They'd Do Anything for Organs, But They Won't Do That

Brian Doherty | October 26, 2004

In some well-publicized recent cases--including the first one arranged via the Internet (how quaint that we are still seeing first-over-the-Internet stories--and still ones that might not be accurate)--people have successfully advertised for donated organs, avoiding, as USA Today reported,

the waiting list maintained by the United Network for Organ Sharing, the nonprofit group that works under government contract to allocate all organs donated from the dead. It doles out organs, in part, according to which patients need them the most.

Even though 17 Americans die a day while waiting for donated organs in the current system, a Denver Post story on some possible attitude changes in our national organ-donating system points out:

Human-transplant advocates defended the practice of some privately arranged procedures in the wake of the nation's first Internet-brokered organ transplant.

Any sweeping prohibition on private arrangements between potential organ donors and their recipients would cost lives because the national waiting list has ballooned beyond the pool of identified donors, several organ recipients and advocates said Monday.

With such a mounting human need, those requiring kidneys, lungs, livers and other organs said they support any mechanism - aside from the buying and selling of organs - that would save lives.

Petty half-measures--like $300 burial donations for relatives in Pennsylvania, donations to charity in donors' names, or "medals of honor"--are in play, but the organ donating community still refuses to add some market discipline to the procedure--the only thing that might guarantee that willing donors and needy patients can actually strike deals that satisfy them both, and save lives.

A Nov. 1998 Reason article by James V. DeLong discusses the mucked-up realities of our centrally planned organ donation system at length, and notes:

Another point so well accepted that it's rarely mentioned is the assumption that organ donors should not be paid. Even though everyone agrees that donation rates need to be raised, few are willing to consider how financial incentives might serve that cause. A lively debate on the issue is heating up in the academic literature, including the pages of the prestigious British medical journal Lancet, and is beginning to spill over into popular discussion.

The idea that it's offensive to discuss transplants in financial terms is droll, since the system is awash in economic calculations by medical centers, surgeons, health insurers--everyone except the donors.

Comments

|10.26.04 @ 11:21AM|#

I'm thinking the results of deregulating the process might have insurance companies fitting this into their policies. In other words, maybe some kind of agreement to offer a certain percentabe of the price (copayment), or anything over a certain price (deductable).

It'd be interesting, for sure.

Highway|10.26.04 @ 11:35AM|#

There are so many problems with UNOS that it would take days to go over them all. One that happened here recently (in Maryland) is that they wanted to force ALL organs to be sent out of state for a time, since Maryland had such a high 'importation' rate. This occurred because people who live in southern Pennsylvania were coming to the major hospitals in Baltimore, Johns Hopkins and University of Maryland, to donate organs to relatives or friends or matches. Since the person was from PA, it counted as an 'import' organ to Maryland, even if the recipient would move back to PA. This same system also punishes advanced centers that would go ahead with a risky transplant, as Hopkins and Maryland both will implant organs that other hospitals would reject, such as due to age or other condition of the donor.

Basically, I think UNOS is more concerned with keeping their privileged gatekeeper status than getting more people healthy, and they erect 'ethical' rationales, like 'sickest first' or import/export quotas, to exert control.

|10.26.04 @ 12:40PM|#

and they erect 'ethical' rationales, like 'sickest first'


If rationality were to be applied, shouldn't organs go to whomever is most likely to survive with said organ, than to the sickest person who is less likely to survive with said organ?

Highway|10.26.04 @ 1:18PM|#

metalgrid,

That's why I used the sarcasm quotes around ethical. DeLong's article makes this point, and shows that UNOS doesn't use any quality or probable quantity of life measure, but rather reduces it down to 'life'. In their accounting, if the person will wake up from the transplant operation, it doesn't matter what happens to them after that, and that cannot be the basis for determining priority.

|10.26.04 @ 2:13PM|#

Highway,

I noticed :)

It's the same type of reasoning that the govt uses to increase the taxes on those of us who work more in order to make more money. Obviously we missed the ride on the statist logic short bus.

|10.26.04 @ 2:55PM|#

Why can't anyone just use the
"It's my body I'll do with it what I want"
argument?

