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Survivor: Now With Actual Carnage
Great reality television revolves around a shortage of some kind: living space, attractive women, millionaire bachelors. Or, you know, kidneys:
A Dutch reality show that claims to be trying to draw attention to a shortage of organ donors said Tuesday it will go ahead with a program in which a terminally ill woman will choose a contestant to receive one of her kidneys.
Big Donor Show has been attacked as unethical and tasteless. At least one member of the Dutch parliament plans to ask the government to block Friday's broadcast.
Viewers will be able to vote for the candidate they feel is most deserving via SMS text message, but "Lisa will determine who the happy one is," BNN said in a statement.
"We know that this program is super controversial and some people will think it's tasteless, but we think the reality is even more shocking and tasteless: waiting for an organ is just like playing the lottery," Laurens Drillich, chairman of the BNN network, said in a statement.
Well, it's really not at all "like playing the lottery." Developed countries do not distribute kidneys randomly. Criteria are drawn up, and the organ-worthiness of individuals determined. Organ-based reality TV is sad and grotesque precisely to the extent that it caricatures typical organ allotment systems; where sick people aren't allowed to pay for something they need, they must prove themselves worthy of a gift. Are Lisa's criteria for organ-worthiness any less valid than those of the United Network for Organ Sharing? Discuss.
highnumber|5.29.07 @ 12:30PM|#
Dammit. Urkobold just got
our post on this up. I was hoping to get the hat tip from Kerry
Howley.
Dammit.
|5.29.07 @ 12:31PM|#
Criteria are drawn up, and the organ-worthiness of
individuals determined. Organ-based reality TV is sad and grotesque
precisely to the extent that it caricatures typical organ allotment
systems; where sick people aren't allowed to pay for something they
need, they must prove themselves worthy of a gift.
But wouldn't the free market in human innards mean that people
would still have to prove themselves worthy (by shelling out
cash)?
|5.29.07 @ 12:44PM|#
Are Lisa's criteria for organ-worthiness any less valid than
those of the United Network for Organ Sharing?
From the UNOS website:
When organs are donated, a complex process begins. The
procuring organization accesses the national transplant computer
system, UNetsm, through the Internet, or contacts the UNOS Organ
Center directly. In either situation, information about the donor
is entered into UNetsm and a donor/recipient match is run for each
donated organ.
The resulting match list of potential recipients is ranked
according to objective medical criteria (i.e. blood type, tissue
type, size of the organ, medical urgency of the patient as well as
time already spent on the waiting list and distance between donor
and recipient). Each organ has its own specific criteria. Learn
more
Using the match of potential recipients, the local organ
procurement coordinator or an organ placement specialist contacts
the transplant center of the highest ranked patient, based on
policy criteria, and offers the organ. If the organ is turned down,
the next potential recipient's transplant center on the match list
is contacted. Calls are made to multiple recipients' transplant
centers in succession to expedite the organ placement process until
the organ is placed. Once the organ is accepted for a patient,
transportation arrangements are made and the transplant surgery is
scheduled.
So the answer is "yes". They are much less valid.
Jennifer|5.29.07 @ 12:44PM|#
Shelling out cash is better than groveling for a favor. You of all people should know this, Dan: don't you find paying a hooker less embarrassing than begging her for a freebie?
|5.29.07 @ 12:52PM|#
Dan, it's worth reading Julian's linked article:
The desire to keep the allocation process value-free may be
understandable, but it is probably impossible. A preference for the
"sickest first" is itself, after all, one kind of value judgment
about the best use of organs. The preference for those in most dire
need is not absolute, however: The expected longevity of the
patient after transplant is also taken into account. As
anthropologist Joralemon points out, this creates an implicit bias
in favor of the young over the old, or, as he puts it, against
those who have "been in the game longer" and in favor of those who
"have more innings to play." The patina of objective clinical
criteria conceals the unavoidably ethical priority ranking
underlying those criteria.
|5.29.07 @ 12:52PM|#
Legitimate medical criteria > money or "grovelling for a
favor"
Arguing between the latter two doesn't seem like a terribly
worthwhile effort.
|5.29.07 @ 12:53PM|#
Shelling out cash is better than groveling for a
favor.
I'd rather
grovel. Won't you please let me? Please?
