Post by Gelare on Jul 9, 2009 9:46:47 GMT -5
The Case for Organ Markets
"Could I get two kidneys with a side of spleen, please?"
Welcome, students, to something a little different. This lecture is going to be what I'm calling a case study, an exploration into one particular argument for one particular issue. Rather than dealing with broad philosophical ideas, we're taking our first step into the modern field of bioethics as this lecture explicitly makes the case for a market in human organs, primarily focusing on kidneys (for reasons I'll go into a little later). As usual, the discussion thread is nearby. Before going forward, I would like to say that this lecture is largely based on a lecture delivered by Professor James Stacey Taylor in June 2009 at Wake Forest University, so credit goes to him. Now then, first question's first:
Sacks of Meat
"Do we have to talk about this now?"
Why are we talking about organ markets? Well, as it turns out, people die. It happens kind of frequently, which is a bit of a shame. And some of these people die because of some really hardcore diseases that can be most effectively treated by organ transplants. Sure, people can be treated for kidney failure with dialysis for a while, but that is a huge bummer for everyone involved in terms of time, energy, and long-term cost, and isn't as good as the real thing (that is, having a kidney). However, there is another option. If you need a kidney, and I have a kidney, I can give you mine. In fact, everyone is born with a spare kidney, and we only need one to be healthy. There's a fairly plentiful supply out there, and a lot of lives to be saved. So what's the problem?
Well, as it turns out, people don't like to be cut open and have their innards removed, even to be put into other people for life-saving procedures. And I sure don't blame them: it certainly doesn't sound like the most enjoyable way to spend my afternoon. And what if my kidney fails sometime in the future? Isn't it better to just hang onto my spare? It seems like there are significant costs involved in donating a kidney, for which people would have to be compensated if we want them to actually offer their kidneys to the dying folks on the waiting lists across the world.
But there's a problem. There is a government-imposed price ceiling on the amount people are allowed to receive for tendering their kidney, to compensate them for the trouble of getting sliced open and taking the risk that something bad could happen as a result of it. That price ceiling is $0. Zero dollars and zero cents. Which, you know, doesn't really seem very generous to a lot of people. So they hang on to their kidneys, and people sit on ever-growing waiting lists, waiting for some organ donor to go flying off his motorcycle, and they die in the meantime.
Bonus Point: Why Kidneys?
Some of you may be wondering why this argument is focusing on kidneys in particular. Couldn't it be generalized to other organs as well? The answer is yes, sort of. But kidneys are special, because we can donate them while we're still alive. With most organs, a person dies and their body is rushed off to be split up into its component parts, because I need, say, my heart most of the time, I can't really give it away until I'm dead and gone. But with kidneys, we have a spare, that we don't really need. We can save the life of someone and then sit next to them in the recovery ward. So kidneys provide a somewhat easier case to make than some other organs which can only be procured after death, and are particularly easier to defend against a particular objection I'll raise later.
Supply and Demand
"Anything can be had...for the right price."
So people aren't being compensated for donating their kidneys so, by and large, they don't. Obviously there are plenty of cases where families will band together and someone will donate an organ to their sibling or something, but that doesn't happen in all, or even a majority of cases. There would be a much better chance of finding a willing (and compatible) donor if we could broaden the search to the general population. And remember, these are seriously matters of life and death. We want as many of these kidney transplants as we can get. This means we need to give people an incentive to donate their kidneys. And money is a pretty good incentive, historically speaking. So we allow donors - although we can no longer really refer to them as such, so we now call them sellers - to receive monetary compensation from the recipient - now called the buyer - to the tune of whatever the market determines, we'll say about ten thousand dollars, and all of a sudden, people have ten thousand new reasons to consider selling their kidney. As anyone can predict, supply will shoot up significantly. The waiting lists will be reduced, if not eliminated. And both parties are better off: one person has a pile of cash, and the other person gets to live. Good deal, huh?
So now, before we go further (and look at objections), I want to be more clear about what this market would actually look like. You wouldn't have individual sellers and individual buyers meeting up, you would have sellers going to the offices of hospitals or insurance companies, who would match them up with a compatible buyer. The insurance companies would really be the ones paying for the organs, not the people languishing in the hospital beds. Tests would be done on potential sellers to make sure that they're healthy and compatible, since you can't really offer a warranty on that sort of stuff. And, of course, anyone who didn't want to sell their kidney wouldn't have to. Now we can look at some counterpoints.
