine that they use to harvest plasma cells from (paid) donors. The risks are extremely minimal, and mostly limited to the side effects from the drug they give you to stimulate cell production.

Nonetheless, it is very, very illegal to compensate donors. That means that people die for want of a transplant. The problem is worst in minority communities, because of the peculiar problems of marrow donation.

In most transplants, you run the risk that your body will decide that the new organ is a foreign object and send white cells to attack it; this is what's called "rejecting the organ", and it's why you have to use immunosuppressant drugs. In the case of marrow transplants, however, the problem is more serious, because marrow is what produces those white blood cells. The risk you run is that those white cells will decide that your body is a foreign object, and attack everything in sight.

That means that marrow donors have to be matched very, very carefully to the recipients--much more carefully than we match other kinds of organ donations. Since there is a strong ethnic component to the matching, minorities who need transplants have the smallest chance of finding a match--just 25%, according to the folks I spoke to at IJ. That's compared to 75% for whites.

It's true that I don't find any of the arguments about the coercive effects of money on peoples' decisions particularly compelling. But at least in the case of kidneys or parts of livers, I can see how you might want to keep people from making a very permanent sort of mistake. I just don't see that sort of rationale in the case of bone marrow. The worst that happens is that you end up with some unobtrusive round scars over the veins in the crook of your arms. There are dozens of professions that are likely to leave you with more impressive legacies. Moreover, if it's really so awful and demeaning, then probably we shouldn't pay for plasma, eggs, or sperm, either.

The purpose of this lawsuit is not to set up an actual market. There are reasons to think that you can't actually build a functioning market in bone marrow, because the number of matches is typically so small, turning every donor into a monopsonist, and every recipient into a potential monopolist. Instead, the idea is to use market incentives to increase the number of donors. Ultimately, the plan is to set up a foundation to offer some sort of modest grant for those who decide to become marrow donors. The process will remain anonymous, and the donor and recipient will never interact. Nor will the foundation negotiate.

It's a great idea. But in order to implement it, they have to get the law to the point where doing so won't get them sent to the pokey.

Of course, just because the law doesn't make any sense, doesn't mean that it will be struck down. But one can hope . . . and wish the folks at IJ godspeed.
Essentially, there is no good reason why it is illegal to compensate people for their bone marrow, and people die because the government outlawed it. I would argue there's also no good reason why it's illegal to sell any organ, but that's probably another topic.
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Re: Markets in Everything: Bone Marrow

Postby tzvibish » Mon Nov 02, 2009 5:06 pm UTC

Well, I think both marrow and organs, while being different situations, both have the same potential of creating a black market (at least in the government's eye). Any black market that deals in human "stuff" is forwned upon. Why? Well, with organ donation, it's dangerous. So I think they're just grouping it with organ markets.

I agree with Vaniver, but that's probably why there's opposition.
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Re: Markets in Everything: Bone Marrow

Postby Izawwlgood » Mon Nov 02, 2009 5:43 pm UTC

There are very valid arguments for this either way. Apparently in India it's common practice for the destitute to donate a kidney, and because of the nature of the market, they aren't compensated the full 'value' of the kidney, the procedure is sloppy and carries enhanced risk of complication, and ethically, accepting organs from the needy is a very slippery slope. On the otherhand, if it was legal practice, perhaps it wouldn't be so dodgy.
Bone marrow on the other hand, seems more like blood or plasma donations (albeit a bit more serious). People should be compensated, and people who are healthy should be in the habit of donating anyway. We just need to figure out how to make it as safe as possible for donors and recipients, and centralize the collection to ensure the poor aren't donating more then they physically can out of desperation (of course, we should just help the poor, but that's another argument).
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Re: Markets in Everything: Bone Marrow

Postby Malice » Mon Nov 02, 2009 6:17 pm UTC

tzvibish wrote:Well, I think both marrow and organs, while being different situations, both have the same potential of creating a black market (at least in the government's eye). Any black market that deals in human "stuff" is forwned upon. Why? Well, with organ donation, it's dangerous. So I think they're just grouping it with organ markets.

I agree with Vaniver, but that's probably why there's opposition.


Black markets are what happens when you make something illegal to buy and sell. Otherwise it's just a market.
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Re: Markets in Everything: Bone Marrow

Postby Heisenberg » Mon Nov 02, 2009 6:33 pm UTC

Izawwlgood wrote:Bone marrow on the other hand, seems more like blood or plasma donations (albeit a bit more serious). People should be compensated, and people who are healthy should be in the habit of donating anyway.

The major difference is the rarity of matches. While every almost every blood donation is used, regular bone marrow donations would simply be thrown away for lack of matches. I have been on the bone marrow registry for years and have matched zero of the people seeking transplants.

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Re: Markets in Everything: Bone Marrow

Postby tzvibish » Mon Nov 02, 2009 6:37 pm UTC

Malice wrote:
tzvibish wrote:Well, I think both marrow and organs, while being different situations, both have the same potential of creating a black market (at least in the government's eye). Any black market that deals in human "stuff" is forwned upon. Why? Well, with organ donation, it's dangerous. So I think they're just grouping it with organ markets.

