We don't want to "commoditize" human organs?

[Superman]

Today in one of my classes, someone asked the teacher about why it's illegal for someone in need of a transplant to buy a healthy organ from someone willing to sell. The need is obviously there, and people in need have offered millions of dollars for them in the past. The professor, a doctor of pathology, answered that the current thought is that it's somehow "unethical" to sanction the "commoditization" of organs.

I didn't think much of that until I later ate lunch by a television playing a Viagara commercial. I immediately thought of how silly it is to have a health care system which seems to do nothing but commoditize care, but then suddenly declare that organ harvesting would be over the line.

Is that at all reasonable? Not than much of the current system is reasonable, but, to me anyway, that's more ridiculous than usual.

[Darth Wong]

Today in one of my classes, someone asked the teacher about why it's illegal for someone in need of a transplant to buy a healthy organ from someone willing to sell. The need is obviously there, and people in need have offered millions of dollars for them in the past. The professor, a doctor of pathology, answered that the current thought is that it's somehow "unethical" to sanction the "commoditization" of organs.

I didn't think much of that until I later ate lunch by a television playing a Viagara commercial. I immediately thought of how silly it is to have a health care system which seems to do nothing but commoditize care, but then suddenly declare that organ harvesting would be over the line.

Is that at all reasonable? Not than much of the current system is reasonable, but, to me anyway, that's more ridiculous than usual.

I suspect there is a (probably justified) fear that if you create an open market for organs, then people will resort to unscrupulous means to obtain them.

[Kanastrous]

And that corner-cutting will lead to organs on the market that are unsafe for transplant.

[Wicked Pilot]

I think we would be better off just instituting an across the board 'you accept a donated organ, you donate yours when you die' policy. There's your payment right there.

[Alerik the Fortunate]

snip

I suspect there is a (probably justified) fear that if you create an open market for organs, then people will resort to unscrupulous means to obtain them.

The concern is probably for something along the lines of the "organ-legging" black market in Larry Niven's Gil Hamilton stories. Plus, selling organs would possibly give an additional unfair advantage to the wealthy in terms of being able to preferentially obtain organs over the more needy, and possibly an additional form of leverage over the poor, who could now be pressured to market their organs in desperate situations. It's just rather distasteful.

[Singular Intellect]

I suspect there'd be a possibility of more homeless people going missing as well, to buyers with the mentality of "no questions asked".

[Broomstick]

At one time, a certain number of blood banks in the US used to pay blood donors. Some even attempted to make a profit from selling blood to hospitals that needed it.

Now, none of them do. All blood donations (to the best of my knowledge) are given without monetary compensation.

So.... why is that? Why did a "free market" system reject donating-for-money? And what implications does that have for selling donor organs?

[Alerik the Fortunate]

Plus, making parts of people into marketable property is probably seen as a step in the direction of making people a form of property, and thus an affront to human dignity and a morally regressive step. The continuing existence of the for profit medical establishment is just an example of hypocrisy and drawing arbitrary lines.

[Sea Skimmer]

I think the point is the current system directs to organs to those in greatest need, among the pool of patients who can pay for the surgery itself. If organs were bought and sold, then only the relatively rich would be able to afford them, insurance companies sure aren’t going to go up against that kind of bidding. Even if the US had universal healthcare this problem would remain. We need more organs, but the best way to do that is to force people to give a reason for opting out of donation, not trying to buy organs off people who are mostly going to be poor and exploited. India already has had numerous cases of black-market dealers buying kidneys from people. They typically get paid half upfront, but after the organ is removed they never see the other half. That would only become a much worse problem given a legal organ market to drive demand.

[General Zod]

At one time, a certain number of blood banks in the US used to pay blood donors. Some even attempted to make a profit from selling blood to hospitals that needed it.

Now, none of them do. All blood donations (to the best of my knowledge) are given without monetary compensation.

How long ago was this, and was it just in your area? To my knowledge a few plasma banks in my city still pay you for donations. Admittedly it's small, but still present. (Unless this was a very very recent thing).