A Wrench in the Plan
"Objection!"
1) How do we ensure the safety of both parties?
The actual transplants, then as now, would be done in hospital operating rooms by qualified surgeons. If the company the seller is dealing with sends them to a disreputable-looking clinic, they can back out at any time. The reputation of these companies is very much on the line; if word gets out that Kaiser is sending their kidney sellers to Pablo's Discount Incision Services, the backlash would not be good, so it's in every company's interest to make sure that their operating rooms are safe. However...
2) People aren't doctors, they wouldn't know a good-quality place from a bad one, and the consequences, future health problems, could be impossible to trace back to that one specific event. We're not all medical geniuses; that's why we go to the doctor in the first place. And to make matters worse, safety costs money. People would be enticed to places with lower safety standards by higher offers for their kidneys.
In this case, the solution is probably to have all such kidney clinics be required to have licenses, either by a large, trusted organization like the American Medical Association (or your national equivalent) or by some agency of the government. Either one is fairly simple to implement.
3) How do we know the sellers are getting a fair price?
A fair price is whatever the person is willing to accept. If the going rate is ten thousand dollars and the seller says yes, then they're willing to accept that price, they deem it in their best interest. If they don't want to sell it, they don't have to.
4) But the sellers will be disproportionately poor, enticed by the high payoffs. They're even less likely to know (or care) about safety, and they might be forced to sell their kidneys to make home payments or something. And it's unjust to make the poor get their kidneys taken out so that rich people can get their transplants.
It would be, certainly, but nobody's making them do anything. First off, insurers are the ones paying for the kidneys, so anyone with insurance, not just rich folks, would have access to the market. Second, no one is suggesting that we haul the poor off on stretchers and yank out their organs in lieu of foreclosing on their house (at least, I'm not suggesting that). I think contracts using organs as collateral should not be legal - so a loan shark couldn't go to their unscrupulous buddies and slice up some poor bankrupt guy, even if the guy promised his kidney beforehand to get that loan. Nevertheless, if a person facing foreclosure wants to sell their kidney to make their payments, is that such a bad thing? Is it bad to allow - but not force - people to sell their kidneys so they can make payments on their house, or buy themselves a car, or get a professional degree? Quite the contrary, it seems that the unjust thing to do would be to deny the poor that chance to lift themselves up.
5) Well, what about the uninsured?
An uninsured seller can easily go to any insurance company. There's be probably more paperwork and tests involved, but they would be only too happy to match the uninsured seller to one of their buyers. An uninsured buyer, of course, faces the same prospect that they do today: they have to either be rich, or have a family member willing to donate for free, or hope there's some charity or government program out there that will cover them. In other words, they face pretty much the same problem with this market as they do for the entire rest of the health care market. It's a little sad sometimes, but it's not a problem exclusive to the actual market for kidneys. If you care about it so much, go donate to some charity, or vote for universal health coverage.
6) But what about organleggers?
Ah, organleggers. Every person is walking around every day with literally hundreds of thousands of dollars worth of precious meat inside them all the time. I can't sell most of mine without dying, but I can sell that guy's organs without (me) dying. Probably make a small fortune, too. What to do, what to do...
If there were a market in human organs, I think it's a foregone conclusion that this would happen. And I am not cool with that. So this is another case where you might want to have the government step in: all organs can only be bought from living, willing individuals or officially licensed sellers (companies that would collect from people who checked the organ donor box on their driver's license and so forth). All offenders will be vigorously prosecuted.
However, this is the area where the fact that we've been talking exclusively about kidney markets, rather than markets for all organs, becomes particularly important. Because, as I said, everyone has a spare kidney. So even if you wanted to limit all organ purchases to be only by licensed buyers from living, willing sellers, you would still make a huge dent in the waiting lists for kidneys - possibly even clear the list.
Under the Knife
"This won't hurt a bit..."
So that's the case for a market in human kidneys. If there's interest in these kinds of articles, I may expand on it later. So, what do you think? Should we legalize a market in human kidneys? Is it fair to everyone involved? Should people be allowed to literally sell their bodies? Are the moral problems too significant? Go fight it out in the discussion thread.