I agree with Vaniver, but that's probably why there's opposition.


Black markets are what happens when you make something illegal to buy and sell. Otherwise it's just a market.


Yes, and when you take law out of a market and make it a black market, you also take that market out of the realm of regulation and oversight, leading to irresponsible, dangerous, and criminal results.
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Re: Markets in Everything: Bone Marrow

Postby EMTP » Tue Nov 03, 2009 4:27 am UTC

Free market fundamentalists aside, most people are disturbed by the idea of poor people being forced by destitution to letting their bodies by stripped of organs to be implanted in the wealthy. That's why it's not legal to sell your organs.

An easier way to increase the supply of organs would be to make donation "opt out" instead of "opt in." Like automatic voter registration, such programs take advantage of people's inherent laziness. You are still free to take your organs into the ground with you, but you must make a deliberate effort to do so, as opposed to a deliberate effort to donate, as under the current system. Experience suggests such a rule would greatly expand the supply of donor organs without homeless vets selling their kidneys for flophouse money and booze.
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Re: Markets in Everything: Bone Marrow

Postby Bright Shadows » Tue Nov 03, 2009 4:35 am UTC

Of course, this is all rather tenuously linked to the bone marrow issue, because we can get it readily and without hard to the donator. If the donator isn't harmed, why shouldn't they give someone their bone marrow? Why shouldn't the be reimbursed for it?
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Re: Markets in Everything: Bone Marrow

Postby The Great Hippo » Tue Nov 03, 2009 4:38 am UTC

EMTP wrote:An easier way to increase the supply of organs would be to make donation "opt out" instead of "opt in." Like automatic voter registration, such programs take advantage of people's inherent laziness. You are still free to take your organs into the ground with you, but you must make a deliberate effort to do so, as opposed to a deliberate effort to donate, as under the current system. Experience suggests such a rule would greatly expand the supply of donor organs without homeless vets selling their kidneys for flophouse money and booze.
One problem: There are serious ethical concerns (not to mention huge conflicts of agenda) with doctors being presented with a situation where they need your organs right now, while they're still fresh - and chances are good (but not 100%) that you're not going to make it. One of the reasons it's 'opt in' is because you're willfully taking on that risk when you do so; making that risk automatic strikes me as somewhat dubious and unethical.

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Re: Markets in Everything: Bone Marrow

Postby Bright Shadows » Tue Nov 03, 2009 4:45 am UTC

The Great Hippo wrote:
EMTP wrote:An easier way to increase the supply of organs would be to make donation "opt out" instead of "opt in." Like automatic voter registration, such programs take advantage of people's inherent laziness. You are still free to take your organs into the ground with you, but you must make a deliberate effort to do so, as opposed to a deliberate effort to donate, as under the current system. Experience suggests such a rule would greatly expand the supply of donor organs without homeless vets selling their kidneys for flophouse money and booze.
One problem: There are serious ethical concerns (not to mention huge conflicts of agenda) with doctors being presented with a situation where they need your organs right now, while they're still fresh - and chances are good (but not 100%) that you're not going to make it. One of the reasons it's 'opt in' is because you're willfully taking on that risk when you do so; making that risk automatic strikes me as somewhat dubious and unethical.

Eh, iirc, some of Europe has opted in favor of that route. Goodness knows how that addresses your concern, except to say that not enough people mind to make the idea political suicide.

Ah, here we are. It's not all of Europe, it's Spain and Belgium.
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Re: Markets in Everything: Bone Marrow

Postby mr_pathetic » Tue Nov 03, 2009 4:52 am UTC

I can see caution in not wanting a black market, but if handled carefully enough, marrow and compensation doesn't sound all that ridiculous.

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Re: Markets in Everything: Bone Marrow

Postby EMTP » Tue Nov 03, 2009 5:08 am UTC

The Great Hippo wrote:One problem: There are serious ethical concerns (not to mention huge conflicts of agenda) with doctors being presented with a situation where they need your organs right now, while they're still fresh - and chances are good (but not 100%) that you're not going to make it. One of the reasons it's 'opt in' is because you're willfully taking on that risk when you do so; making that risk automatic strikes me as somewhat dubious and unethical.


I just don't see it. The physician gets no benefit from preserving the organs and both the interests of compassion and the competitive desire for a "win" argue for focus on the patient's needs exclusively. In addition the whole culture and physician education formal and informal is organized around obligation to the patient you are treating -- your patient, not society in the abstract. Doctors are no more tempted to cut a patient's life short to serve another patient's need for the organs than defense attorneys are tempted to fail in their work to make the streets safer. Morality, professionalism, and professional pride all mitigate against such an outcome.
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Re: Markets in Everything: Bone Marrow

Postby The Great Hippo » Tue Nov 03, 2009 5:34 am UTC

EMTP wrote:I just don't see it. The physician gets no benefit from preserving the organs and both the interests of compassion and the competitive desire for a "win" argue for focus on the patient's needs exclusively. In addition the whole culture and physician education formal and informal is organized around obligation to the patient you are treating -- your patient, not society in the abstract. Doctors are no more tempted to cut a patient's life short to serve another patient's need for the organs than defense attorneys are tempted to fail in their work to make the streets safer. Morality, professionalism, and professional pride all mitigate against such an outcome.
As I understand it, there's a lot of conflicting agendas; people have been debating this for a while. One of the problems is that organs apparently start to suffer damage very quickly if they're not harvested soon - which creates a pressure on doctors to make a quick determination as to the viability of a patient's chances. Other mitigating circumstances can impact this prognosis too - you're forgetting that not all patients have the same guarantees of quality of life (If patient A is in a vegetative state, I do have an incentive to give patient A's heart to patient B, who is young, otherwise healthy, and - besides their non-functioning heart - prepared to live a full, active life).

