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Ethical Considerations Organ Markets

Compensation for Living Donors, Part I

I call this Part I because the proposal to compensate living donors is complex and ever-morphing. I’ve avoided this discussion because of its potential to be incindiary, and my inability to comprehensively discuss every one its facets. However, I think silence is more detrimental, and by the power of the blog, I can continue to explore this and other living donor-related issues on an ongoing basis.

We’ll start with this blog post, and more specifically, the comments pertaining to.

The writer, not surprisingly, is the husband of a 3-time kidney recipient. The books he discusses are, also not shockingly, written by a recipient or relative of a recipient (and worse, an accessory to transplant tourism, a breach of human rights and international law). It’s incredibly easy, and some would say self-righteous, for them to believe living donors should be paid for their organs; they have no idea what it is to be a living donor, or live with the inherent risks of reliniquishing a needed organ.

In other words, they believe the United States government should get into the business of buying and selling human body parts.

The comments ranged as follows:

Total Yes – 19
Total No – 28

Yes-es:
Because I or someone I love needs an organ: 3

Because it’s my body and I should be able to do what I want with it: 3

[This is a pretty typical libertarian answer to many topics, but imo, simplistic. There are many laws in every country governing what its citizens can and cannot do with their bodies. Seat belt, helmets, statuatory rape, narcotics limitations, etc.]

Based on a 10-year old opinion piece with zero logic, specifically that ‘America’s elite’ aka physicians and transplant centers shouldn’t be allowed to determine who gets organs and who doesn’t: 2

Because everyone else gets paid, why shouldn’t donors? 2

[Doctors, etc are paid for a service, skills or time, not for a permanent disfigurement.]

If compensation in the form of health care or tax deduction: 2

Because Paired Donation (or ‘bartering organs’ as he put it) is the same as financial compensation: 1

Because a DECEASED donor’s family has $41,000 in medical bills and other people benefited from his death, they should be paying his medical bills: 1

[If the govt pays a deceased donor’s medical bills in exchange for the organs, it takes advantage of those w/o insurance or in lesser socio-economic statuses.]

Because even though there would be exploitation, there will less than if it remains illegal: 1

If donors are ‘willing’ and abuses can be controlled: 1

Based on some nonsensical racist rhetoric: 1

No Reason: 1

Yes, based on faulty logic, specifically that since there is a market for blood, semen and hair, there should be a market for organs: 2.

[Why it is faulty? 1. Blood, semen and hair regenerate. 2. Harvesting blood, semen and hair does not require invasive, major surgery. 3. Harvesting blood, semen and hair does not subject the donor to life-long and possibly life-threatening health and psychological risks.

And btw, as someone pointed out, the ‘payment for blood’ experiment in the U.S. failed miserably. Payment for organs would fail for all the same reasons.]

No, based on that failed system: 2

No, based on distrust of the government and its agents: 19

No, because of major abuse: 3

No, for ethical reasons: 1

NO, organs would go to the rich: 1

No, because compensation is just assuaging collective conscience that living donors are being exploited for their organs: 1

No, but all costs should be covered and insurance companies should not be able to exclude living donors from coverage: 1

That’s one of two comments by a living donor

The other:

No, because a recipient’s insurance company will cease paying for the living donor’s surgical and otherwise costs if the LD is being paid for the organ.

And finally,
Smart ass, non-productive remarks: 11

I could’ve lumped those into the ‘govt distrust’ category because they mostly consisted of snide comments about our current president, but in the interest of fairness…

The most indepth and thoughtful post is from this JM Hanes, as follows. Interestingly, no one has sought to challenge him yet:

Tragically, I think we can cross off a free market system which is not just an invitation to exploitation and abuse, but a guarantee. It takes almost no imagination to conjure up the ensuing glut of advertisements and questionable solicitation, along with industrial strength, profit based (cost cutting!), harvests and a whole new class of ambulance chasers. If I can sell a kidney, why not an eye or skin, or the occasional vein or vessel?

“A government system would also get built in a “blind” method, where donors and recipients never meet or know each other’s identities, to avoid the appearance of the rich buying organs from the poor.”

The only blind people here will be donors, recipients and almost anyone who might otherwise be in a position to question the political bureaucrats who will be screening and tracking both sides of the equation as well as prioritizing, and very likely means and age testing, the list of who gets what, when, where and how — the least of which may be deciding who gets cadaver kidneys and who gets live donor kidneys.

It’s entirely possible that those maintaining on dialysis could end up waiting 7 years regardless, or that anyone whose first transplant failed would end up at the back of the line on a secondary list. Would intra-family donations be subject to regulation as transactions? Almost any transaction can now be subjected to the federal dictates of interstate commerce, of course, and the step between incentives and compulsion is very small.

When it comes to exploitation, whom do you envision all these potential live donors to be? Do you really think those who are financially comfortable will be lining up in any numbers to sell their organs? I’m sorry to be blunt, but do you believe your friends would have put their kidneys up for sale to recipients they didn’t know? What about parents who might want to offer up the kidneys of minor children — for the good of the family?

That’s just a 2 minute start on the questions that occurred to me once I got over recoiling from the prospect of commercializing the sale of body parts. In this reduction to cost/benefit analyses, has the enormous cost of running dollars through the federal government really been factored in? Have you included every conceivable kind of litigation which might arise? Because it will. When we abandon altruistic donation, we will reach a host of unanticipated moral, legal and political questions sooner rather than later.

Ultimately, the sheer mass of both enabling and preventive regulation, and of subsequent government rule-making, management and oversight, will reach nightmarishly byzantine and inevitably political heights. Even from a financial perspective alone, I believe we would be far wiser to pour such resources into promising research. Alas, where government is concerned, we must confront the searingly difficult questions of financial triage, which includes measuring the relative value of kidney transplants against other forms of intervention. Where lives hang in the balance, there are no painless answers.

JM Hanes

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