"Could I get two kidneys with a side of spleen, please?"
Welcome, students, to something a little different. This lecture is going to be what I'm calling a case study, an exploration into one particular argument for one particular issue. Rather than dealing with broad philosophical ideas, we're taking our first step into the modern field of bioethics as this lecture explicitly makes the case for a market in human organs, primarily focusing on kidneys (for reasons I'll go into a little later). As usual, the discussion thread is nearby. Before going forward, I would like to say that this lecture is largely based on a lecture delivered by Professor James Stacey Taylor in June 2009 at Wake Forest University, so credit goes to him. Now then, first question's first:
Sacks of Meat
"Do we have to talk about this now?"
Why are we talking about organ markets? Well, as it turns out, people die. It happens kind of frequently, which is a bit of a shame. And some of these people die because of some really hardcore diseases that can be most effectively treated by organ transplants. Sure, people can be treated for kidney failure with dialysis for a while, but that is a huge bummer for everyone involved in terms of time, energy, and long-term cost, and isn't as good as the real thing (that is, having a kidney). However, there is another option. If you need a kidney, and I have a kidney, I can give you mine. In fact, everyone is born with a spare kidney, and we only need one to be healthy. There's a fairly plentiful supply out there, and a lot of lives to be saved. So what's the problem?
Well, as it turns out, people don't like to be cut open and have their innards removed, even to be put into other people for life-saving procedures. And I sure don't blame them: it certainly doesn't sound like the most enjoyable way to spend my afternoon. And what if my kidney fails sometime in the future? Isn't it better to just hang onto my spare? It seems like there are significant costs involved in donating a kidney, for which people would have to be compensated if we want them to actually offer their kidneys to the dying folks on the waiting lists across the world.
But there's a problem. There is a government-imposed price ceiling on the amount people are allowed to receive for tendering their kidney, to compensate them for the trouble of getting sliced open and taking the risk that something bad could happen as a result of it. That price ceiling is $0. Zero dollars and zero cents. Which, you know, doesn't really seem very generous to a lot of people. So they hang on to their kidneys, and people sit on ever-growing waiting lists, waiting for some organ donor to go flying off his motorcycle, and they die in the meantime.
Bonus Point: Why Kidneys?
Some of you may be wondering why this argument is focusing on kidneys in particular. Couldn't it be generalized to other organs as well? The answer is yes, sort of. But kidneys are special, because we can donate them while we're still alive. With most organs, a person dies and their body is rushed off to be split up into its component parts, because I need, say, my heart most of the time, I can't really give it away until I'm dead and gone. But with kidneys, we have a spare, that we don't really need. We can save the life of someone and then sit next to them in the recovery ward. So kidneys provide a somewhat easier case to make than some other organs which can only be procured after death, and are particularly easier to defend against a particular objection I'll raise later.
Supply and Demand
"Anything can be had...for the right price."
So people aren't being compensated for donating their kidneys so, by and large, they don't. Obviously there are plenty of cases where families will band together and someone will donate an organ to their sibling or something, but that doesn't happen in all, or even a majority of cases. There would be a much better chance of finding a willing (and compatible) donor if we could broaden the search to the general population. And remember, these are seriously matters of life and death. We want as many of these kidney transplants as we can get. This means we need to give people an incentive to donate their kidneys. And money is a pretty good incentive, historically speaking. So we allow donors - although we can no longer really refer to them as such, so we now call them sellers - to receive monetary compensation from the recipient - now called the buyer - to the tune of whatever the market determines, we'll say about ten thousand dollars, and all of a sudden, people have ten thousand new reasons to consider selling their kidney. As anyone can predict, supply will shoot up significantly. The waiting lists will be reduced, if not eliminated. And both parties are better off: one person has a pile of cash, and the other person gets to live. Good deal, huh?
So now, before we go further (and look at objections), I want to be more clear about what this market would actually look like. You wouldn't have individual sellers and individual buyers meeting up, you would have sellers going to the offices of hospitals or insurance companies, who would match them up with a compatible buyer. The insurance companies would really be the ones paying for the organs, not the people languishing in the hospital beds. Tests would be done on potential sellers to make sure that they're healthy and compatible, since you can't really offer a warranty on that sort of stuff. And, of course, anyone who didn't want to sell their kidney wouldn't have to. Now we can look at some counterpoints.