On top of that, it isn't the likelihood of these risks that bothers me (for instance, I think the chances of this situation coming about for me, personally, are pretty low), but the implication that these are risks I should default to. Rather, when possible, I prefer to chose to put myself at risk for the sake of others - even if that risk is relatively tiny. Of course, the gain we get from a program of 'opt-out' organ donation might far outweigh the loss, but I still think it's a concern that's very worth mentioning.

Edit: Oh, and yes - the website I linked to above is socially conservative - but that doesn't mean the points being raised are irrelevant. There have been some serious moral concerns with the issue of organ donation in the past. I do admit, however, that the issues I have might have long since been addressed (the article I linked to is from... 2002, I think?), so this entire line of reasoning might be moot.

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Re: Markets in Everything: Bone Marrow

Postby Cynical Idealist » Tue Nov 03, 2009 6:07 am UTC

EMTP wrote:An easier way to increase the supply of organs would be to make donation "opt out" instead of "opt in." Like automatic voter registration, such programs take advantage of people's inherent laziness. You are still free to take your organs into the ground with you, but you must make a deliberate effort to do so, as opposed to a deliberate effort to donate, as under the current system.

Where I am, it takes exactly as much effort to become a donor as to not become a donor, assuming you get a driver's license.

On one of the forms, there are two boxes: []Yes, I want to be an organ donor, []No, I do not want to be an organ donor. You check one, and if you don't check either I imagine that the person at the DMV calls you a dumbass and you get to wait in line again.
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Re: Markets in Everything: Bone Marrow

Postby scrovak » Tue Nov 03, 2009 10:42 am UTC

I always thought the big thing against compensation for donation of blood, organs, marrow, etc. is that someone may very well donate someone else's organs, marrow, or blood in exchange for compensation. Who's to say a doctor saving his patient wouldn't look away if the compensated donor already had X removed at another location?
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Re: Markets in Everything: Bone Marrow

Postby Chen » Tue Nov 03, 2009 1:48 pm UTC

scrovak wrote:I always thought the big thing against compensation for donation of blood, organs, marrow, etc. is that someone may very well donate someone else's organs, marrow, or blood in exchange for compensation. Who's to say a doctor saving his patient wouldn't look away if the compensated donor already had X removed at another location?


Im unclear how you would donate someone else's organ. And really thats easily dealt with by stipulating you can only donate your OWN organs for cash (if it were made legal). I could see instituting fairly large wait times before you could have an organ removed in exchange for money to try to make sure people actually thought through the issue rather than spur of the moment organ donation that would be regrettable later. I think if someone wants to sell an organ they should have the right to. People simply need to be aware of the consequences....of course with most people being idiots this probably wouldn't work out too well. Its also somewhat unclear what effect this would have on health care. Presumably someone with only 1 kidney has higher health care costs (on average) than people with 2 kidneys, for example.

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Re: Markets in Everything: Bone Marrow

Postby Zamfir » Tue Nov 03, 2009 3:28 pm UTC

Vaniver wrote:
The purpose of this lawsuit is not to set up an actual market. There are reasons to think that you can't actually build a functioning market in bone marrow, because the number of matches is typically so small, turning every donor into a monopsonist, and every recipient into a potential monopolist. Instead, the idea is to use market incentives to increase the number of donors. Ultimately, the plan is to set up a foundation to offer some sort of modest grant for those who decide to become marrow donors. The process will remain anonymous, and the donor and recipient will never interact. Nor will the foundation negotiate.



This is an intersting part, and it makes clear that any implementation would have to done oh so careful, but I guess it could be turned into a workable system.

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Re: Markets in Everything: Bone Marrow

Postby General_Norris » Tue Nov 03, 2009 6:06 pm UTC

Chen wrote:[Im unclear how you would donate someone else's organ


(Points gun)

Now, since you are so nice you are going to donate that kidney. And since you are rally really nice you are going to later give me that money or I will kill you and all your family.

To put it simply, coercion. Specially coercion of zeroed people. Not cool.

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Re: Markets in Everything: Bone Marrow

Postby Izawwlgood » Tue Nov 03, 2009 6:10 pm UTC

It doesn't even have to be violent; if you take away all of an individuals other options, and the only means for procuring funds for themselves or their families involves giving up kidneys or bone marrow or lungs or chunks of their liver, you have a serious issue.
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Re: Markets in Everything: Bone Marrow

Postby The Great Hippo » Tue Nov 03, 2009 6:12 pm UTC

Izawwlgood wrote:It doesn't even have to be violent; if you take away all of an individuals other options, and the only means for procuring funds for themselves or their families involves giving up kidneys or bone marrow or lungs or chunks of their liver, you have a serious issue.
Wasn't it an issue before, when the only alternative was for their family to starve?

