Survivor: Now With Actual Carnage

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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.

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  1. Thank god for the Dutch!!

  2. Is the sale of organs illegal in the Netherlands?

  3. Dammit. Urkobold just got our post on this up. I was hoping to get the hat tip from Kerry Howley.
    Dammit.

  4. Call the show You Gotta Me Kidney!

  5. 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)?

  6. 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.

  7. 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?

  8. 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.

  9. Legitimate medical criteria > money or “grovelling for a favor”

    Arguing between the latter two doesn’t seem like a terribly worthwhile effort.

  10. Shelling out cash is better than groveling for a favor.

    I’d rather grovel. Won’t you please let me? Please?

  11. 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.

  12. ‘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.

  13. 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.

  14. 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.

  15. Perhaps, Jennifer, perhaps.

    But that’s a different question.

  16. Interesting as well, the way the “right” of the donor is put in quotation marks.

  17. Joe — re 12:57 — Utilitarianism is a form of ethics.

  18. 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.

  19. 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.)

  20. 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.

  21. 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

  22. 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.

  23. 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.

  24. 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.

  25. 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.

  26. 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.

  27. I’m not dead yet!

  28. 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.

  29. 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.

  30. 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?

  31. 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.

  32. 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.

  33. 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.

  34. 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?

  35. 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.

  36. Good point, Rex.

    Now, do you see what that observation does to your Point B?

  37. 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.

  38. 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.

  39. 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.

  40. 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.

  41. 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?

  42. 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.

  43. “Absolutely no cost”? You lose your organ! Plus the time spent in the hospital and recovering. That’s quite costly, I’d say.

  44. “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.

  45. “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.

  46. I am all in favor of a market for human organs.

  47. 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.

  48. We could call it “Who Wants to Filter Out Their Own Urea?”

  49. 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.

  50. get your organs right here, red hot organs…get em while they last…get your red hot organs…

  51. gives a whole new meaning to game shows like the price is right and family feud don’t it…

  52. “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?

  53. 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!”

  54. 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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