The Kidney Stays in the Picture

Former Reason Editor Virginia Postrel tells the positively true adventure of how she donated a kidney in the latest Texas Monthly.

The recipient of Virginia's organic largess, Sally Satel of the American Enterprise Institute, had an op-ed in the NY Times yesterday about how craptacular the current system for donating organs is (largely because they must in fact be "donated" rather than bought and sold in some way, shape, or form).

On June 12, AEI will be hosting a forum in Washington, DC, titled "Buy or Die: Market Mechanisms to Reduce the National Organ Shortage," featuring introductory remarks by one Newt Gingrich, who is no doubt rapidly approaching the mileage warranty on any number of body parts. More info and RSVP here.

Comments

[Dave W.]

The concern is that poor people will feel economically pressured to sell off organs. Some people are uncomfortable with that, for ethical or moral reasons or something. If we can figure out a good way to address that concern, then our chances at positive legal reform in this area will be greatly enhanced.

[alkali]

Both the Satel op-ed and the title of the AEI forum suggest that we are facing a "national" organ shortage. Query: do other industrialized countries have this problem? If not, is it because they allow organ sales, or because of cultural differences or some other reason?

[Jason Ligon]

I don't know how to address the concern Dave W. It certainly weighs heavily on some minds, but I don't get it. Why is it better, or even more ethical, to have an organ shortage more severe than there needs to be?

As with most regulation, this sort of thing doesn't elminate the problem, it makes it worse and relocates it.

[JW]

Why not? It's their body. They can do what they want with it.

It beats whoring to pay the rent (other than congresscritters that is.)

[methodman]

Ok, how bout this: they're their organs, and if they want to sell them, ain't nonemybiz. (Upon previewing, I see this has been suggested.)

Or, perhaps more palatable but useless in a Satel/Postrel situation: people who agree to donate their organs when they die can reap cash rewards for their wives/children/etc.

I presume an objection about how selling organs to the highest bidder would follow shortly, because Bill Gates shouldn't have a better shot at a liver than my fat, lazy and stupid cousin.

[Jason Ligon]

alkali:

My guess is that since most other countries have systems in which the government always tells you when you can have a procedure, there is a gap in perceptions. I don't think people in other countries see government mandated scarcity as anything other than a necessary feature of a 'modern' healthcare system.

[the other Mark]

Why not? It's their body. They can do what they want with it.

But poor people are too stupid to make their own decisions, didn't you know that? Only social workers and politicians can make the decisions.

[Dan]

"Donate" really REALLY means "donate."

My dad donated a kidney to a family friend who was way down on the list and running out of time. He is a factory worker who makes very little money and had to be out of work for months during the operation and recovery time.

The recipient graciously offered to pay my dad for the time he was out of work so that he would not be worse off economically for having given away an organ. The state and the hospital and the kidney organization all said that was absolutely forbidden and if found out they would not do the operation.

[speedwell]

"The concern is that poor people will feel economically pressured to sell off organs.... If we can figure out a good way to address that concern...."

Seems kind of simple to me. Poor people are not as able to take care of their bodies, especially if they are in such desperate straits as to sell of organs for the cash. So organs from poor people (assuming they show the effects of ill health and nutrition) will probably be downgraded in the marketplace. Lower prices, less incentive.

[speedwell]

Thinking about it some more... with a thriving market in organs, there's also an increased probability that the organs of poor people in indifferent health will actually be rejected as substandard. Right now we're so desperate for donated organs we'll take anything so long as it still has some mileage on it.

[Ironchef]

Ahhh, the "poor people" - the #2 reason the State has grown to be the invasive monstrosity it is. (right beside "the children")

[Ruthless]

Has anyone done some thinking about how plasma donors are related to these issues?

[agentalbert]

So if a poor but otherwise healthy person wants to sell a kidney for $30,000 (just a guess), and get an apartment, car, and some groceries, we shouldn't let that happen?

[Swillfredo Pareto]

The Institute of Medicine cautioned against treating the body as if it were "for sale."

Right, which explains why the donated organs are free to the recipients. Oh wait, what was I thinking? What a bunch of erratic thinking for so learned a crowd.

[Russ R]

Here's an attempt at applying basic market principles to the organ shortage.

