I do agree with the author that the paucity of organs for transplants creates many conflicts.

What about this: right now we have a system where you have to opt *in* to donate your organs, but what if Canada had a system where you had to opt *out* if you don’t want to donate your organs? It’s not unprecedented at all, I think several European countries have opt-out systems.

This is a link to a UK article about their own debate:
http://www.uktransplant.org.uk/ukt/newsroom/statements_and_stances/statements/opt_in_or_out.jsp

Thoughts anyone?

The idea of commercializing kidney donations has been given some serious thought in other parts of the world. For example, in Iran the sale of kidneys is legal and regulated, with a kidney going for about $5000-6000. Strauss is arguing that this would be a way to increase the amount of donors and to increase the amount of healthy donors. Although I agree wholeheartedly that new methods of securing donors is more than necessary, we also need to think about those donating organs. How can we guarantee them fair treatment and health care? Will legalizing the sale of organs protect those who donate? Check out this article; it includes an overview of some laws regarding transplants from around this world.

http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/legalise-organ-sales-to-ease-severe-shortage-says-transplant-surgeon-418903.html

Also, the idea of presumed consent (having to opt out instead of in) has been debated in Ontario already. I think it’s a really interesting concept. Certainly a concept deserving of a closer look. Interestingly, this system has a few different forms (see Mandy’s article). In Spain consent is presumed, but the family still has the option to opt out. In Austria consent is presumed and the family is not given any say. Any thoughts on these systems?

http://www.cbc.ca/canada/toronto/story/2006/02/17/to_organs20060217.html
http://www.cbc.ca/health/story/2007/04/19/organ-donation.html

Although an “opt-out” system is definitely interesting and something that should be looked at, Mr Strauss notes that recipients of kidneys from live donors have a better prognosis than those from deceased donors, regardless of their age/disease status. My main concern with the sale of kidneys for transplant is that there would be a greater number of marginalized/impoverished donors who would be availing themselves to this. Although it is possible to live on only one kidney (one-third if you’re running at peak performance), the risks of future disease must be evaluated. I don’t have any hard stats on this, but with the lower costs of salt, sugar and fat-laden foods (e.g. 2 L of pop = $1, 2 L of milk = $3.50), I would imagine there is a high percentage of lower-income patients who suffer from a number of diseases, especially diabetes (Type II). Diabetes causes, among other things, vascular disease, notably in the kidneys. With the amount of money that donors would receive for their kidneys (probably not all that much, in Iran it’s $5000 - $6000), they would not be able to alter their lifestyle sufficiently to offset the potential complications of living the rest of their lives down a kidney. I fear that people looking for a quick bit of cash who choose to donate would be putting themselves at a great disadvantage down the road, and this is something that needs to be addressed.

I’ve been wrestling with my elective paper for the past couple weeks so I haven’t had time to weigh in here, but now I’ve got a few rare spare minutes.

Quoting Mr. Morash: “My main concern with the sale of kidneys for transplant is that there would be a greater number of marginalized/impoverished donors who would be availing themselves to this.”

This tends to be one of the main arguments on the topic. While I’m not sure where I stand on the overall topic of commercializing organs, I don’t buy into this argument.

I find it somewhat patronizing to say that the poor can’t make good decisions for themselves, so we have to make it for them. If somebody has thought through the pros and cons of selling a kidney, and has come out deciding that the $10 000 is worth it, then who are we to say it isn’t. The obvious rebuttal to that is that the middle man buying the kidney is not likely to be informing the seller about all the cons. However, this is a problem with informed consent and the process of the transaction and not a problem inherent in the transaction itself.

If we’re talking about the third world, $10 000 is not just some money that the person is trading their kidney for. It’s a home, survival for their family, a new life. Even in Canada, $10 000 is enough money to change a lot if you’re actually at the bottom. You could go from living on the street without a job to renting a low income home, buying a suit, keeping clean, and knowing where your next meal is coming from. All of a sudden finding a job becomes a much greater possibility.

All and all, I’m just a crazy left-wing libertarian and think if somebody decides to make the informed choice to sell their kidney, that’s their decision and we are in no place to tell them their decision is wrong. It may be that they have no other option, but in that case thank god somebody’s there to give them that option.

Tim

But Tim, how did you ever know it was me?
P.S. I like your left-wing views.

I thought Strauss’s argument was quite notable for being based entirely on medical efficacy; it was as though he’s talking about sourcing surgical screws, and one source is better than another, so why not buy them from the better source?

He doesn’t even address the question about whether buying parts of human beings involves any other considerations apart from efficacy.

Tim picks up on the issue, and takes a strong stand! Are you this libertarian about everything, or only organs? I mean, we have all sorts of product safety and labour laws that protect those who would be vulnerable in a completely libertarian market because they have less economic freedom than other people do to make the choices that are good for them. We place strict limits on the degree of danger to which employers can expose employees. Lots of laws recognize power imbalances and try to mitigate them. So it would be very unusual if we took the stand of being drastically less protective around this one thing that involves an violation of bodily integrity.

So it’s not surprising that Western democracies, placing high value on respect for bodily integrity and some value on equity, don’t permit organ sales. We don’t even permit sale of blood products, and blood, unlike a kidney, is a personal “renewable resource” Plasma products in the U.S. are an exception; the U.S., as is often the case, is an outlier in allowing greater freedom of the marketplace than other Western democracies.

In the interests of full disclosure, I ought to let you know that many bioethicists argue as Tim does for a free market in organ donation. It’s always surprising to me; I think it comes from the fact that ethicists are often training in individualistic ethical thinking and not in political philosophy or sociology.

John is speculating about health effects for poor organ sellers, and his speculation is not far off the mark. Those who sell are those who are least likely to be able to maintain the healthy lifestyle that is necessary for someone missing a kidney. The article “The Hidden Cost of Organ Sale” by Rothman and Rothman gives a nice summary towards the end of some of the data on this from India.

http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1600-6143.2006.01325.x

(If you’re on-line at school on on the vpn you should get access to the pdf.) It also turns out that a one-time lump-sum payment isn’t sufficient to lift people out of poverty. The circumstances that create poverty are still there. Indeed, the poor health resulting from the donation may make it even worse.

I’ll make a separate comment about opt-out systems–that’s an interesting debate! Spain has a “soft” opt-out system, according to the link Mandy posted from the Telegraph. That is, consent of the deceased donor is presumed, but consent is sought from the family and the family can refuse. Spain is considered a model of success in organ donation. It’s not just that they have the law; there’s lots of public buy-in to the system. Oddly enough, most provinces in Canada give the deceased donor in law full control over donation–but in practice, the family is allowed a veto even if the person has signed their donation card. This is an interesting situation, and people are sometimes surprised to hear this.