There was an article in the NY Times a few days ago discussing the organ shortage and giving some proposals (article here). I meant to blog about it, but my life has been pretty busy at the moment so I haven’t gotten around to it. However, Sigrid Fry-Revere of the Cato Institute wrote about the particular article today. Says Fry-Revere:
The organ shortage can only be solved by increasing, not decreasing, the control people have over the disposition of their organs. Only an increase in liberty, not a restriction of liberty, has any chance of solving the organ shortage. New and innovative ways to motivate individuals to donate, including the option of compensation for donation both in the case of deceased and live organ donation, are what we need, not new ways to take organs without people’s consent.
One option Brody discusses is donation after cardiac arrest. There is nothing wrong, in principle, with retrieving organs after cardiac arrest, but what defines death and when to give up on a patient are not decisions that should be motivated by a need for organs. It is never appropriate for a doctor to alter how he treats one patient in order to provide an organ to save another patient. Just last month, a San Francisco transplant surgeon was charged with three felonies for allegedly hastening the death of a patient in an attempt to harvest his organs.
When she says “taking organs without people’s consent” she’s referring to an opt-out system. We sign our drivers licenses when we want to donate organs, but in some countries you must ’sign your card’ when you don’t want to donate your organs. Basically it’s as if the state owns your body when you die, hence the restriction on your rights (or your family members who also may not want your organs donated). An opt-in situation like we have is preferable rights-wise, but obviously there is this massive organ shortage with people dying everyday or getting so sick that they can no longer undergo an operation even if an organ becomes available. That’s why Fry-Revere suggests compensating people or family members for their organs – you still own them, but now there is an incentive for more people to donate when they die (or in the case of kidneys, possibly when they are still alive).
The most common criticism I hear against this suggestion is that it “unfairly targets poor people”. That is, if you offer a financial incentive poor people will be more likely sell their organs because they’re strapped for cash. I’m not really sure why people think this, for several reasons. First, I would argue that the people who are most harmed by organ shortages are poor people, who tend to have poorer health in general (i.e. more likely to have diabetes and thus more likely to have kidney disease, or more likely to have high blood pressure and have kidney disease). If poor people are more likely to have conditions that place them on waitlists, then it seems that allowing people to pay for organs (or their insurance, medicaid, medicare) would be most beneficial to poor people. I think that insurance would cover the procedure, because if a good match can be made and the patient treated earlier, it likely saves money in the long run.
Second, there are lots of clinical trials right now where you are compensated for your time that you could argue target poor people, but they don’t. For instance, all around my campus there are fliers to participate in vaccine trials, asthma studies, etc and get paid decent amounts. Poor people don’t sign up for these, college students do. But any time someone mentions “organ sales” I don’t hear people complaining that it unfairly targets young male college students. I understand that a vaccine trial is probably not as risky as donating a kidney, but both still entail a risk, so why do we compensate one group for the risk and not the other?
I think if organ sales were ever legalized, that you wouldn’t see a huge increase in live persons donating kidneys, but would probably see an increase in cadaver donations – perhaps compensation would take away some of the taboo. Maybe someone would agree to donate because they know their family could use the money to cover the cost of their funeral, or pay off any remaining medical bills (or maybe they were kind of leaning towards donation, and the compensation convinced them to donate just so they can benefit someone else). I don’t see why this should be a problem, or why it is so controversial. It’s a solution that allows for more organs (and probably better immunologic matches), more people to be treated before their quality of life becomes poor, and does not infringe upon the ownership of your body. I think at the very least we should try it out on a small scale, so that if any problems do occur we can learn from them before launching it nationwide. Do you disagree, and if so why?
To read Sigrid Fry-Revere’s article, click here.
