Last Christmas I was at a relative’s house watching the news when a brief segment came on about organ donation. The ongoing problem, of course, is that there are far more people in need of organs than there are organ donors. The purpose of the news report was to encourage people to donate their organs, to which the relative I was watching television with rhetorically asked, “Who wouldn’t donate their organs?”
Well, I wouldn’t for one.
Why not? Because of nonsensical views put forth by bioethicists which Jeffrey Kahn summarized nicely in a recent article for CNN’s web site. Kahn gets off on the wrong foot immediately in my view, writing,
Whenever we face shortages of particular types of medical care we need to decide how best to allocate those scarce resources. Nowhere is this more acute than in our decisions about who should receive organs for transplant, particular for life-saving transplants.
Just who is this mythical “we” that has to make these sorts of decisions? In the United States it is essentially the government. Congress gave the United Network for Organ Sharing a monopoly on organs donated for transplant and UNOS sets policies for how organs are distributed. Unfortunately UNOS has a history of regularly changing its criteria and bowing to political pressure to modify its criteria to benefit one group or another.
For example, the obvious criteria for a government-sponsored organ distribution system would be to create an index of medical viability so that organs went to individuals based on criteria of how much benefit (i.e. prolonged life) a given individual is likely to receive from a transplanted organ. Unfortunately there are severe political problems with that — specifically, any such formula will, for a variety of medical reasons, drastically limit the number of organs received by African Americans. The UNOS response, under intense political pressure from some who viewed the system’s pattern of organ distribution as racist, was simply to apply a little affirmative action and begin to arbitrarily increase the odds of a black patient receiving a transplant.
The survivability criteria also, for a number of reason, tends to favor adults over children, and UNOS under pressure agreed to arbitrarily alter its ratings to try to get more organs to children.
Now I’m not arguing that trying to increase organ transplants to blacks or children is bad. What I am arguing is that once the process becomes politicized in this manner, there is no end to it.
For example, Kahn notes that there are currently behavioral restrictions on recipients, which he seem to approve of. For example, some transplant programs require people who are potential liver transplants to be alcohol and drug-free. Ironically those programs typically require receivers of liver transplants to be free of methadone — a drug used to kick the heroin habit — which studies suggest actually increases the likelihood that liver transplant recipients will go back to drugs once they receive the liver (i.e. since they can’t receive methadone, they kick the heroin habit just long enough to get the liver transplant, and then go right back to the drug).
But where are UNOS and others going to draw the line? Should a smoker be eligible for a heart transplant? How about someone who is likely to ignore his or doctor’s advice to maintain a low-fat diet after a heart transplant? Maybe we should ban gay men who insist on having multiple sexual partners from having transplants altogether because of their risk of “wasting” a transplant by contracting AIDS.
Kahn and other bioethicists maintain that if I receive an organ transplant — which I have to pay for out of my own pocket since insurance companies rarely cover such procedures — that I suddenly incur all sorts of obligations to some fictional “we” who made the transplant possible. I find this an absurd claim that is not applied elsewhere in medicine and sets a dangerous precedent.
After all, if society can impose behavioral restrictions as a condition of receiving a transplant, why not do so for other medical treatments? Since my life was probably saved by a society-wide system of vaccination and other forms of medical treatments, do I have an obligation then to refrain from any behavior that bioethicists and others consider risky and unhealthy? If not, why are transplants a special case? (Kahn’s argument that transplants are scarce resources doesn’t hold water since all medical treatment involves uses of scarce resources).
I find this government-mandated paternalism that is at the heart of organ transplant distribution to be obscene, and so have no intention of donating my organs. Don’t worry, though, in a few years I’ll probably have no choice. Taking their cue from the opt-out spammers, many bioethicists today are pushing for a standard whereby they will simply assume that you want your organs donated unless you explicitly make a request otherwise. Add to that the effort to change the definition of death to make it easier to harvest organs, and the entire transplant area is filled with opportunists who are regularly willing to bend ethical rules to serve what they think are greater ends.
Transplants and personal responsibility. Jeffrey P. Kahn, CNN, March 5, 2001.
There are no revisions for this post.