July 12, 2009

Paying Organ Donors

A rash of articles on organ donation in the last week or so, (coinciding roughly with the announcement of Steve Jobs' successful kidney transplant) focused mostly on how transplant organ demand far exceeds supply, and on the practical and ethical questions involved in proposals to address the shortage. Legalizing compensation for donors has been proposed, as have some other, more coercive programs.

Jeff Jacoby is an advocate for the former.

The same economic system that generally makes good healthcare available to all does price certain products and services high enough that only the wealthy can afford them. It isn’t news that the world’s finest surgeon commands a high fee, or that the latest “miracle’’ drugs tend to be expensive, or that billionaires can afford things that mere mortals can’t.

Yet when it comes to the donation of human organs, countless people believe that the market must be prevented from functioning.

Under current law, an organ may be transplanted to save a patient’s life only if it was donated for free. Federal law makes it “unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation.’’ The surgeon who performed Jobs’s liver transplant, the hepatologist who diagnosed him, the anesthesiologist who managed his pain, the nurse who assisted, the medical center that provided the facilities, the pharmacy that supplied his medications, even the driver who brought him to the hospital - all of them were paid for the benefits they rendered. Only the organ donor (or the donor’s family, if the liver came from a cadaver) could receive nothing except the satisfaction that comes from performing an act of kindness.

That, many say, is as it should be: Organs should be donated out of goodness alone; otherwise the rich might exploit the poor. Others flatly oppose any hint of commerce in human organs. Opening the door to “financial incentives,’’ declared the Institute of Medicine in 2006, could “lead people to view organs as commodities and diminish donations from altruistic motives.’’

...do read it all.

Then there's this semi-serious NYT op-ed by Daniel Asa Rose, a guy who I guess is qualified to write an op-ed for the Times because he went to China with his cousin to get him a kidney transplant, and then wrote a book about it. Rose favors a change to a "presumed consent" system, under which you must specifically opt out of being an organ donor, instead of voluntarily opting in. They're trying it in Europe, after all. I don't have a dog in the fight, being a card-carrying organ donor, but that strikes me as a little heavy-handed.

Rose goes on to claim that if we would just "better finance" stem cell research, so that "we could start simply growing kidneys", and create better mechanical organs, no one would have to wait more than a year for a kidney. Hmmm....is that all? I hope he's aware of the credible evidence that the Chinese supply of available organs for highly profitable transplants for foreigners may include organs removed from unwilling, innocent Falun Gong detainees. Maybe that would matter to him.

Virginia Postrel at The Atlantic has a more serious treatment of the topic. Postrel is herself a kidney donor, though she declines to mention it in this article, so she has been through the system. I won't even try to pull excerpts. It's a great read, and you need to do it all.

As Postrel details with well-thought out policy proposals for managing donor compensation (all via insurance payments), there are ways, at least in our society, to prevent attempts to abuse the system. But as the Chinese example linked above shows, when human body parts take on six-figure dollar values, per body, and large numbers of people are controlled by those with little regard for human life, man is capable of monstrous things.

UPDATE: Ethan Gutmann, who wrote an exposé last November on the organ harvesting in China, has an article in the new print issue of NR (NAWS) saying that his research indicates over 10,000 Falun Gong detainees have been murdered by the Chinese government for their organs. As with everything about this gruesome story, it is almost too horrible to contemplate, and as such, the natural human tendency is to disbelieve it. But as Jay Nordlinger said of this situation three years ago, "sometimes the unthinkable needs to be thought about."

Posted by dan at July 12, 2009 2:10 PM