Jennifer|5.29.07 @ 12:55PM|#
Legitimate medical criteria > money or "grovelling for a
favor"
Except for the piddling little detail that under the current
regime, the one actually DONATING the organ has no say in who gets
it. I'd tear up my donor card now if I knew that after I died, my
organs would go to keep the likes of James Dobson alive. Better my
organs turn to ash in a crematory.
|5.29.07 @ 12:57PM|#
'As anthropologist Joralemon points out, this creates an
implicit bias in favor of the young over the old, or, as he puts
it, against those who have "been in the game longer" and in favor
of those who "have more innings to play." The patina of objective
clinical criteria conceals the unavoidably ethical priority ranking
underlying those criteria.'
No, not really. That younger and healthier people are going to get
organs first is just an artifact of valuing the greatest good for
the greatest number, not an ethical criterion that is actually
being applied.
This is about triage - deciding on the most efficient use of
limited medical resources. Favoring those with a greater change of
success is a more efficient distribution of those resources than
saving those offering the most money.
|5.29.07 @ 1:00PM|#
Well, Jennifer, the "right" of a donor to dictate the terms of his dissection is a different matter than the efficiency of such a system.
Jennifer|5.29.07 @ 1:00PM|#
This is about triage - deciding on the most efficient use of
limited medical resources.
Perhaps they wouldn't be so limited if it weren't illegal to make
money off of them.
Jennifer|5.29.07 @ 1:07PM|#
Interesting as well, the way the "right" of the donor is put in quotation marks.
|5.29.07 @ 1:11PM|#
You gotta have heart.
Miles and miles and miles of heart.
It's great to get a liver of course,
But lets put lungs before the chart!
You gotta have heart.
|5.29.07 @ 1:13PM|#
If there was an "organs for profit" model:
A) Far more people would be willing organ donors, thereby
increasing the number of available organs. (Imagine a situation
where you essentially get life insurance for free, in exchange for
being put on a special expedited donors list and taking a few
medical tests to determine compatibility).
B) It would encourage more research into artificial and cloned
replacement organs. (Scavenging organs from dead humans is not the
most efficient method of organ production.)
Chucklehead|5.29.07 @ 1:18PM|#
Joe -- re 12:57 -- Utilitarianism is a form of
ethics.
Well, it's also joe's politics, so you can see how he'd get
confused.
The Wine Commonsewer|5.29.07 @ 1:34PM|#
Organ-based reality TV is sad and grotesque precisely to the
extent that it caricatures typical organ allotment
systems.......
You are not allowed to say so and if you do say so, 90% of America
will say it isn't so. They'll say that it's nothing like that at
all.
Denial isn't just a river in Egypt regards, TWC
The Wine Commonsewer|5.29.07 @ 1:36PM|#
Just in case it isn't clear, the foregoing is a comment on the mindset of America and not a critique of Ms Howley's insights.
|5.29.07 @ 1:44PM|#
Yes, jp, and since the conversation has been about "what organ distribution system will save the most people," it's one that everyone is assuming, and going from there.
thoreau|5.29.07 @ 1:55PM|#
joe, I agree that a carefully controlled triage system is the
only way to save the greatest number of lives when the supply of
transplantable organs is low.
The question is whether a payment system might entice more people
to donate their remains upon passing (in exchange for some money
for their survivors), and thereby increase the number of available
organs and hence the number of lives saved.
|5.29.07 @ 1:57PM|#
Joe -- Just to clarify, I was responding to this comment:
That younger and healthier people are going to get organs first
is just an artifact of valuing the greatest good for the greatest
number, not an ethical criterion that is actually being
applied.
You seemed to be granting to utilitarianism a status outside ethics
as a basis for decision-making.
|5.29.07 @ 2:11PM|#
If there was an "organs for profit" model:
A) Far more people would be willing organ donors, thereby
increasing the number of available organs. (Imagine a situation
where you essentially get life insurance for free, in exchange for
being put on a special expedited donors list and taking a few
medical tests to determine compatibility).
B) It would encourage more research into artificial and cloned
replacement organs. (Scavenging organs from dead humans is not the
most efficient method of organ production.)
C) It would mean an awful lot of people would be worth more dead
than alive. Let's hope that I don't need to further elaborate on
what that would probably lead to.
|5.29.07 @ 2:14PM|#
Perhaps they wouldn't be so limited if it weren't illegal to
make money off of them.
Indeed they would not. But count me in with the group that likes
keeping the number of dead bodies being harvested limited.
|5.29.07 @ 2:35PM|#
thoreau,
"The question is whether a payment system might entice more people
to donate their remains upon passing (in exchange for some money
for their survivors), and thereby increase the number of available
organs and hence the number of lives saved."