[Sea Skimmer]

People are still sometimes paid for plasma donation because it’s pretty debilitating and the process takes a few hours to complete in some cases. IIRC most plasma comes from a relatively small number of semi professional persons. I personally can’t see viewing blood/skin/bone marrow in quite the same light as internal organs, just because you can donate all of those without suffering long term harm. Donating any kind of internal organ like a kidney is a serious blow to your body with lifelong implications.

[Alyrium Denryle]

At one time, a certain number of blood banks in the US used to pay blood donors. Some even attempted to make a profit from selling blood to hospitals that needed it.

Now, none of them do. All blood donations (to the best of my knowledge) are given without monetary compensation.

So.... why is that? Why did a "free market" system reject donating-for-money? And what implications does that have for selling donor organs?

because doctors at least somewhere in their minds know that what they do is not a business. And bioethicists who write these policies, reject the free market system, by and large, for healthcare.

There are a lot of very very good reasons for not allowing organs to be sold. Most of them have already been mentioned. Corner cutting, distributive justice, possible human rights violations when a profit motive is involved. It is nasty business. Hell, back when AIDS first hit a few french officials were sentenced for a looooong time in prison because they covered up HIV infected blood in order to maintain french dominance of european blood product markets.

Resorting to the market is NOT an option with healthcare in general... it definitely should not be with organ transplants

[Superman]

Plus, selling organs would possibly give an additional unfair advantage to the wealthy in terms of being able to preferentially obtain organs over the more needy, and possibly an additional form of leverage over the poor, who could now be pressured to market their organs in desperate situations. It's just rather distasteful.

I agree, but the wealthy already do receive the best treatments. They can afford the best medications, the best surgeons, etc. The system is already set up to benefit the wealthy, but, supposedly, one of the justifications against allowing the sale of donated organs is that it would somehow be unethical. I agree that other reasons exist, but I find it laughable that suddenly, in a health care system that allows companies to advertise their medications on television, a line is drawn.

[Kanastrous]

I think we would be better off just instituting an across the board 'you accept a donated organ, you donate yours when you die' policy. There's your payment right there.

A large proportion of organ recipients are themselves poor candidates for donation.

"Giving the organs back" post-mortem isn't medically practical.

At one time, a certain number of blood banks in the US used to pay blood donors. Some even attempted to make a profit from selling blood to hospitals that needed it.

Now, none of them do. All blood donations (to the best of my knowledge) are given without monetary compensation.

So.... why is that?

People desperate and down-and-out enough to view blood donation as a source of necessary income, frequently have habits that expose them disproportionately to disease or contaminants that you don't want, in the blood banks.

[Alerik the Fortunate]

I agree, but the wealthy already do receive the best treatments. They can afford the best medications, the best surgeons, etc. The system is already set up to benefit the wealthy, but, supposedly, one of the justifications against allowing the sale of donated organs is that it would somehow be unethical. I agree that other reasons exist, but I find it laughable that suddenly, in a health care system that allows companies to advertise their medications on television, a line is drawn.

I think the reason for the dichotomy in the real world is that people are used to the rich having better access to quality everything, but having the ability to buy and sell organs crosses the line to creepy chattelization of human beings and violation of the sovereignty of the body which even the poorer should be entitled to; the emotional impact thereof probably stimulates the desire to find ethical justifications for the position. Also, it's a relatively newer topic, and thus subject to reactionary phobia, like issues with cloning and stem cells, rather than medicine and most surgeries, which are an accepted part of the status quo. Since these other things, like drug advertising, are considered normal because of experience, and the reality of their negative influences are not made regularly apparent, they don't raise enough of an alarm to counter the Capitalism Is Inherently Good and Socialism Is From the Devil indoctrination people receive in this country.

[BountyHunterSAx]

I think we would be better off just instituting an across the board 'you accept a donated organ, you donate yours when you die' policy. There's your payment right there.

Can I just me-too this once? I hadn't thought of that before, but that's an *excellent* idea.


While it still might create temporary shortages for one organ or the other (the guy who takes a liver transplant probably wont' re-supply a liver), it's certainly equitable, and it does *worlds* to stop the large array of shortages that exist today. And when you consider that, morally, accepting a donated organ implies you're okay with the morality of donating them in the first place, the person should have no problem signing up for being a donater.