Though I will agree that when we have additional options besides 'starving', people tend to care about your concerns less. If I have no choice but to starve, someone may help me. If I can choose between starving or giving up a kidney, at least a few people will say "Why should I help you? You could give up a kidney and not starve".

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Re: Markets in Everything: Bone Marrow

Postby Vaniver » Tue Nov 03, 2009 6:37 pm UTC

EMTP wrote:Free market fundamentalists aside, most people are disturbed by the idea of poor people being forced by destitution to letting their bodies by stripped of organs to be implanted in the wealthy. That's why it's not legal to sell your organs.

An easier way to increase the supply of organs would be to make donation "opt out" instead of "opt in." Like automatic voter registration, such programs take advantage of people's inherent laziness. You are still free to take your organs into the ground with you, but you must make a deliberate effort to do so, as opposed to a deliberate effort to donate, as under the current system. Experience suggests such a rule would greatly expand the supply of donor organs without homeless vets selling their kidneys for flophouse money and booze.
But, that's a fundamentally mistaken view of who benefits from the sales of organs. It also shows why reality is more important than intentions.

Let's look at kidneys, for example. Most people have two, so selling your spare is something you can do without significant moral concerns (deciding to sell your heart because you'd like your family to benefit from your suicide is something I'm not going to touch in this post, beyond pointing out I'm not going there). If your kidneys aren't working, you're going to die. Dialysis extends your lifespan, but not by much- and it's an unpleasant, expensive process that gradually weakens you.

When you have, say, 1,000 people a month being added to the kidney wait list, and 100 kidneys a month given to people on the wait list, what that means is once you hit steady state, 900 people a month are dying because they didn't get a kidney transplant. Those people that are given the 100 kidneys are the people who have been on the wait list the longest- the people who have managed to survive on dialysis longer than anyone else. What percentage of them were wealthy, do you think? They needed to be in good enough physical health to survive more dialysis than anyone else, and be in good enough financial health to be able to afford more dialysis than anyone else. My guess is the poor are underrepresented among people that get a kidney compared to their representation entering the list.

In 2003, the average wait time to get a kidney was 1121 days. Wait times are pretty much only getting longer, so I hesitate to contemplate what the wait time will be for someone who goes on the list today. How much do you think three years of dialysis costs? If a year is roughly $30,000, you're looking at paying $90,000 to survive long enough to get a kidney. Oh, and if you die after 2 years of dialysis, you don't get refunded that $60,000.

Now let's ask the question: what's the supply function for kidneys? The only place where it's legal to sell your kidneys is Iran, where the prices for kidneys was around $2,000 (source 1) in 2003 and $4,000 (source 2) in 2006, which is somewhere between a fourth and half of per capita GDP. A rough estimate for America would thus be around $10,000 to $25,000. The upper bound of my rough estimate is cheaper than a year of dialysis (estimates I've heard from people who do more research in this sort of thing are around $20,000 for a kidney).

As well, if the experience of Iran is any guide, not only will the supply for kidneys outstrip the demand (meaning no waiting list for the sick), people on the waiting list to sell will take better care of themselves and go to the doctor more regularly, to establish their kidneys as more valuable.


So, it's not the rich that benefit the most from legal organ sales. It's the poor who would otherwise die on the waiting list. The other beneficiaries are the people who get to sell something they're not using- the person who can now afford to go to college, or start their own business, or pay off debts, or do any number of other things. And, everyone who gets a kidney doesn't have to wait through three years of dialysis to get it.


So, someone who opposes organ sales because they think that they're fighting for the poor in a class struggle is condemning thousands of people a year to die (and they're predominantly the poorer people who need organs), and preventing thousands of people a year from getting money that they desperately want or need. The road to hell is paved with good intentions.
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Re: Markets in Everything: Bone Marrow

Postby Malice » Tue Nov 03, 2009 10:06 pm UTC

Izawwlgood wrote:It doesn't even have to be violent; if you take away all of an individuals other options, and the only means for procuring funds for themselves or their families involves giving up kidneys or bone marrow or lungs or chunks of their liver, you have a serious issue.


I think the whole point of the thread is that one of those things is not like the other, one of those things does not belong. Giving up kidneys or lungs or chunks of liver is something you can only do once, and it's a serious surgical procedure. Bone marrow regenerates, and can be no more troublesome than donating plasma.
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Re: Markets in Everything: Bone Marrow

Postby Chen » Wed Nov 04, 2009 1:09 pm UTC

Izawwlgood wrote:It doesn't even have to be violent; if you take away all of an individuals other options, and the only means for procuring funds for themselves or their families involves giving up kidneys or bone marrow or lungs or chunks of their liver, you have a serious issue.


Well this currently can occur now, except its done in an illegal and dangerous manner. Now I'll grant it would certainly gain more prevalence if it were legal, and its likely that people wouldn't only use it as an absolute last resort. Still right now the alternative, assuming all other avenues are expended, would be to procure those funds illegally or simply not get them at all.