Yes, I'd prefer to see people swapping organs on eBay, but back here in Realityville, since we're nowhere near recipients paying donors directly for their organs (which only really applies to organs that come in pairs like kidneys, and maybe an ovary or testicle), maybe we should compensate people to increase the supply of cadaveric organs (which includes the ones that live donors can't part with). Oh, and do so in a way that won't create incentives to go around collecting body parts from accident scenes, or abducting and butchering involuntary "donors". (See: http://www.imdb.com/title/tt0094693/plotsummary )

One way to increase the number of cadaveric organ donors is to get more people to sign organ donor cards, and one way to compensate them is to give them the benefit of a head start on the waiting list should they ever require an organ.

Example... You and I both require an organ and after matching for tissue type and size, a suitable one becomes available, but because you signed your organ donor card before I did, you get priority. Anyone who doesn't sign their card gets to wait at the back of the line. (If you're not willing to share yours, why should you be entitled to someone elses?)

[Dave W.]

It certainly weighs heavily on some minds, but I don't get it.

Reading recommendations:

Dickens novels (eg, Oliver Twist)
Sermon On The Mount

Ultimately, the value of bodily integrity, like the value of human life itself (if any) comes down to metaphysics and faith, not reason. I don't have a utilitarian argument to explain why I find the idea of people giving up kidneys to keeping eating to be repugnant. Then again, I don't have a utilitarian argument to to explain why I find it repugnant that they let all those black people drown during Katrina.

I can't wait for the Holday season so T. and I can continue our interactive remix of Dickens, a Christmas Carol, starring the ghosts of consumer choice past, present and future, as well as scientist who has turned his intellectual prowess into some serious bling!

[thoreau]

Russ-

That's an interesting idea.

Of course, you realize that a market for organs would lead to people waking up in bathtubs full of ice after drinking something laced with sedatives at a party, and finding a note that says "Call 911 when you wake up."

It's true. I swear. My college roommate's mother's friend's neighbor's sister's son had it happen to him. His girlfriend tried to cheer him up by baking him some cookies. They were good cookies, and the recipe was worth the $250 she had to pay for it.

[Dave W.]

So if a poor but otherwise healthy person wants to sell a kidney for $30,000 (just a guess), and get an apartment, car, and some groceries, we shouldn't let that happen?

I bet we can bargain him down to much less. Let's offer $1000. make sure he understands that there are lots of poor people out there and some are pretty hungry. The more we get rid of welfare, the better deals we should be able to secure on the organs.

[Swillfredo Pareto]

I find it repugnant that they let all those black people drown during Katrina.

Beg the question much?

[Ruthless]

What is the atheist equivalent of sainthood?
I'm thinking of Virginia Postrel.

[James B.]

What about Professor Postrel's suggestion of zero income tax liability in the year that a person donates a kidney? This gives the Wall Street trader a much bigger incentive to give over the random down -on-his-luck poor person, and since you only have 2 kidney's you can't abuse this provision to avoid the income tax.

[Dave W.]

I didn't see that suggestion in the article, James. Sounds like a great idea, a great way to handle the concerns I have in this area.

[Timothy]

Because lord knows we've got to make sure Dave W's concerns are addressed!

[Dave W.]

Another way to do it would to be give permanent resident rights to any foreign national who donated to a USian. We could kill 2 birds with one stone.

[thoreau]

Of course, if we exempt kidney donors from taxes, then some year when Trump does especially well, we'll have to endure "The Recipient."

"I've invited 16 sick candidates from around the country to compete for the chance to receive my gold-plated kidney. It's hyooge! It wasn't gold-plated originally, but I feel that gold just adds an extra touch of class and exemplifies the Trump brand, so I've been taking gold supplements for the past 6 months to get it ready for its moment on camera."

[Pro Libertate]

I think this is how Soylent Green gets started.

[Jennifer]

Even assuming that poor people selling extra kidneys and lungs would be a real problem, that doesn't explain why full-fledged organ and tissue donors--the ones who let their entire bodies be re-distributed after their death--couldn't receive money for their families or heirs.

I'm an organ donor, and if I were to die in a hospital tomorrow, some hospitals and organ banks would make millions of dollars selling off useful little pieces of me, while my boyfriend/heir wouldn't even have my funeral costs defrayed.

[Dave W.]

I'm an organ donor, and if I were to die in a hospital tomorrow, some hospitals and organ banks would make millions of dollars selling off useful little pieces of me, while my boyfriend/heir wouldn't even have my funeral costs defrayed.

C'mon -- u know the answer, Jennifer. The answer is:

Sometimes there is a risk that the ailing patient will not be able to pay her hospital bill. However, if she dies and her organs are donated, then the bill gets paid. If she lives, the bill becomes much larger and might not get paid. Sets up a very bad incentive for doctors and hospitals. Also, some men take their role of provider so seriously, you would probably see some accidents motivated by hope of financial gain for the wife n kiddies.

