« Goa ramblings | Main | Should we get rid of the penny? »
Virginia Postrel is Mad
No one is more familiar with the ethics of organ donation than Virginia Postrel so when she says that the National Kidney Foundation is behaving reprehensibly you can be damn sure she is right.
The National Kidney Foundation is behaving reprehensibly, especially given its mandate. When I first got interested in organ donations, I naively thought that the foundation would be in the business of doing everything possible to encourage kidney donations. I was terribly wrong. The group vehemently, and successfully, opposed a bill that would have allowed tests of incentives for organ donors. (CEO John Davis brags here, scroll to second item.)
So determined is the NKF that kidney donors should never, ever, in any way be compensated for their organs--no matter how many kidney patients current policy kills--that the organization is now trying to stamp out public discussion of the idea. When they heard that AEI is planning a conference on the subject for June 12, they wrote a letter to AEI president Chris DeMuth suggesting that the conference shouldn't be held. The letter from NKF chief Davis (PDF available here) opens:
The officers and staff of the National Kidney Foundation (NKF) were surprised to learn that AEI has scheduled a forum entitled "Buy or Die: Market Mechanisms to Reduce the National Organ Shortage" that will be held on June 12, 2006. ...we believe that the concept of financial incentives has been adequately debated for 15 years, begining with the National Kidney Foundation's 1991 workshop on "Controversies in Organ Donation," and culminating in the definitive Institute of Medicine (IOM) report that was issued late in April 2006. We don't see how an AEI forum would contribute substantively to debate on this issue. [Emphasis added.]
In other words, "We'd like to maintain our monopoly on the policy debate, so please shut up."
...For more background on the policy debate, see previous posts here, here, and here. Marginal Revolution blogger and GMU economist Alex Tabarok takes a detailed look at incentives here.
Posted by Alex Tabarrok on June 3, 2006 at 06:52 AM in Education | Permalink
Comments
The ‘kidney for sale’ debate enters territory that people are uncomfortable with. Most people view the body/life/health as a sacred matter much like religion is. Debate the existence of God and see how far you get. We haven’t evolved sufficiently.
Posted by: Chairman Mao at Jun 3, 2006 8:12:02 AM
Most people view the body/life/health as a sacred matter much like religion is.
So why is the government involved?
Posted by: Paul Dietz at Jun 3, 2006 2:42:30 PM
I am pleased that this discussion will occur. For years I have maintained that there should be markets in blood and organs. Few were willing to discuss the possibilities and many seem angered by the idea.
Posted by: G Roper at Jun 3, 2006 3:18:24 PM
Sure, letting people pay for kidneys would mean more kidneys available and more lives saved. But at the end of the day, with rich people living and poor people dying and poorer people selling their kidneys, you'd have a pretty sick world.
Of course I wouldn't really mind Mongolia becoming the "Land of the One Kidneyed People" as they each sell a kidney for a hundred bucks, cause that would mean that - should I ever need it - I'd have a kidney available to save my life. That way everyone's happy. The Mongolians can buy an extra horse and we Westerners get to live. Nobody thinks of the otrher one as real and so, no feelings are hurt. But were the buying and selling to take place within one country, methinks some people may be pissed off enough at the inequality to start a revolution.
I kid, I kid. For as long as we can get free porn on the internet we're not starting any revolution.
mnuez
Posted by: mnuez at Jun 3, 2006 4:20:33 PM
I'm not sure what to think about the inequality indignation (in fact, it perplexes me in many other areas of policy as well; maybe because I am a white middle class kid living in California?) but can you not just look at things the same way you do sweatshops? Why stop these people from giving the only thing they have to contribute because the result is not up to your personal standards? Would you stop a quadraplegic from working at $5 an hour?
Posted by: Chi at Jun 3, 2006 5:11:44 PM
In my will, I have it stated that if sales of my organs are legal upon the date of my death, and if my spouse is
still alive, sell said organs for all the market will pay. If it is not legal to sell them and my spouse is not
alive, then donate them. If it is not legal, and my spouse is alive, then since my assets devolve to her; she
can determine the disposal of said assets. The rest of this blather about one-kidneyed countries is "magician's
assistant" distraction and mis-direction. I own my kidneys and shall dispose of said assets in the best way
possible for me and mine. You own yours and thus possess the right to do the same. Who knows what the market
clearing price for any organ would be, it might be €10 or £20 or ¥300,000. Of course I suspect that there would
be plenty of blood available if blood were a priced commodity given that we produce a lot of it and the production
cost is close to 0.
Posted by: CK at Jun 3, 2006 5:33:31 PM
People's instinctive reaction to the selling of bodily components seems to be based on concern for the seller. I don't know whether this is a health issue or an instinctive revulsion to selling body parts, but I don't understand it. Where is concern for the seller in other transactions? If I want to sell my house, is the government going to make sure I have somewhere else to live first? Moreover, presumably any legal sale of organs from a live donor would include a serious informed consent stipulation, which should take care the health issue - after all, people are allowed to compromise their own health by smoking and eating too much McDonalds - and the revulsion to selling body parts is illogical since (a) selling sperm and even eggs is permitted, and (b) *giving* organs is allowed.
This reminds me of prostitution. I, like many people, earn my living by selling a portion of my mental output. Others earn their living by selling a skill or talent they possess, such as the ability to create music or tell stories. Some people earn their living by selling what their body can do: run fast, or hit home runs, or look good on television. The only thing that makes selling sex different from selling public speaking appearances is that many people feel that they personally would hate doing it. Well, I would hate mucking out horse's stalls all day, but that doesn't make it unethical for someone else who either likes it better or has fewer choices than I to make their living at it.