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Re: Markets in Everything: Bone Marrow

Postby Philwelch » Thu Nov 05, 2009 8:23 pm UTC

General_Norris wrote:
Chen wrote:[Im unclear how you would donate someone else's organ


(Points gun)

Now, since you are so nice you are going to donate that kidney. And since you are rally really nice you are going to later give me that money or I will kill you and all your family.

To put it simply, coercion. Specially coercion of zeroed people. Not cool.


This isn't an argument against commerce in organ donation—it's an argument against commerce at all. As it stands, it's easier to sell someone else's laptop or even a plasma TV than their kidney, and I don't anticipate that ever changing.
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Re: Markets in Everything: Bone Marrow

Postby EMTP » Fri Nov 06, 2009 3:04 am UTC

Vaniver wrote:
Let's look at kidneys, for example. Most people have two, so selling your spare is something you can do without significant moral concerns (deciding to sell your heart because you'd like your family to benefit from your suicide is something I'm not going to touch in this post, beyond pointing out I'm not going there).


In point of fact, plenty of things can knock of your kidney function to the extent that you will be very glad you have two. 30 million Americans have chronic renal failure, and any of them would be in a worse way with only one kidney.

So, someone who opposes organ sales because they think that they're fighting for the poor in a class struggle is condemning thousands of people a year to die


Protecting people from people who want to cut out their organs for profit is not conducting a class struggle. Markets are everywhere regulated and most citizens do not share the view that any limitations on what the wealthy can buy with their money constitute a war upon the rich.

Your reasoning is fatally flawed: You presume the only way to supply needed organs is to cut them out of poor, desperate, or very stupid people. In reality, there are an infinite number of ways to go about achieving that goal (I offered one example above), so not wanting to pursue one in particular is in no way, as you hyberbolically assert, "condemning thousands of people a year to die." Do you support taking one kidney from every person henceforth convicted of white-collar crimes? If not, you are condemning thousands of people to die, you mass-murderer by proxy, you.
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Re: Markets in Everything: Bone Marrow

Postby Philwelch » Fri Nov 06, 2009 3:31 am UTC

EMTP wrote:
Vaniver wrote:
Let's look at kidneys, for example. Most people have two, so selling your spare is something you can do without significant moral concerns (deciding to sell your heart because you'd like your family to benefit from your suicide is something I'm not going to touch in this post, beyond pointing out I'm not going there).


In point of fact, plenty of things can knock of your kidney function to the extent that you will be very glad you have two. 30 million Americans have chronic renal failure, and any of them would be in a worse way with only one kidney.


All the more reason to increase the supply of donor kidneys.

EMTP wrote:
So, someone who opposes organ sales because they think that they're fighting for the poor in a class struggle is condemning thousands of people a year to die


Protecting people from people who want to cut out their organs for profit is not conducting a class struggle. Markets are everywhere regulated and most citizens do not share the view that any limitations on what the wealthy can buy with their money constitute a war upon the rich.

Your reasoning is fatally flawed: You presume the only way to supply needed organs is to cut them out of poor, desperate, or very stupid people. In reality, there are an infinite number of ways to go about achieving that goal (I offered one example above), so not wanting to pursue one in particular is in no way, as you hyberbolically assert, "condemning thousands of people a year to die." Do you support taking one kidney from every person henceforth convicted of white-collar crimes? If not, you are condemning thousands of people to die, you mass-murderer by proxy, you.


The main difference is: people who sell their kidneys do so voluntarily. It's possible to regulate the market so it does not become exploitative.

The fact is, it already costs tens of thousands of dollars to get an organ transplant, and the donor is the only one who receives none of it.
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Re: Markets in Everything: Bone Marrow

Postby EMTP » Fri Nov 06, 2009 3:43 am UTC

Philwelch wrote:The main difference is: people who sell their kidneys do so voluntarily. It's possible to regulate the market so it does not become exploitative.


First statement questionable, second statement completely unfounded. Evidence?

The fact is, it already costs tens of thousands of dollars to get an organ transplant, and the donor is the only one who receives none of it.


And the price of tea in China is?
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Re: Markets in Everything: Bone Marrow

Postby Philwelch » Fri Nov 06, 2009 3:58 am UTC

EMTP wrote:
Philwelch wrote:The main difference is: people who sell their kidneys do so voluntarily. It's possible to regulate the market so it does not become exploitative.


First statement questionable, second statement completely unfounded. Evidence?


On the voluntary point: Someone who sells their kidney would, in the current medical system: be well informed prior to surgery such that the medical requirement for informed consent was met, signify their informed consent, sign a contract with consideration that they do in fact intend to sell their kidney, and have every opportunity up to going into surgery to opt out of the procedure. There's a pretty solid prima facie argument that the exchange is fully voluntary—more so, at least, than your suggestion of harvesting these organs from prisoners. If you think it's "questionable", raise those questions and make your case.

On the regulation point: If we change the law to allow paid kidney donations, there's no fundamental reason that law couldn't just exclude poor people from becoming kidney donors. Just set a means test based on the prospective donor's income tax returns. I would not think such a measure would be necessary, but perhaps you do. Less drastic measures are also possible: restrictions against donating if you have large unaffordable debts to repay, for instance.