A Wrench in the Plan
"Objection!"
1) How do we ensure the safety of both parties?
The actual transplants, then as now, would be done in hospital operating rooms by qualified surgeons. If the company the seller is dealing with sends them to a disreputable-looking clinic, they can back out at any time. The reputation of these companies is very much on the line; if word gets out that Kaiser is sending their kidney sellers to Pablo's Discount Incision Services, the backlash would not be good, so it's in every company's interest to make sure that their operating rooms are safe. However...
2) People aren't doctors, they wouldn't know a good-quality place from a bad one, and the consequences, future health problems, could be impossible to trace back to that one specific event. We're not all medical geniuses; that's why we go to the doctor in the first place. And to make matters worse, safety costs money. People would be enticed to places with lower safety standards by higher offers for their kidneys.
In this case, the solution is probably to have all such kidney clinics be required to have licenses, either by a large, trusted organization like the American Medical Association (or your national equivalent) or by some agency of the government. Either one is fairly simple to implement.
3) How do we know the sellers are getting a fair price?
A fair price is whatever the person is willing to accept. If the going rate is ten thousand dollars and the seller says yes, then they're willing to accept that price, they deem it in their best interest. If they don't want to sell it, they don't have to.
4) But the sellers will be disproportionately poor, enticed by the high payoffs. They're even less likely to know (or care) about safety, and they might be forced to sell their kidneys to make home payments or something. And it's unjust to make the poor get their kidneys taken out so that rich people can get their transplants.
It would be, certainly, but nobody's making them do anything. First off, insurers are the ones paying for the kidneys, so anyone with insurance, not just rich folks, would have access to the market. Second, no one is suggesting that we haul the poor off on stretchers and yank out their organs in lieu of foreclosing on their house (at least, I'm not suggesting that). I think contracts using organs as collateral should not be legal - so a loan shark couldn't go to their unscrupulous buddies and slice up some poor bankrupt guy, even if the guy promised his kidney beforehand to get that loan. Nevertheless, if a person facing foreclosure wants to sell their kidney to make their payments, is that such a bad thing? Is it bad to allow - but not force - people to sell their kidneys so they can make payments on their house, or buy themselves a car, or get a professional degree? Quite the contrary, it seems that the unjust thing to do would be to deny the poor that chance to lift themselves up.
5) Well, what about the uninsured?
An uninsured seller can easily go to any insurance company. There's be probably more paperwork and tests involved, but they would be only too happy to match the uninsured seller to one of their buyers. An uninsured buyer, of course, faces the same prospect that they do today: they have to either be rich, or have a family member willing to donate for free, or hope there's some charity or government program out there that will cover them. In other words, they face pretty much the same problem with this market as they do for the entire rest of the health care market. It's a little sad sometimes, but it's not a problem exclusive to the actual market for kidneys. If you care about it so much, go donate to some charity, or vote for universal health coverage.
6) But what about organleggers?
Ah, organleggers. Every person is walking around every day with literally hundreds of thousands of dollars worth of precious meat inside them all the time. I can't sell most of mine without dying, but I can sell that guy's organs without (me) dying. Probably make a small fortune, too. What to do, what to do...
If there were a market in human organs, I think it's a foregone conclusion that this would happen. And I am not cool with that. So this is another case where you might want to have the government step in: all organs can only be bought from living, willing individuals or officially licensed sellers (companies that would collect from people who checked the organ donor box on their driver's license and so forth). All offenders will be vigorously prosecuted.
However, this is the area where the fact that we've been talking exclusively about kidney markets, rather than markets for all organs, becomes particularly important. Because, as I said, everyone has a spare kidney. So even if you wanted to limit all organ purchases to be only by licensed buyers from living, willing sellers, you would still make a huge dent in the waiting lists for kidneys - possibly even clear the list.
Under the Knife
"This won't hurt a bit..."
So that's the case for a market in human kidneys. If there's interest in these kinds of articles, I may expand on it later. So, what do you think? Should we legalize a market in human kidneys? Is it fair to everyone involved? Should people be allowed to literally sell their bodies? Are the moral problems too significant? Go fight it out in the discussion thread.