Here again, there may be creative fixes, but we can at least identify the non-liber fears here.

[Jennifer]

Also, some men take their role of provider so seriously, you would probably see some accidents motivated by hope of financial gain for the wife n kiddies.

You could use the same argument to explain why poor people shouldn't be allowed to buy life insurance--it might motivate people to commit suicide, or seek out accidents, in hopes of leving their heirs well-provided-for.

So how much money do you think a person should have before being allowed to buy life insurance?

[Dave W.]

So how much money do you think a person should have before being allowed to buy life insurance?

How have the life insurance companies addressed the analogous problem in their area?

1. They have rules that you don't get the premium through suicide or assisted suicide.

and

2. They sat the premiums high enough relative to the payouts so that poor people buying big payout policies is not a huge problem.

That said, there have long been lawsuits related to whether the insured killed himself or not. To this day, some people probably do kill themselves for insurance money and get away with it. However, without the two strategies I listed above, this problem would be a lot, lot bigger.

Thankfully we have some JamesB's around who can help us get the strategies that will work in a posthumous organ donation context. the first step, as with Katrina, is admitting that we have a problem.

[Dave W.]

"premium" should be --payout--

[Jennifer]

They have rules that you don't get the premium through suicide or assisted suicide.

Anybody who owns a car can figure out a way to die and make it look like an accident. I'm simply pointing out that your argument against allowing organ donors to make money off their deaths is no different from any argument that can be used against life insurance--both cases can offer people financial incentives to die.

[dagny]

People already trade a portion of their health for money when they take on dangerous and/or strenuous jobs.

And as for money for corpsified organs: yeah, the real argument against it you could also state against life insurance, which can have some pretty good, get-out-of-debt-free (besides the nasty dying bit) payoffs.

[Dave W.]

Anybody who owns a car can figure out a way to die and make it look like an accident.

What is more challenging is when the wife wants to arrange an accident for her husband without being detected.

http://tinyurl.com/pzlu8

You are correct that the difference between the problem in the life insurance context and the paid organ donation context is not a difference in kind.

[Jennifer]

What is more challenging is when the wife wants to arrange an accident for her husband without being detected.

So let's outlaw life insurance, shall we? Never mind the fact that it is often extremely helpful and beneficial--what really matters is that sometimes bad things happen because of it! Just like bad things might sometimes happen if we let organ donors make money from their donations.

[Dave W.]

Let's not outlaw life insurance. Because of the fact that it is often extremely helpful and beneficial--what really matters is that the insurance industry has taken care to regulate the policies so that bad things don't happen too often because of it.

We should emulate life insurance in looking for regulations so that this problem stays at some kind of reasonably low degree. Unfortunately for us, I don't think we can charge people premiums in order to maintain their right to be paid for posthumous organ donation. So we need a different mechanism to discourage the opportunists.

Besides the bigger part of the problem is opportunistic doctors and hospitals. If we can get their incentives sorted out in an acceptable way, solving the problem of opportunistic suicides and murders will probably seem like child's play. Bad things will definitely happen often if we let hospitals make money from their patients' donations.

[mk]

How many years have you been waiting for a chance to use that headline Nick?

[Lowdog]

I'd be tempted to sell one of my kidneys if the price was right. I'm not poor, but I'm not rolling in the dough, either. $30,000 would go a long way for me.

[johnl]

An example of where the wild west of reproductive medicine is ahead of the rest of the business. If you are dying because you need a kidney, there is no way to compensate a donor. But there is a market for human eggs.

[Dave W.]

I'd be tempted to sell one of my kidneys if the price was right. I'm not poor, but I'm not rolling in the dough, either. $30,000 would go a long way for me.

If you can convince your wife and kids to sell, then you could get double, triple or even quadruple that much. Put some pressure on them, but no hitting, please.

[Lowdog]

I don't have a wife or kids, Dave, so you don't have to worry about me pressuring anybody into selling their organs.

[Robert]

'Twasn't illegal until Al Gore Jr.'s Organ Transplant'n Act of 1984. It exempted blood because there was an existing market, and would've immediately caused a shortage which would be rightly blamed on the Act. However, solid organs hadn't yet developed a market, so as xplant'n became more popular the shortages which developed wouldn't be blamed on the Act.

[Jennifer]

Bad things will definitely happen often if we let hospitals make money from their patients' donations.