My personal opinion is that there is no good, rational reason why someone wouldn't sell their kidney for the right price as long as there is a healthy supply of donor kidneys should they need a donation in turn. People have irrational icky feelings about bodily integrity, but if we set those aside for a moment, it's really not a bad deal to sell your kidney for something in the tens of thousands of dollars, unless you're already fabulously wealthy. I'll go one step beyond that: if it were legal, I would be completely happy to sell my kidney for a figure in the tens of thousands of dollars, were the market to remain operating. And no, I am neither impoverished nor significantly indebted nor (despite what your personal opinion may be) stupid.

EMTP wrote:
The fact is, it already costs tens of thousands of dollars to get an organ transplant, and the donor is the only one who receives none of it.


And the price of tea in China is?


Well you were implying that paying for kidneys is just another way for the rich to exploit the poor, when in fact they would not actually add much to the cost of organ transplants.
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Re: Markets in Everything: Bone Marrow

Postby EMTP » Fri Nov 06, 2009 4:18 am UTC

Philwelch wrote:
On the voluntary point: Someone who sells their kidney would, in the current medical system: be well informed prior to surgery such that the medical requirement for informed consent was met, signify their informed consent, sign a contract with consideration that they do in fact intend to sell their kidney, and have every opportunity up to going into surgery to opt out of the procedure. There's a pretty solid prima facie argument that the exchange is fully voluntary—more so, at least, than your suggestion of harvesting these organs from prisoners. If you think it's "questionable", raise those questions and make your case.


You haven't demonstrated that the exchange is "fully voluntary." Only that, ideally, no physical violence would be involved. Destitution is a powerful coercive force.

On the regulation point: If we change the law to allow paid kidney donations, there's no fundamental reason that law couldn't just exclude poor people from becoming kidney donors. Just set a means test based on the prospective donor's income tax returns. I would not think such a measure would be necessary, but perhaps you do. Less drastic measures are also possible: restrictions against donating if you have large unaffordable debts to repay, for instance.


I doubt such a clause could be enforced, even if it were found to be constitutional.

Well you were implying that paying for kidneys is just another way for the rich to exploit the poor, when in fact they would not actually add much to the cost of organ transplants.


Whether they add much to the cost of the transplant has nothing to do with whether strapping someone to a table and cutting out his organs for the benefit of the highest bidder is exploitive or not.
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Re: Markets in Everything: Bone Marrow

Postby Philwelch » Fri Nov 06, 2009 5:42 am UTC

EMTP wrote:You haven't demonstrated that the exchange is "fully voluntary." Only that, ideally, no physical violence would be involved. Destitution is a powerful coercive force.


You haven't demonstrated it would be anything else. The weight of the evidence supports me. Do you have a point, or are you just playing devil's advocate and losing?
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Re: Markets in Everything: Bone Marrow

Postby EMTP » Mon Nov 09, 2009 2:02 am UTC

Philwelch wrote:You haven't demonstrated it would be anything else. The weight of the evidence supports me. Do you have a point, or are you just playing devil's advocate and losing?


What evidence would that be, exactly? The only fact you have offered in the discussion is that Iran has a legal market in kidneys. I don't think "If Iran does it, it must be OK" is much of an argument, and you haven't offered evidence for anything else.

You also offered the assertion that: Disagreeing with your solution to the problem = condemning thousands to death. That argument failed both logically and rhetorically and the last time I checked, paying money to cut out a person's organs was still both illegal and unpopular. So you are losing the argument both theoretically and practically.
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Re: Markets in Everything: Bone Marrow

Postby Bright Shadows » Mon Nov 09, 2009 2:33 am UTC

EMTP wrote:You also offered the assertion that: Disagreeing with your solution to the problem = condemning thousands to death. That argument failed both logically and rhetorically and the last time I checked, paying money to cut out a person's organs was still both illegal and unpopular. So you are losing the argument both theoretically and practically.

Explain yourself. One of the most basic ideas of psychology says that when incentives are present, people will do things more. More donors, fewer deaths due to a lack of kidneys, etc. I don't see where the logic is failing. Thousands of people could be saved, and the downsides pretty much have to outweigh those lives. Do they? Is the possibility of corruption REALLY going to shove out the possibility of saving people from horrible, expensive deaths, let alone how much corruption there would be, if any at all?

Also, using public opinion as a reason for not doing something is a pretty terrible way to support yourself.
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Re: Markets in Everything: Bone Marrow

Postby Mokele » Mon Nov 09, 2009 3:16 am UTC

One of the most basic ideas of psychology says that when incentives are present, people will do things more.


But not for the best reasons. Do you *really* want a system where people sell parts of themselves to pay rent, to buy their next fix, to escape economic desperation? A system where a canny cult leader could literally run a body farm where any given subject is "consenting". A system where, in order to qualify for unemployment benefits, you have to explain why you can't sell any body parts?