-AHMAD

[Kanastrous]

It's not an excellent idea, for the reason given above: organ recipients generally don't meet the standards to be good post-mortem donation candidates.

[Superman]

I think I've always heard that most European countries have the 'auto donor' system. Unless you opt out, when you die, you donate your organs.

[Kanastrous]

"In old Soviet Union, organs donate you!"

[Wicked Pilot]

A large proportion of organ recipients are themselves poor candidates for donation.

"Giving the organs back" post-mortem isn't medically practical.

If every one of their donatable organs aren't acceptable for transfer then so what? Take the good ones, bury the bad ones. A system's simple lack of being perfect and foolproof doesn't make it automatically useless. If further steps are required then you take them.

[Wicked Pilot]

Maybe another method could be discounts on insurance premiums for doners. (tax breaks if one has universal government care) Wouldn't medical cost go down if people aren't waiting around for a new kidney?

[Sea Skimmer]

Maybe another method could be discounts on insurance premiums for doners. (tax breaks if one has universal government care) Wouldn't medical cost go down if people aren't waiting around for a new kidney?

Maybe, but organ donations usually require a lot of follow-up care including a lifetime of medications to depress the immune system, which in turn often leads to all sorts of complications. What’s more many donated organs actually only last for 10-20 years and then the person needs another one.

[Alyrium Denryle]

Plus, selling organs would possibly give an additional unfair advantage to the wealthy in terms of being able to preferentially obtain organs over the more needy, and possibly an additional form of leverage over the poor, who could now be pressured to market their organs in desperate situations. It's just rather distasteful.

I agree, but the wealthy already do receive the best treatments. They can afford the best medications, the best surgeons, etc. The system is already set up to benefit the wealthy, but, supposedly, one of the justifications against allowing the sale of donated organs is that it would somehow be unethical. I agree that other reasons exist, but I find it laughable that suddenly, in a health care system that allows companies to advertise their medications on television, a line is drawn.

As I pointed out, it is ethicists and physicians primarily making this decision, not governments

[Broomstick]

At one time, a certain number of blood banks in the US used to pay blood donors. Some even attempted to make a profit from selling blood to hospitals that needed it.

Now, none of them do. All blood donations (to the best of my knowledge) are given without monetary compensation.

How long ago was this, and was it just in your area? To my knowledge a few plasma banks in my city still pay you for donations. Admittedly it's small, but still present. (Unless this was a very very recent thing).

I said BLOOD, not plasma. They are not the same thing.

I believe the last the of the pay-for-blood companies went out of business back in the mid-80’s during the HIV/AIDS eruption, but I’m going strictly on memory power so don’t quote me on that.

People are still sometimes paid for plasma donation because it’s pretty debilitating and the process takes a few hours to complete in some cases. IIRC most plasma comes from a relatively small number of semi professional persons. I personally can’t see viewing blood/skin/bone marrow in quite the same light as internal organs, just because you can donate all of those without suffering long term harm. Donating any kind of internal organ like a kidney is a serious blow to your body with lifelong implications.

Blood donations grow back within a month, but skin donations leave scars and bone marrow donations used to carry a risk of fracture and weakening of the bone from which they were taken, although techniques are improving such that this is MUCH less a problem than even 10 years ago. They aren’t really risk free, although most donors don’t consider a few scars that problematic, especially compared to saving a life.

At one time, a certain number of blood banks in the US used to pay blood donors. Some even attempted to make a profit from selling blood to hospitals that needed it.

Now, none of them do. All blood donations (to the best of my knowledge) are given without monetary compensation.

So.... why is that?

People desperate and down-and-out enough to view blood donation as a source of necessary income, frequently have habits that expose them disproportionately to disease or contaminants that you don't want, in the blood banks.

Bingo. Someone knows their medical history. It was unanticipated, but the majority of pay-for-donation donors were at high risk of blood-borne diseases, just as they were more likely to be poor and desperate. Those factors are often connected, of course.

