It is against federal law to receive anything of value in return for donating a kidney. The result is the following kind of absurd kidney gymnastics reported by Forbes:
It took 12 surgeons, six operating rooms and five donors to pull it off,
but five desperate strangers simultaneously received new organs in what
hospital officials Monday described as the first-ever quintuple kidney
transplant.
….Four of the sick patients had approached Johns Hopkins with a
relative who was willing to donate a kidney but was an incompatible
donor. The fifth had been on a waiting list for a kidney from a dead
person.Together, those nine people and an "altruistic donor" had enough matched kidneys among them to pull off a five-way swap.
The
altruistic donor, Honore Rothstein, decided to donate a kidney after
losing her husband and daughter to accidents and illness, Vohr said.
She did not know any of the donors or recipients.…
In a live-donor practice used increasingly in the U.S. over the past
few years, a patient who needs a kidney is matched up with a compatible
stranger if the patient lines up a friend or relative willing to donate
an organ to a stranger, too.Dr. Robert Montgomery, director of
Hopkins’ transplant center and head of the transplant team, called
Monday for a national kidney-swap program, saying it could help ease
the nation’s shortage of transplant organs and cut costs by getting
people off dialysis.He noted, however, that live-donor kidney
swaps present ethical problems for some institutions since federal law
prohibits receiving something of value in exchange for an organ. Some
institutions feel multiple arrangements come uncomfortably close to
quid pro quo, Montgomery said. He called for a clarification of the law.
What a bizarre definition of ethics. Try and explain that one to your kids. I can’t.
Here is my podcast with Richard Epstein on the topic.
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Great piece!
As the son-in-law of someone who has Polycystic Kidney Disease (PKD) and has had two live donor transplants (his sister and his wife), I am constantly baffled by people who perceive the current state as ethical. Thank god my father-in-law was lucky enough to have two relatives who were close matches. If not, where would he be?
As a student of economics and human behavior, I also believe that the organ donation system should be an opt-out system rather than an opt-in system. In other words, the presumption should be that you WANT to donate your organs rather than that you DO NOT want to donate your organs. Given that people tend to accept the default when it comes to most choices, I believe that that small change would go a long way toward solving the problem.
I aplaud the doctors and nurses and the institution. The costs for these free procedures must have been astronomical. What's that? They CHARGED for their trafficing in human organs? No, that's not possible. Doctors are ethical and insist that money not change hands in such circumstances. Physician heal thyself.
How is any transplant is legal if the law says you can't receive something in return? Afterall I can't think of a many things that could feel better than the feeling you'd get from helping save a fellow human beings life.
The city coroner puts it this way: An indigent patient dies, his family donates his organs, and yet they cannot afford a proper burial for the deceased. Why is this? Where are our medical ethicists?
In principle, I agree with Dr. Roberts' position. In practice, I believe that safeguards are necessary so that abuses and trafficking in human organs doesn't become just another part of "big business".
Call it "ethics" or "protecting the weak" or "government interference"… it is needed because it is the nature of "free enterprise" to find the "legal" niche that leads to the greatest profit for those with the most power.
What's wrong with trafficking in human organs???
We "traffic" in food and shelter and other necessities of life??
Geoffrey, your question is reason enough for "interference".
In practice, I believe that safeguards are necessary so that abuses and trafficking in human organs doesn't become just another part of "big business".
In practice, restricting the payment to donors simply means that the doctors and hospitals capture more of the profit. That encourages too many transplant centers chasing the profit, each of whom gets too little experience and causing people to die. It also means that the doctors and hospitals have an incentive to traffic in human organs, just that the donor is not getting paid.
I think I understand your point:
"What you want $200 for your heart? I can get a newer one for only $169.99 at Wal-Mart. You should rethink your non-competitive position. And, in case Wal-Mart runs out, I have a supplier who uses the best supplies from a large group of mentally deficient people. They just represent a cash drain on the community anyway."
I truly have never understood the argument against legalized organ selling. And if the threat that some big evil business will start killing mentally deficient people for their organs, as insinuated by Bruce, is the best argument against it, I guess I'll never understand.
The stand against organ selling is like many liberal causes – it causes great suffering for many vulnerable people all so that the elitists can feel smugly self righteous. The only difference with this particular liberal cause is that the suffering is so visible and the two are so obviously connected.
Rather than *selling* organs to individuals or brokers, keep the system as it is and allow a *tax credit* (usable until the credit is fully expended) for each organ usable by the donor or the donor's immediate family. How about:
* $25K for a heart
* $10K for a liver
* $5K for a kidney
for example.
* This keeps the donation strictly between the donor and the recipient,
* doesn't cost the recipient directly for the donation,
* provides and incentive for the donor,
* doesn't rely on "desperate" donors, and
* reduces the overall health costs to society by eliminating unnecessary "maintenance while waiting" costs since the supply of body parts would increase (if the incentive presumption holds water).
It also keeps the concern of the "trafficking business" out of the equation.
Qoute from Bruce Hall: "Rather than *selling* organs to individuals or brokers, keep the system as it is and allow a *tax credit* (usable until the credit is fully expended) for each organ usable by the donor or the donor's immediate family. How about:
* $25K for a heart
* $10K for a liver
* $5K for a kidney"
Try to think outside the collectivist box. The argument is to remove government from the organ donor industry, but your solution is just different government interference. Just because something is "controlled" by the "government" doesn't make it automatically pure and ethical. In most cases its just the opposite.
"Just because something is "controlled" by the "government" doesn't make it automatically pure and ethical. In most cases its just the opposite."
A good example of that is the organ tourism industry in China, where they execute people and sell their organs. They've recently announced a crack-down on live, paid organ (kidney) donations, but selling organs is apparently OK as long as the government kills the person first and doesn't share any money with the family.
Last year fewer than half the people on the organ donor waiting list received organs. Today there are approximately 93,000 people waiting for an organ. About twenty people on the list die every day waiting for an organ that never comes.
It is time to put speculative implementation concerns aside and let these people help themselves by either outright purchasing and organ or raising the money to do so. All the dangers we associate with a market in organ donation exist because it is a black market. U.S. law already requires free, voluntary and informed consent for all medical procedures. Legalizing the sale of organs would bring the exchange out into the open where these safeguards would be required as they already are in every hospital.
It is also time to put ethical concerns aside. Let those who may be tempted by financial incentives be tempted, whether they are poor or just want that new car doesn’t matter. Difficult choices are better than no choice at all. Offering an organ for transplantation is much less risky than being a surrogate mother, football player or coal miner. Another common objection to legalizing the sale of organs is that doing so would be an affront to dignity. Whose dignity? It seems to me individuals should decide for themselves what is or is not an affront to their dignity. That person who might be tempted to sell an organ now has a choice s/he didn’t have before. How is that an affront to dignity? The person who wants to be ultraistic and donate an organ for free can still make that choice. No affront to dignity there. And, the person who might very well not get an organ has a new chance at life. How is that an affront to dignity?
Everyone involved in the procurement of organs, except the actual donor, gets paid. That simply doesn’t make sense. Members of the United Network for Organ Sharing (UNOS) get paid. Members of the Organ Procurement and Transplantation Network (OPTN) get paid. So does every healthcare professional involved in the transplantation process. If it is not ethical for the donor to profit from donating an organ, then it shouldn’t be ethical for all the other people involved in the process to profit either. The ethical solution would be to encourage people to save lives, even if it takes money to do so.
http://www.lifesharers.org