And do you *really* think no enterprising criminal will find a way to start harvesting organs without consent? All it takes is one doctor with a huge gambling debt or a coke problem and they've got an in. If it were so simple to keep the criminal element at bay, why haven't we managed to do so with drugs, guns, booze, money, stolen property, or absolutely anything else?

Creating a society where selling your organs is a legitimate way out of economic hardship will go a long way towards creating a permanent social underclass.

Can you even *have* informed consent when you dangle such a massive payoff in front of someone who's known only a lifetime of poverty?
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Re: Markets in Everything: Bone Marrow

Postby Bubbles McCoy » Mon Nov 09, 2009 4:09 am UTC

Mokele wrote:But not for the best reasons. Do you *really* want a system where people sell parts of themselves to pay rent, to buy their next fix, to escape economic desperation? A system where a canny cult leader could literally run a body farm where any given subject is "consenting". A system where, in order to qualify for unemployment benefits, you have to explain why you can't sell any body parts?

And do you *really* think no enterprising criminal will find a way to start harvesting organs without consent? All it takes is one doctor with a huge gambling debt or a coke problem and they've got an in. If it were so simple to keep the criminal element at bay, why haven't we managed to do so with drugs, guns, booze, money, stolen property, or absolutely anything else?

We already have a regulatory system in place to ensure that the only kidneys entered into the system meet a certain criteria, if you have no faith in the ability to enforce the criteria then whether or not selling kidneys is explicitly legal will have no bearing on whether or not any of these things happen. So long as the organ donor system has already prevented any form of exploitation according to a rule set, modifying the rule set will not somehow result in everything going out the window. I'm also not sure about your claims about economic desperation, if someone is so poor that they believe their situation to be noticeably improvable by selling a kidney, how is this somehow worse than anyone else selling it? If they get money to make their lives noticeably more comfortable and someone else gets to keep living, seems kinda like a win-win to me.

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Re: Markets in Everything: Bone Marrow

Postby Bright Shadows » Mon Nov 09, 2009 4:12 am UTC

Mokele wrote:
One of the most basic ideas of psychology says that when incentives are present, people will do things more.


But not for the best reasons. Do you *really* want a system where people sell parts of themselves to pay rent, to buy their next fix, to escape economic desperation? A system where a canny cult leader could literally run a body farm where any given subject is "consenting". A system where, in order to qualify for unemployment benefits, you have to explain why you can't sell any body parts?


In order:
It's the individual's choice to make. I'm pretty supportive of the notion that your body is yours and mine is mine, and acting like it, though.

Obviously we need safeguards against abuse, just like in every other market in the history of the world. Below, you posit that we fail at safeguarding, and I disagree, so that's going to be an issue.

Fallacious point is fallacious. You don't have to sell anything, not your car, not your home, not your shirt, to qualify for unemployment. You don't have to explain why you haven't sold them, either. In addition, what you do with your body constitutes a matter of privacy. You would not, as far as I can tell when dealing with US law (not very far, I grant), have to explain anything to anyone because of that fact.

Mokele wrote:And do you *really* think no enterprising criminal will find a way to start harvesting organs without consent? All it takes is one doctor with a huge gambling debt or a coke problem and they've got an in. If it were so simple to keep the criminal element at bay, why haven't we managed to do so with drugs, guns, booze, money, stolen property, or absolutely anything else?

Creating a society where selling your organs is a legitimate way out of economic hardship will go a long way towards creating a permanent social underclass.

Can you even *have* informed consent when you dangle such a massive payoff in front of someone who's known only a lifetime of poverty?

Separated line #1: Explain plz. I really don't see how giving people another way to not live in destitution creates an underclass. Also, at the very worst, it's going from one social underclass to another.
Separated line #2: Requiring pre-operation counseling would reduce this problem significantly, but it's still kinda there. Let me get back to you.

EDIT:
I didn't get a note on Bubble's post, so sorry for any annoyance caused by repetition.
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Re: Markets in Everything: Bone Marrow

Postby Silas » Mon Nov 09, 2009 4:40 am UTC

Bright Shadows wrote:One of the most basic ideas assumptions of psychology economics says that when incentives are present, people will do things more.

One of the big ideas in psychology is that people's behavior can't be boiled down to utility-maximizing engines. Some of the most interesting questions out there for psychologists (and economists) is why people occasionally (read: daily) don't respond to obvious incentives. It is naive to assume that letting people get paid for their kidneys (or bone marrow- wasn't that what this thread was about?) will actually increase the number of kidneys donated, without a carefully-designed program and policy.
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Re: Markets in Everything: Bone Marrow

Postby Philwelch » Mon Nov 09, 2009 5:45 am UTC

EMTP wrote:
Philwelch wrote:You haven't demonstrated it would be anything else. The weight of the evidence supports me. Do you have a point, or are you just playing devil's advocate and losing?


The only fact you have offered in the discussion is that Iran has a legal market in kidneys.


I never said anything of the kind.

EMTP wrote:You also offered the assertion that: Disagreeing with your solution to the problem = condemning thousands to death.


No, that was Vaniver.

You still haven't offered an argument yet.

Mokele wrote:
One of the most basic ideas of psychology says that when incentives are present, people will do things more.


