Organ transplants

Banning Organ Sales Kills People

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Sally Satel (who herself received a donated kidney from former Reason editor Virginia Postrel) talks in the Washington Post about all the lives lost because lawmakers think there is something vulgar or awful or dangerous about allowing any sort of market compensation for human organs.

Excerpts from the introduction to the Satel interview:

About 30 Americans a day either die on the waiting list or are removed from it because they have become too ill to receive a transplant. Taxpayers also bear a significant burden in the case of kidneys because of the special status of renal dialysis within the Medicare program. In 1972, Congress mandated that Medicare cover the costs of care for end stage renal disease regardless of patient age. In 2011, over 500,000 people took advantage of this benefit at a cost of over $34 billion, which is more than 6% of Medicare's entire budget…..

What might change this? The culturally unspeakable but economically sensible solution of allowing compensation for donors (though Satel doesn't want to go for a full "free market" model, which would likely do even better in matching willing donors to needy recipients).

Satel told the Post of a possible model toward allowing some compensation in organ donation:

a governmental entity, or a designated charity, would offer in-kind rewards, like a contribution to the donor's retirement fund, an income tax credit or a tuition voucher, or a gift to a charity designated by the donor. Because a third party provides the reward, all patients, not just the financially secure, will benefit.

Meanwhile, imposing a waiting period of at least six months would ensure that donors didn't act impulsively and that they were giving fully informed consent. Prospective compensated donors would be carefully screened for physical and emotional health, as is done for all donors now. The use of in-kind benefits coupled with a waiting period would screen out financially desperate individuals who might otherwise rush to donate for a large sum of instant cash and later regret it.
The donors' kidneys would be distributed to people on the waiting list, according to the rules now in place.

It's a mild change, perhaps not too frightening to those with a deep-seated and irrational disgust-aversion to the notion of selling body parts, though it wouldn't do all that full market incentives could to save lives.

Satel sums up, offering inadvertently a quiet defense of the full free-market model she does not publicly embrace:

 If we keep thinking of organs solely as gifts, there will never be enough of them. Deaths will mount, needless suffering will continue, and the global black market in organs will continue to flourish.

Reason has written about this topic for many years.

A graet Reason TV video from March on how organ sales could save 30 lives a day:

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  1. But, poor people will sell all of their organs, if this is allowed!

  2. Allowing the sale of kidneys might avert the student loan default meltdown.

    1. I sold my plasma for $10 of beer money.

      1. See BuSab – this is why organ sales can’t be allowed. Those dang kids will just sell of their kidneys for beer money.

        1. College kids don’t drink beer. They drink Keystone.

          1. In my experience it was the cheapest available vodka.

        2. *pictures a tragic O Henry story where a college student sells their kidney to get beer money, only to be ironically thwarted by their inability to filter alcohol*.

          1. “The Gift of the Frat Guy”

  3. If it kills one rich person, it will all be worth it.

  4. Meanwhile, imposing a waiting period of at least six months would ensure that donors didn’t act impulsively and that they were giving fully informed consent.

    I get this for live donations like a kidney, how does this work for the more traditional DOA donation?

    This guy has only been a donor for five months. Better leave that heart in case he comes to his senses next week!

    1. Presumably, dead donors won’t be compensated, and so don’t need the waiting period since they haven’t been forcefully coerced under the threat of cash.

    2. Dead donors don’t get paid. This is the way you can sell this politically. If you want to go the traditional (liberal reading: poor person) route you can wait for someone to die and see if you are a tissue match. You won’t be competing against rich people when someone dies since rich people will have already bought a kidney from a live donor.

      Or they could still get paid, but the donor’s survivors would have to decide on an offer pretty quickly. You might accept a very low offer since you gain nothing by holding out.

      The best area on this would be liver transplants. You can donate part of your liver and it will grow back. I’m not sure if you can do it over and over, but from a donor’s (or better yet, seller’s) perspective, you’re not parting with a replacement part, you’re parting with surplus of a renewable resource.

      1. Or they could still get paid, but the donor’s survivors would have to decide on an offer pretty quickly. You might accept a very low offer since you gain nothing by holding out.

        Actually there’s one thing you still need when you die.

        Pass a law whereby if you are signed up as a donor when you die, the hospital gets to harvest everything useable. Then they provide what’s left of you a first-class funeral according to your pre-planned wishes.