The original post, and the first half-dozen comments in the thread,
were not about that at all. They were about the ethics of
"grovelling for a favor" vs. "play for pay" vs. using medical
criteria.
It wasn't until Dan T. and I landed a few rather hard blows to the
claim of equivalency that Jennifer raised that second
question.
jp,
Gotcha. That wasn't my intent - I was just rebutting Julian
Sanchez's argument that basing decisions on medical judgements
introduces "unavoidably ethical criteria ranking" because there are
demographic differences between recipients and nonrecipients. I was
just going with his use of "ethical" in that statement, when it
probably wasn't the best word choice.
Rex Rhino,
Your "B" argument is invalid. Hospitals already pay providers of
organs (meaning, the hospital that harvests them) for the organs
tjhey provide for implantation. There is already a huge profit
motive to develop this technology, because the labs are already
allowed to make a profit selling them.
|5.29.07 @ 2:40PM|#
Does no one have any problem with state control of scarce
resources that are critical to the continued survival of some
people?
t? joe? That's cool with both of you?
|5.29.07 @ 2:43PM|#
It would mean an awful lot of people would be worth more
dead than alive.
And?
Don't you mean: It would make apparent what is already the case -
that an awful lot of people are worth more dead than alive.
|5.29.07 @ 2:48PM|#
And?
Don't you mean: It would make apparent what is already the case -
that an awful lot of people are worth more dead than
alive.
I suppose you could say that.
Although despite the dismissive "And?" I'm not really willing to
assume that you'd be cool with slavery, legalized murder and all
the other great stuff that comes along when human beings are
considered just another commodity to be bought and sold.
thoreau|5.29.07 @ 2:49PM|#
t? joe? That's cool with both of you?
R C-
I thought I made it clear that I favor a market for transplants. My
point was that if something is banned then the only way to
(partially) mitigate the consequences is probably via regulation,
but that we could fully mitigate the consequences, and help more
people, via a market.
|5.29.07 @ 2:51PM|#
RC Dean,
You're going to have to do better than the magic words "state
control." We all need to breath air, and yet the state controls the
SO2 emissions from cars! Ohnoes!
What, exactly, are you asking if I have a problem with?
Do you even know?
|5.29.07 @ 2:52PM|#
C) It would mean an awful lot of people would be worth more
dead than alive. Let's hope that I don't need to further elaborate
on what that would probably lead to.
This is already the case - There is already a huge profit to be
made from donated organs - for the doctors, nurses, hospitals,
equipment manufacturers. Some people are already worth more dead
than alive.
The only difference now is that everyone but the donor gets paid.
Why is it "safer" or more "ethical" to allow the person (or the
family of the person) making the greatest sacrifice to not get
anything for it, when everyone else is making such huge amounts of
money on it.
|5.29.07 @ 3:00PM|#
I don't think the "worth more dead than alive" argument is silly. But it's also worth considering that life insurance creates the same incentive. Murders are sometimes committed simply to get insurance money. We've managed to deal with that through punishment of murder, rather than by banning life insurance.
LarryA|5.29.07 @ 3:13PM|#
It would mean an awful lot of people would be worth more
dead than alive. Let's hope that I don't need to further elaborate
on what that would probably lead to.
The first effect of paying donors would be a huge drop in the value
of organs as the market flooded. Only a small percentage of the
population would benefit from a transplanted organ, so any system
that creates an incentive for a higher percentage of donors would
leave a surplus. I simply don't see "slavery and legalized murder"
as a necessary part of the market supply system.
Restricting payments and discouraging donors would
be more likely to result in a shortage of organs (as we have now)
and lead to a black market that will quite likely feature slavery
and murder, if not in the U.S. then in other countries.
Human beings' organs are already just another commodity to be
bought and sold, only the price for the donor is artificially set
at zero.
|5.29.07 @ 3:18PM|#
I don't think the "worth more dead than alive" argument is
silly. But it's also worth considering that life insurance creates
the same incentive. Murders are sometimes committed simply to get
insurance money. We've managed to deal with that through punishment
of murder, rather than by banning life insurance.
True, but if Person A has life insurance with Person B as the
beneficiary, the only person who has that particular incentive to
murder A is B. And if A turns up dead, you can bet that B will be
the most obvious suspect.