|10.26.04 @ 7:02PM|#

My wife and I aren't Libertarians, but she has had four kidney transplants. I'lll stand up for UNOS. UNOS goes for sickest first because they need the organ the most... and by sickest they mean the person with the most severe liver/kidney (the transplants I'm most familiar with) problems. To receive a transplant you need to be otherwise "healthy". The best transplant candidate is a non-smoking marathon runner on dialysis, they are in great shape, they just don't have functional kidneys! You aren't going to get a transplant if you have terminal cancer and in many centres a transplant if you aren't compliant with your diet and drug regime prior to transplant (the thinking being if you don't take care of yourself before the transplant you won't do so AFTER the transplant. And believe me, a transplant is not a panacea, it takes a LOT of effort to stay healthy after having received one). So the "sickest first" doesn't necessarily mean what you t'ink it means-in Inago Montoya's words.

"Why can't anyone just use the
"It's my body I'll do with it what I want"
argument?"-Rhetorical Libertarian argument, for the same reason you can't score heroin legally or sell your body for sex, dude...

My wife does NOT agree with the sale of organs, I do. She fears that Bill Gates will get a kidney and she won't, he can afford to pay more than she can. I understand her fears, but I counter by pointing out that Bill Gates can buy more hambergers than she can, but there's no shortage of hamburgers, due to the market system. I think selling organs would INCREASE the supply and lower prices. HOWEVER, I dare say very few people here have faced the certitude of death or life degradation that comes from being in a situation requiring a transplant...so it does behoove us to pay a bit of attention to those fears.

|10.26.04 @ 7:42PM|#

I like the comment that everyone else has self-interest in mind, but the donor is forbidden to consider anything but a noble cause.

The doctor doesn't perform the surgery for free; the insurance company doesn't pay for it out of the goodness of their hearts; the hospital doesn't donate the operating room; the patient's self-interest is obvious.

How many donor cards would get signed if the donor knew his family would receive money over and above his life insurance? For people that cannot afford life insurance, this might be all they have to leave their families. One can even imagine a company that offers free life insurance in exchange for the right to harvest whatever organs are available.

But this is forbidden. Everyone else in the program gets something out of it while the donor is required by law to be completely selfless. I admire completely selfless people. I really do. And I admire them all the more because I don't know any.

Highway|10.26.04 @ 11:35PM|#

Joe L.

I hope your wife is doing well, 4 transplants is surely nothing pleasant to go through, so best of luck to her.

And I do understand the concept of 'sickest first', and realize that it does mean exactly that. But it is also a partial cop-out from a perspective of evaluating potential benefits to other recipients. It's a very bureaucratic way of doing things, since it's easy for doctors to just look at who has the least chance of living without the transplant. But with organs in such short supply, and people dying every day waiting for them, maybe it shouldn't be the only criteria.

|10.27.04 @ 8:44AM|#

Well Highway,
I see your point, BUT it is akin to "Zero Tolerance" Rules. They allow administrators to act without thinking, "We ahve a zero tolerance rule for weapons, so a butter knife and an AK are equivalent."

In the case of transplants, the sickest first avoids a LOT of complications. Are you a racist, sexist, bigot, homophobe? How come at Johns Hopkins Democrats have a statistically significant better chance of receiving a trnsplant? These are the sorts of questions doctors and medical centres will face if they broaden their criteria. Right now, it's fairly simple, OK not really true, I guess it's MORE simple to allocate on the current basis than to include other criteria.

Yes, I think the answer is the sale of organs. Hey, if I want to reserve my kidneys for my wife OR a Republican I ought to be allowed to. But it is going to be difficult to move from here to there. And until we move from the current here to the hoped to there of sale of organs, I think "Sickest first" isn't a bad rule.

Highway|10.27.04 @ 9:43AM|#

I think we both agree that the MAIN problem is the shortage of organs, and until they are a commodity, with supply able to outpace demand, the issue will stick around. I don't think allowing payments for organs would totally close the gap, but it would make a dent in it. That's why I put my hope on advances in the production of tissues, although it may be a long way off.

|10.27.04 @ 11:38AM|#

I hope that technology can help alleviate the shortage. Payment might crack some of the opposition to cadaver donation. I can't give my heart up for transplant, no mattter how much yo offer, but if my estate could net 10-20K it might make my haeirs allow the harvesting.