I'll Trade You Two Spleens and a Pancreas...

Julian Sanchez | October 5, 2004

One of the first pieces I wrote for Reason was about the group LifeSharers, whose members pledge to donate organs upon death, but request that priority be given to any other compatible members on the waiting list. The medical establishment, as I noted there, seems mostly opposed to this approach. Today, there's a New York Times story on the apparently kosher practice of explicit quid pro quo organ trades, wherein the family members of people requiring organs undergo simultaneous operations, swapping to achieve a match. Can anyone construct a coherent bioethical theory according to which this is OK, but LifeSharers is objectionable?

Comments

|10.5.04 @ 2:07PM|#

Yes. "Blood is thicker than water."

Your wife (or mother, father, son, daughter, brother) and a complete stranger are both drowning at the same time. You can only save one.

It takes a bioethicist to solve this?

|10.5.04 @ 2:30PM|#

Gee, that LifeSharers sounds like a real fun club. What do they do for fun, get together and compare blood analyses?

|10.5.04 @ 2:36PM|#

What if I don't like my family member as much as I do the other drowning guy. I can't choose the other guy and be moral?

No, this is an issue of ownership. "My body my choice" indicates that if you are alive, you can dictate what happens to stuff in your body. This is not desirous really, since the medical establishment knows better than you what should happen to your kidney, but we must make allowances for selfish acts to preserve the principle we hold in other realms.

Once you are dead, the blessed Establishment who Really Knows Best for Soceity At Large can do what they should have been doing all along - controlling your innards.

Oh, you said coherent ...

|10.5.04 @ 2:47PM|#

fishfry: the metaphor doesn't hold. If you're joining up with a group voluntarily then by definition they're not complete strangers; even if you aren't personally acquainted with each member of the group, you're associated by mutual membership.

Even so, the dilemna posed by the drowing spouse example is easily solved: both of you enroll in the group. Thus you don't have to decide between your wife and the stranger, as both have priority over the 89 other passengers who are also drowning.

|10.5.04 @ 2:48PM|#

I think fishfry is misreading how this works. The way it works is that MY family member needs an organ, and YOU'RE a compatible donor, while YOUR family member needs an organ for which I'M a compatible donor. We trade. So while you're helping a family member, it's still a trade with a stranger. (Not, of course, that "blood is thicker than water" constitutes a particularly coherent ethical principle.)

Jeff|10.5.04 @ 2:57PM|#

Who wants a piece of me!?

Highway|10.5.04 @ 3:06PM|#

Well, I can imagine that it's considered more of an offshoot of how living donor organ transplants work, while the LifeShare system is for transplants from a the recently deceased. The living donor system has always allowed for finding a suitable donor and having the transplant done. I think this is just an opportunity, using better typing and transplant surgery (and follow up) techniques to increase the pools of available donors. Using the idea that once you've found a donor compatibility, you might as well look along those same lines for other transplants that might be necessary. Since you've already identified a family that can have suitable organs, it's a good starting place to look.

As such, the quid pro quo trading doesn't run into conflict with the United Network for Organ Sharing (UNOS) or any other groups that might be the ones who currently apportion organs and draw up the waiting lists, based on their criteria. LifeShare DOES monkey with their lists, saying that they want to move certain people up (although you would think that every person waiting for an organ would be inclined to sign up with LifeShare: What have you got to lose?) based on their participation in a group that ISN'T UNOS. At least that's an explanation of the difference between the two. Your search for a coherent ethical model doesn't obtain because the ethics between the two cases don't matchup (I personally think UNOS has too much power, but that's a personal opinion).

|10.5.04 @ 4:54PM|#

May I decide the issue by voting with my vagina?

|10.5.04 @ 5:21PM|#

"May I decide the issue by voting with my vagina?"

Yes, but not someone else's.

Jeff|10.5.04 @ 5:41PM|#

I want to state for the record that I refuse to use the voting booth after Zelda...

And has anyone ever done a study on the cleanliness of voting booths. Metal levers under naked bulbs in humid gymnasiums, being touched by thousands of sweaty hands over a 12 hour period.
Shudder...

|10.5.04 @ 7:04PM|#

Tell it to the doorknob, Jeff.

|10.5.04 @ 7:41PM|#

I'd argue that in the public sphere, all ethical arguments come down to agreements about what is palatable to the powerful. A system wher eht edead can't say what to do with their organs just fast tracks all the debate by allowing doctors to take the organs from the absolutely powerless (the dead.) Whereas when there are living relatives with a prior interest in what happens to the organs, as is the case of the organ swap arrangement, the doctors are prevented from practicing their personal ethics by others with a stake in the organs' fate.

|10.5.04 @ 9:20PM|#

As a healthcare attorney who works extensively with organ procurement and transplant issues, I have never for one minute understood why some people find organ transplant and other related issues so hard to figure out that they cede power to a "bioethicist."

The whole bioethics gig is a scam. Pure and simple. I have never seen a bioethical "dilemma" that isn't readily resolvable using common sense notions of self-ownership and informed consent.