Now, it's obviously a worst-case scenario to assume that a market
in organs will lead to a dramatic increase in murders or
questionable suicides. But even a world where desperate people are
selling their own kidneys seems like bad news to me.
|5.29.07 @ 3:23PM|#
This is already the case - There is already a huge profit to
be made from donated organs - for the doctors, nurses, hospitals,
equipment manufacturers. Some people are already worth more dead
than alive.
These people are not making profit from the sale of organs - they
are paid for performing the services required to transfer organs
from the donor to the recepient.
|5.29.07 @ 3:39PM|#
The first effect of paying donors would be a huge drop in
the value of organs as the market flooded. Only a small percentage
of the population would benefit from a transplanted organ, so any
system that creates an incentive for a higher percentage of donors
would leave a surplus. I simply don't see "slavery and legalized
murder" as a necessary part of the market supply system.
Restricting payments and discouraging donors would be more likely
to result in a shortage of organs (as we have now) and lead to a
black market that will quite likely feature slavery and murder, if
not in the U.S. then in other countries.
Here's a question then - since there is absolutely no cost
associated with organ donation, why is there a shortage anyway?
|5.29.07 @ 3:41PM|#
Dan -- Don't you think it would be pretty easy to figure out
what happened if a wino's corpse is found and his kidneys are
missing? They had to go somewhere, quickly, and an operating room
had to be involved.
With regard to desparate people selling organs, that I think
presents a tougher problem. Should, say, a 20-year-old junkie be
permitted to sell something whose absence will significantly impair
his health for the rest of his life? Is he capable of making an
informed decision? Assuming that's a real problem, maybe it could
be remedied by a mandatory waiting period before the seller's
commitment becomes enforceable. Also, an organ market would
presumably make possible the "replacement" of sold organs if the
seller's fortunes improve.
|5.29.07 @ 3:46PM|#
"Absolutely no cost"? You lose your organ! Plus the time spent in the hospital and recovering. That's quite costly, I'd say.
|5.29.07 @ 3:47PM|#
"Here's a question then - since there is absolutely no cost
associated with organ donation, why is there a shortage
anyway?"
To clarify, I mean no cost for the donor. Yet some people I guess
refuse to donate anyway.
|5.29.07 @ 3:49PM|#
"Absolutely no cost"? You lose your organ! Plus the time
spent in the hospital and recovering. That's quite costly, I'd
say.
No cost because you're dead. I know this doesn't apply to all organ
donations but most of them require a dead body.
|5.29.07 @ 4:06PM|#
Doesn't anybody see the ratings potential here? From an
entertainment point of view this could be huge. I especially see
promise in a "vote for the worst" campaign.
It won't have a long shelf life however. By the third season, it
will become apparent that the chick with the biggest hooters always
wins.
|5.29.07 @ 4:21PM|#
What, exactly, are you asking if I have a problem
with?
State control over a resource that thousands of people need to stay
alive.
Do you even know?
I know the degree of state control over organ transplants.
I represent a major organ transplant center, so I am intimately
familiar with UNOS, the new federal regs for heart transplants, the
whole apparatus of state control over transplants.
And this level of control is fundamentally different from pollution
control regs. Whereas those regs say what you can put into the air,
the transplant regime dictates whether you are allowed to breathe.
Literally.
|5.29.07 @ 4:32PM|#
get your organs right here, red hot organs...get em while they last...get your red hot organs...
|5.29.07 @ 4:34PM|#
gives a whole new meaning to game shows like the price is right and family feud don't it...
Jennifer|5.29.07 @ 4:39PM|#
"Here's a question then - since there is absolutely no cost
associated with organ donation, why is there a shortage
anyway?"
Another way to phrase the question: since there is absolutely no
benefit associated with organ donation, why isn't the shortage
worse?
|5.29.07 @ 6:58PM|#
Call the show You Gotta Me Kidney!
Very good. I saw this and was gonna respond, but ...
We could call it "Who Wants to Filter Out Their Own
Urea?"
DANG you, joe! You stole what I was going to say, almost word for
word. Dang you, sir.
Well then, I have to come up with other ideas.
"I've Got-a Excrete"
"Renal 9-1-1!"
The Wine Commonsewer|5.29.07 @ 8:59PM|#
It would mean an awful lot of people would be worth more
dead than alive.
Anyone with a fat life insurance policy is worth more dead than
alive. Like Mrs TWC for instance. Wait. Hmmmm.
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