Hospitals already make money from donations, as do the organ banks. It's only the donors themselves who are left out.

[Dave W.]

I don't have a wife or kids, Dave, so you don't have to worry about me pressuring anybody into selling their organs.

You are lucky. You'd be amazed at how expensive raising a family can be.

[SmokingPenguin]

What about live liver donations? People can donate 1/2 of their liver. Here's the odd thing - the liver, if healthy, will grow back to full size. It's the only human organ that will do so, as far as I know. Given this, could there be any legitimate argument to stop commerce in voluntarily donated livers?

[thoreau]

The moral hazard related to letting a family collect cash for their deceased relative's organs seem easy to resolve. Murder is already illegal, and medical malpractice carries stiff penalties, including damage awards and potential loss of license. (And yes, I know, in Libertopia licensing would be handled by private bodies, yadda yadda.)

And if somebody commits suicide? Well, a relative of mine committed suicide. She left behind a devastated husband and a disabled son. I won't pretend that cash for organs would have eased any pain, but it might have eased a few burdens for a single father with a disabled son.

Smoking Penguin: I had forgotten about that. Cool! Yeah, I'd give up part of my liver for $10k.

[The Real Bill]

You'd give up part of your liver for only 10 grand?! That's way too cheap.

I, too, fear organleggers. But stiff enough legal penalties might deter most.

[Jennifer]

Another thought occurs to me: I keep reading stories that the Chinese have been executing some prisoners and selling their organs for transplants in America. I don't know if it's true, but it certainly sounds every bit as plausible as American organ donors murdered by greedy heirs.

If organ-selling were legal in America, at least for after-death organ donors, it might reduce demand for the organs of murdered Chinese prisoners. So what "bad thing that might happen" is the worst, do you think--the bad thing that might happen if Americans have financial incentives to be organ donors, or the bad thing that might happen if China, one of the world's less-nice governments, continues to have a financial incentive to murder prisoners it doesn't give a damn about anyway?

(By the way: it would be far easier for the Chinese government to murder for organs, than it would for any average American. You can't simply kill somebody, put their body on ice and have their organs be any good--you can only get organs from someone who died in a hospital, on life support, in an extremely controlled environment. So if you wake up in an icy hotel bathtub with a missing kidney, take comfort in knowing your kidney won't do that thieving bastard much good anyway.)

[thoreau]

As far as my end game, I have thought about donating organs, but I think a more appropriate fate for me would be as a cadaver in a medical school's anatomy class. Might as well deliver one final science lesson at the end of my life.

Apparently it's illegal for medical schools to pay the deceased's family, but maybe something could be arranged once I'm a full-time faculty member: A semester's salary, paid to my wife, for classroom services rendered.

[thoreau]

Cuz, hey, if British universities can have embalmed corpses wheeled into faculty meetings, surely I can remain on the faculty for an extra semester post mortem.

Auditor: "Why do you have a dead guy on your payroll?"

Registrar: "He's teaching our anatomy class this semester."

[Dave W.]

Another thought occurs to me: I keep reading stories that the Chinese have been executing some prisoners and selling their organs for transplants in America.

Actually that's just a myth. It is based on a true story though. What really happens is that the Chinese kill all second and third babies and grind the bodies to sell them as commodity meat in New England. I propose that we make it legal to do this in the US so that we can compete with those Chinese so and so's!

[Isaac Bartram]

thoreau

When some friends of my mother checked up on donating their bodies to the University of Florida Medical School they were told that the school would be glad to accept the cadavers if the donor arranged and paid for transportation of the body to Gainesville. This ended up being more expensive than the simple cremation that they would otherwise arrange (they were Quakers so extravagant burial rituals were not considered). They elected not to do it (Quaker frugality won out over Quaker do-goodery).

Perhaps the geezer population in Florida has created an oversupply of corpses so that the Gators can be that choosy. I certainly hope that other medical schools have more friendly policies.

[Pro Libertate]

UF has to be choosy. Our army of zombies can't afford to include Quakers, who might object to eating brains on religious grounds. That wouldn't do at all.

[Isaac Bartram]

Pro Libertate

Guffaw!!

[Pro Libertate]

Isaac, just wait until football season. Our defense will have opposing offenses for lunch.

[Isaac Bartram]

Our army of zombies can't afford to include Quakers, who might object to eating brains on religious grounds.

I had no idea that that was how UF recruited its players.

Maybe that explains why Swarthmore was never a football powerhouse.