Posted by: Erica at Jun 3, 2006 10:33:47 PM
The objections to incentives fail to adequately consider a) the range of incentives that might be considered or b) the way organ markets, if such things existed, would in fact operate within a system of insurance (including federal programs) and transplant centers. Incentives, for instance, might include tax advantages of interest primarily to the wealthy. One, proposed by my economist husband, would be a one-year exemption from federal income tax. That would result in organs going from the rich to the poor.
If there were a fully open market, organ acquisition would become just another cost of the transplant, like immunosuppressant drugs or transplant surgeons' fees, to be covered through the normal channels. The problem is when you don’t make payment an above-board part of the medical system. That’s when you get the many problems we currently observe in black markets, ranging from inadequate care and contract/financial protections for those who sell organs to the availability of organs only to those who are willing to break the law and have the means to travel abroad.
I don’t believe permitting payments, whether for organs outright, through tax incentives, or simply to make up for lost wages (which isn’t illegal but doesn’t happen today in large part because people think it's illegal), would make unpaid donations disappear. Blood donations coexist with blood banks that pay for blood. Volunteer fire fighters work alongside professionals. I would have donated a kidney without compensation even if it were legal. But I am a relatively affluent person who can afford to take such risks, and miss a certain amount of income, without compensation.
Expecting people to take risks and give up something of value without compensation strikes me as far more blatant exploitation than paying them. I don’t expect soldiers or police officers to work for free, and I don’t think we should base our entire organ donation system on the idea that everyone but the donor should get paid. Like all price controls, that creates a shortage--in this case, a deadly one.
While giving up a kidney has risks, it is no more risky and far less emotionally fraught than being a surrogate mother, something many women receive both money and personal gratifications from doing. I suspect that if, like the people who use surrogates (or egg donors), kidney patients were affluent professionals with political clout, markets in kidneys would also be legal. Unfortunately, the typical kidney patient tends to be a relatively low-income wage earner without the time, education, or social capital it takes to get policies changed.
As for the idea that "Most people view the body/life/health as a sacred matter much like religion is," I certainly agree. When people hear that you are going to donate a kidney, they tend to be repulsed, though after the fact they dole out lots of praise. But we don't need everyone to think it's OK to give or sell kidneys. A tiny minority will do. The rest of the world can simply tolerate their odd behavior.
Posted by: Virginia Postrel at Jun 3, 2006 11:10:45 PM
Paul Dietz,
A good question. Some people don’t view body/life/health as a sacred matter and are willing to put a price on such things, which disturbs a large part of the population and thus you have government intervention.
Moreover, gov’t is tasked (rightly or wrongly) with protecting human life – another reason for it’s intervention.
Posted by: Chairman Mao at Jun 4, 2006 3:56:21 AM
Wait, it gets better! They also don't want your kidney if you try to donate it to a stranger without compensation.
Posted by: mobile at Jun 5, 2006 10:19:50 AM
Over half of the 92,000 Americans on the national transplant waiting list will die before they get a transplant. Most of these deaths are needless. Americans bury or cremate about 20,000 transplantable organs every year. Over 6,000 of our neighbors suffer and die needlessly every year as a result.
There is a simple solution to the organ shortage -- give organs first to people who have agreed to donate their own organs when they die.
Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. About 60% of the organs transplanted in the United States go to people who haven't agreed to donate their own organs when they die. People who aren't willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.
Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. They do this through a form of directed donation that is legal in all 50 states and under federal law. Anyone can join for free at www.lifesharers.org or by calling 1-888-ORGAN88. LifeSharers has 4,510 members, including over 400 minor children enrolled by their parents.
Posted by: David J. Undis at Jun 6, 2006 10:32:16 AM
Please keep in mind that David Undis's stats above are, as he says, for organs--all of them--not for kidneys and that he is talking specifically about posthumous donation, which is essential for some organs. His tireless efforts can do little, however, to significantly reduce the waiting list for kidneys, which is at 66,000 today and projected to rise to 100,000 or more by 2010.
Posted by: Virginia Postrel at Jun 8, 2006 4:24:10 PM
vrouw dildo vredig ^^^ blonde prostituee in bad ^^^ live show fotografia ^^^ boutique x orgy ^^^ divine infirmiere irve ^^^ sans esprit ado uriner ^^^ plus froid mama cinema ^^^ le plus froid papa vingt trois ^^^ celeste amatoriali azione ^^^ piu bollente cameriera urinate ^^^ stilig snut alska ^^^ hettare brudar dildo ^^^ attraente infermiera azione ^^^ prodigiosamente ragazze doppio penetrazione ^^^ vagin soutient gorge ^^^ mooier babe ejaculatie ^^^ lesbisk imea verenkuva ^^^ penis siitin bukkakelinks ^^^ hetest hanlig far ^^^ snobb sadsprut ^^^ kjoligere imager ^^^ kaldere usynlig russisk ^^^ adrikios koritsi ^^^ ikios xanthos praxi ^^^ pere moyen ^^^ plus frais galerie ^^^ tolmiros kolpos ^^^ tolmiros fthinos ^^^
Posted by: levan at Sep 8, 2006 5:33:14 AM
Mabinogi online gold
Mabinogi money
Mabinogi Gold
cheap Mabinogi gold
buy Mabinogi gold
2moons dil
2moons gold
buy 2moons dil
2moon dil
cheap 2moons dil
Flyff gold
flyff Penya
flyff money
buy flyff penya
cheap flyff penya
cheap flyff gold
aion gold
buy aion gold
cheap aion money
aion money
cheap aion gold
Dofus kamas
buy dofus kamas
cheap kamas
dofus kama
dofus gold
dofus money
Knight Online Gold
Knight Gold
Knight Noah
Knight Online Noah
Posted by: aion at Jul 7, 2009 4:22:03 AM