In countries where there is a market that pays donors for organs – whether legal or not – those selling tend to be – surprise! – the poor and desperate who are also, again, more likely to be at high risk for certain communicable diseases. I see no reason why a legal pay-for-organs system anywhere else would be different. How would you screen out the carriers with disease when those same people are desperate enough that they might seek to conceal their medical conditions in order to profit from selling an organ?

For similar reasons, notions of “recycling” condemned criminals stumble as well, beyond just the ethics of disassembling bad people. Those most likely to be sentenced to death or severe sentences are also those most likely to be at high risk of problematic conditions and/or organ damage

I think we would be better off just instituting an across the board 'you accept a donated organ, you donate yours when you die' policy. There's your payment right there.

Can I just me-too this once? I hadn't thought of that before, but that's an *excellent* idea.

While it still might create temporary shortages for one organ or the other (the guy who takes a liver transplant probably wont' re-supply a liver), it's certainly equitable, and it does *worlds* to stop the large array of shortages that exist today. And when you consider that, morally, accepting a donated organ implies you're okay with the morality of donating them in the first place, the person should have no problem signing up for being a donater.

OK, folks, this is really important:

If every single usable organ was recovered and given to a needy person it would NOT end the organ shortage.

There are two huge reasons for this:

1) Organs MUST be matched to the recipient. That means that some donated organs are “wasted” because they simply don’t match any waiting recipients. If a person needs O- blood you can’t simply substitute AB+ because that’s what you have on hand – if you don’t have a match giving the wrong stuff to the recipient will kill that person. Blood is relatively easy in this regard – matching for other organs is far more difficult. Outside of identical twins no one has a perfect match. The less perfect the match the higher required dose of immune suppressants and the more likely there will complications. Those are greatest disadvantage would be those of mixed distant ancestry – this is one reason why African-Americans are much harder to match to an organ than those of purely European, African, or Asian ancestry. This is one instance where coming from an inbred family is an advantage (assuming the reason you need an organ is not an inherited disease).

2) Organs for donation need to come from healthy people who die in specific ways, usually brain injury. Most people in the modern world die of disease or old age, rendering their organs very unsuitable. Even among those who die young and healthy, they have to arrive at the hospital still breathing – if you’re in a car wreck and bleed out before the paramedics can get your body to advanced life support your organs will not be usable for transplantation.

So please do not be under the illusion that this will “solve” the organ shortage. It won’t. It might work for, say, kidneys, where someone can part with one and still have a fairly normal life and lifespan, but it won't work for singleton vital organs like the heart.

A large proportion of organ recipients are themselves poor candidates for donation.

"Giving the organs back" post-mortem isn't medically practical.

If every one of their donatable organs aren't acceptable for transfer then so what? Take the good ones, bury the bad ones. A system's simple lack of being perfect and foolproof doesn't make it automatically useless. If further steps are required then you take them.

It won’t work – between the initial illness leading to transplant and the subsequent damage caused by both rejection episodes and the immune-suppressant drugs NONE of an organ recipient’s organs are suitable for donation. NONE. The sole exception might be the corneas… but since some of those drugs also greatly increase the risk of cataracts even those stand a good chance of being unsuitable. If you receive an organ transplant you will never be a donor afterward.

The only exception I can think of would be a situation where one of a pair of identical twins needs a transplant due to injury – without either a protracted illness or the need for immune-suppression drugs something like a kidney in that particular situation might be usable after the recipient’s death but that would be such an exceedingly rare phenomena that policy simply can’t be set by it.

Maybe another method could be discounts on insurance premiums for doners. (tax breaks if one has universal government care) Wouldn't medical cost go down if people aren't waiting around for a new kidney?

Maybe, maybe not.

The cheapest thing is, of course, for the sick people to die but I’ll assume that’s ethically unacceptable to everyone here.

Medical costs don’t go away after transplant – recipients require daily medication for life, regular medical testing (which in some cases can be quite expensive), care during rejection episodes… It never becomes cheap.

[Wicked Pilot]

You people need to quit throwing wet blankets on my ideas. I'm getting discouraged here.