  5. My body, my choice.

    1. Sorry, but that applies only when the goodthinkful people would make the exact same choice.

    2. My body vjayjay, my choice.

  6. Kinda, sorta on topic…

    I went to the doc this AM. Posted on the wall was a notice…paraphrasing…

    Federal regulation requires disclosure of ownership of healthcare facilities by healthcare providers. The following providers are part owners in the Great Falls Clinic….

    So I guess docs on a salary are good and those influenced by profit motive are bad in the eyes of the federal government?

    Who do you trust more, the doc who gets paid regardless or the one who makes money based on the quality of his service?

    Profitz iz teh eevul!

    1. I’ve never heard of a doctor who doesn’t get paid regardless. Even if the patient dies, you still have to pay them.

      1. If he owns the practice/facility it’s in his best interest to ensure you get the best care possible as he’s out personally if you don’t come back. The doc on the salary doesn’t give a shit.

        1. The doctor won’t be on salary very long if suddenly no patients want to come see them, so I’m pretty sure he’s just as worried if you don’t come back.

        2. The doc on the salary doesn’t give a shit.

          I think most professional people give something of a shit about doing a good job, or at least about reputation. And they could still be fired.
          There is the other argument that doctor’s being on salary take away the incentive to provide useless tests and procedures, which seems not entirely invalid.

          1. So, rate the give a shit factor of:

            a. A guy who makes more money by providing better care.

            and

            b. A guy who needs to do just well enough to not get fired.

      2. Same as any other creditor for the estate.

        He can stand in line with the electric company and the property tax assessor.

    2. Well, you never know. The Koch brothers could be running that clinic so that they can steal poor people’s organs. I gather that they enjoy that sort of thing.

  7. An acquaintance of mine is watching his wife die in a hospital room in Boston as we speak.

    She needs a liver, and in New England so few livers are available for transplant that liver failure is generally a death sentence.

    This is why when I rise to power, and the DEA agents are sent to the boats, the professional bioethicists promoting the ban on organ sales will be chained waist-deep in the noisome mess and be forced to endure the stench and the moans of agony. Their price for exit will be one corpse of a DEA agent. They will be given toothpicks with which to speed the process along.

    1. Dude, why send the DEA to the boats – Do ’em up ‘Coma’ style and harvest the organs as needed.

      http://en.wikipedia.org/wiki/Coma_(1978_film)

  8. No, you can’t sell your organs, but if you want to abort your baby, just go ahead.

    1. Doctor, I’d like to abort my kidney!

  9. The alt-text was better when Postrel’s kidney was intact.

    1. I thought her kidneys filtered the alt-text. With only one now, that’s how the occasional alt-text slips through.

  10. a governmental entity, or a designated charity, would offer in-kind rewards, like a contribution to the donor’s retirement fund, an income tax credit or a tuition voucher, or a gift to a charity designated by the donor. Because a third party provides the reward, all patients, not just the financially secure, will benefit.

    That sounds terrible. Do we really want more government?

    1. That’s obviously not ideal. But possibly better than the current situation.

  11. I didn’t RTFA, but people sell guitars and drums, even keyboards and pianos on Craig’s list all the time. What’s the problem with selling organs?

    1. the NGOs get cut out of their vig.

    2. I hope your intestines necrotize for that.

    3. They might have elephant ivory keys?

  12. At least let people sell their organs when they die. I don’t think that most people realize that when you donate your organs after your death, everyone except for your family who is involved gets to make money on the deal.
    I don’t agree, but I can see some point to the restrictions on living people selling their organs. But what possible reason is there not to allow a dead person’s estate to benefit from the sale of their remains?

    1. Exactly why I’m not a donor. If my family can’t get some filthy lucre from selling any viable bits and bobbles from my corpse, then fuck off and die, at that point I will already have.

    2. Re: Zeb,

      At least let people sell their organs when they die.

      You will take my liver from my cold, dead hands!

  13. Graet article!

  14. Again with the kidneys. Why is reason always trying to make me pay for my kidney?

  15. Meanwhile, imposing a waiting period of at least six months would ensure that donors didn’t act impulsively and that they were giving fully informed consent.

    People who sell their organs are irrational, so let’s give them six months to change their minds.

    And then we’ll give them another six…

    Yeah, I’m cynical about the good intentions of people that think we’re desperate, unthinking fools.

  16. Wait, there’s 30 people who die every day?! Aren’t they pretty tired of it by now?

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