But not for the best reasons. Do you *really* want a system where people sell parts of themselves to pay rent, to buy their next fix, to escape economic desperation? A system where a canny cult leader could literally run a body farm where any given subject is "consenting". A system where, in order to qualify for unemployment benefits, you have to explain why you can't sell any body parts?


No one is proposing anything of the kind.

Mokele wrote:And do you *really* think no enterprising criminal will find a way to start harvesting organs without consent? All it takes is one doctor with a huge gambling debt or a coke problem and they've got an in. If it were so simple to keep the criminal element at bay, why haven't we managed to do so with drugs, guns, booze, money, stolen property, or absolutely anything else?


Yet another straw man argument. The best way to set up a system for organ donations would be as follows: individuals register as donors and are approved by a panel after investigation. Once a match is found, the donor and recipient both go to the same hospital where the transplant is performed. The donor receives payment and (under US law) a 1099 form documenting the income. There aren't any middlemen other than the ordinary banks and intermediaries, nor is there any way to buy someone else's kidney and sell it.

You can't just show up with a kidney in a cooler and receive payment for it. No one's proposing that.

Mokele wrote:Creating a society where selling your organs is a legitimate way out of economic hardship will go a long way towards creating a permanent social underclass. Can you even *have* informed consent when you dangle such a massive payoff in front of someone who's known only a lifetime of poverty?


I'm not saying we do this with undocumented workers or anything. I'm proposing a means test, where employed workers, retired people meeting a basic level of net worth and/or income, and full time students would be eligible.

If you really have a problem with this, go to your local plasma center or sperm bank and complain to them: they've been buying people's precious bodily fluids for years.

Silas wrote:It is naive to assume that letting people get paid for their kidneys (or bone marrow- wasn't that what this thread was about?) will actually increase the number of kidneys donated, without a carefully-designed program and policy.


It's not naive at all. To wit: nearly all kidney donations are done by family members who don't want their loved ones to die or endure dialysis forever. (Isn't that even more "exploitative" than money? "Give me your kidney or Mommy suffers and dies?" Why don't you people complain about that?) Those donations would continue. In addition, I would sell my kidney. Therefore, we can safely assume that the number of kidneys donated will actually increase—in the limit case, by one (me) but in the average case, probably a great deal more.

Yes, there are imperfections in the standard economic assumptions. But people do respond to incentives, and more people are willing to sell something if you offer more money for it.
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Re: Markets in Everything: Bone Marrow

Postby Silas » Mon Nov 09, 2009 6:31 am UTC

Philwelch wrote:Yes, there are imperfections in the standard economic assumptions. But people do respond to incentives, and more people are willing to sell something if you offer more money for it.

I think organ donations are one of those emotionally charged areas where the actual effect of cash incentives is hard to predict. There are subtle dynamics involved, and- for a lot of donors- it doesn't come down to an objective cost/benefit decision.

I don't say that an organ-selling scheme to boost donor participation is doomed to failure. But I do say that introducing a financial element may undermine the humanitarian ethic that motivates a lot of unpaid donors. It's easy to say here that, 'if x number of people will donate their kidneys for the good of their fellow man, then surely y>x number of people will donate their kidneys for the good of their fellow man, plus fifty bucks.' But it doesn't always work that way- bringing money into the picture at all may just distract potential donors from thinking about the good their organs will do someone, and lure them into the "how much money is it worth to cut my life expectancy by five years" mindset. And that calculation almost never supports a "give" decision.
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Re: Markets in Everything: Bone Marrow

Postby Philwelch » Mon Nov 09, 2009 8:41 am UTC

Silas wrote:
Philwelch wrote:Yes, there are imperfections in the standard economic assumptions. But people do respond to incentives, and more people are willing to sell something if you offer more money for it.

I think organ donations are one of those emotionally charged areas where the actual effect of cash incentives is hard to predict. There are subtle dynamics involved, and- for a lot of donors- it doesn't come down to an objective cost/benefit decision.

I don't say that an organ-selling scheme to boost donor participation is doomed to failure. But I do say that introducing a financial element may undermine the humanitarian ethic that motivates a lot of unpaid donors.


The vast, vast, vast majority of unpaid donors are blood relatives of the recipients. Altruists who donate their kidneys to total strangers are an almost negligible number of people.
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Re: Markets in Everything: Bone Marrow

Postby Bubbles McCoy » Mon Nov 09, 2009 9:34 am UTC

Silas still raises an interesting point, as even though kidney donors themselves might generally be relatives, organ donors as a whole tend to come from the recently dead. If it becomes expected that organs come for a price, then getting the same number of organs we currently do will require an enormous sum, let alone getting more organs then we currently do. If payment becomes the norm in one sector of organ donation, then the feel-good aspect in others might become severely reduced and net organ yield as priced by the market might end up lower.

At a glance though, I don't know if it would really matter. I'd have to see more comprehensive numbers on how many bodies are used annually for organ use, but if waiting for a kidney currently amounts to some $90,000+ in medical expenses, quite a bit can be deferred for organ purchase conceivably without raising costs at all. For example, if $20,000 is offered for one and $35,000 for the deuce & associated goodies, the kidney gap could very well be closed in short order with net cost savings.


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