Biotechnology

How "the Gift of Life" Comes Up Short

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In Sunday's New York Times Book Review, former Reason Editor Virginia Postrel has good things to say about Kieran Healy's Last Best Gifts: Altruism and the Market for Human Blood and Organs, which argues that payments for human tissues shouldn't be illegal and, indeed, need to be discussed more openly in today's medical environment. A snippet:

"Public ambivalence about transplantation was overcome, in part, by arguing that donation was the 'gift of life,' " [Healy] writes. "The success of this idea now makes it more difficult to garner support for a market for organs." By emphasizing altruism, transplant advocates gave comfort to the bereaved, conferring meaning on a tragic event and justifying what might otherwise seem like desecration. This early success helps explain why, even in the face of a critical shortage of organs, many leaders in the transplant field oppose any financial incentives for organ donors, including tax credits or payment toward funeral expenses.

The "gift of life" story is useful but, according to Healy, oversimplified. Shaped by a strongly anticommercial ideology, it places too much emphasis on the division between giving and selling. It doesn't acknowledge the diverse ways in which people define the social meanings of exchange, regardless of whether money is involved. The fable of heroic altruists also misleadingly emphasizes the motives of the donor (or the donor's family) over the system in which the decision to give or not takes place. "The voluntary donation of human goods is an organizational accomplishment," Healy argues….

There are nowhere near enough brain-dead accident victims to fill that demand, regardless of family beneficence or organizational efficiency. Fortunately, nobody has to die to supply a kidney. They can come from living donors, who can live perfectly normal lives with a single kidney and who now account for nearly 40 percent of all kidney transplants. With the kidney shortage at crisis proportions, the debate over financial incentives is really a debate over whether living adults should be allowed to sell their own organs or, at the least, receive a tax credit or some other indirect compensation….

Healy's sociological message resonates through that debate. Financial incentives would operate within complex organizational structures, as well as contract and liability law. Bureaucratic institutions, notably hospitals and insurers, would shape the environment in which transplants take place. Many kidney sellers would still have humanitarian motives. "The idea that markets inevitably corrupt," Healy writes, "is not tenable precisely because they are embedded within social relations, cultural categories and institutional routines." Commerce isn't antithetical to culture; it is part of it.

Whole thing here.

Postrel on being a kidney donor here.

Reason's Kerry Howley explored the commercial side of egg donation in "Ova for Sale."

Reason's Ronald Bailey made "The Case for Selling Human Organs."