Tag: Organ Donation

University of Philadelphia Study of Payments for Kidney Donations

USA Today reports on a study by researchers at the University of Philadelphia on attitudes toward monetary compensation for live kidney donors.

The study, published this month in the Annals of Internal Medicine, asked 342 participants whether they would donate a kidney with varying payments of $0, $10,000 and $100,000. The study called for a real-world test of a regulated payment system.

The possibility of payments nearly doubled the number of participants in the study who said they would donate a kidney to a stranger, but it did not influence those with lower income levels more than those with higher incomes, according to Scott Halpern, one of the study’s authors and senior fellow at the University of Pennsylvania’s Center for Bioethics.

As the article notes, almost all live kidney donations occur where there is some family bond. Less than 100 people become live kidney donors for strangers each year. The result is that in 2009, 6,475 people died while awaiting a kidney transplant.

Yet the ethicists opposed to paying live kidney donors quoted in the USA Today story largely rely on the “ick” factor — since we pay people for blood, unfertilized eggs, and for surrogate motherhood today (to mention nothing of compensating people to become human targets by entering the military) but we don’t pay people to donate kidneys, well, there’s just something wrong with compensation for kidney donations.

George Annas, professor of health law, bioethics and human rights at Boston University’s School of Public Health, predicts a payment system would result in an increase in health care costs for transplants. He says the study raises the question of whether the United States really wants to put body parts on the market, even a regulated one.

“I would not be against a reasonable trial to see how it works … (but) we do not want a society in which the rich literally live off the bodies of the poor,” Annas says.

Of course the study in question found that income levels weren’t not a major factor in deciding whether or not individuals told researchers they would be willing to become live donors given enough compensation.

But more importantly, the question is not whether Annas will get to live in a world where people are compensated for becoming live kidney donors, but whether any of those 6,475 people who died last year — and the thousands who will die this year — might have a chance at living in a world where there was financial compensation for live kidney donors.

As one of the study’s authors, Scott Halpern, told USA Today,

There’s no real reason why that model [the current Organ Procurement and transplantation Network] has to be continued. There’s nothing intrinsically unique about organ donations that requires it to be a truly altruistic act.

UK’s Brown Advocates Taking Organs Without Consent

The Telegraph reports that UK Prime Minister Gordon Brown is advocating for a plan that would lead to a presumption that individuals want their organs donated for transplantation purposes unless the individual specifically opts-out or family members object.

Like the United States, in the UK overwhelming numbers of people tell pollsters that they support organ donation, but when it comes time to actually get about the process of donating, large numbers opt out. According to the Telegraph, even though 90 percent of people in the UK say they support organ donation, 40 percent of relatives refuse consent when it comes time to decide whether or not to allow the organs of their loved ones to be donated.

In my opinion, this is a case of people telling pollsters what they think the pollsters want to hear. Few people are willing to appear so selfish as to deny another human being an organ after it is no longer useful to the original owner — especially in hypothetical future situations that most people don’t like to think about. When the reality finally hits, families are suddenly not so sure about their original view. Personally, I refuse to allow my organs to be donated in the event of my death until they fix the entirely screwed up system of regulation of the donor market that currently exists in the United States.

Joyce Robin of the UK’s Patient Concern nails Brown’s proposal with the observation that,

They call it presumed consent, but it is no consent at all. They are relying on inertia and ignorance to get the results they want.

It is just part of the ongoing war against patient autonomy in Western bioethics which presumes that people are autonomous to the extent that their medical decisions conform to a very limited range of possibilities. Give them enough time, and the position will eventually shift to the view that refusing to donate organs is absurd and invalid a choice in much the same way that the desire by some people to sell their organs is presumed to be today.

Source:

Organs to be taken without consent. Patrick Hennessy and Laura Donnelly, UK Telegraph, January 14, 2008.

Selling Organs to Saudis

Imagine you need a liver transplant, but there’s a problem. There is, of course, a shortage of organs and unfortunately you are the 52nd person on the list in your region. What do you do?

Well, if you’re a Saudi national, you pull some strings, and you get the Royal Embassy of Saudi Arabia to agree to pay the hospital about 25 percent more than a typical liver transplantation would cost. Mysteriously, you then go to the top of the list and get your liver.

At least that’s what happened at St. Vincent Medical Center in California. Staff at the hospital allegedly falsified numerous documents in order to cover up the blatant sale of the liver to the Saudi national.

In fact, St. Vincent’s appears to have been the place to get a liver if you happened to be a wealthy foreigner. Nationally, the United Organ Sharing Network decrees that no more than 5 percent of organs should go to foreigners. Nationwide the rate is much lower, according to the Los Angeles Times, but at St. Vincent’s 8 percent of all liver transplants at the hospital went to foreigners(and St. Vincent’s is a very large transplantation center).

St. Vincent’s organ transplantation program has been suspended and UNOS is still investigating. What they should do in response to this create an open market in organs and allow the rest of us to get in on the money. Organ selling — its not just for corrupt California hospitals anymore.

Source:

Hospital Halts Organ Program. Los Angeles Times, September 27, 2005.

Gary Becker and Julio Elias on A Market for Organs vs. the Volunteer Army

Gary Becker and Julio Elias have a paper (PDF) online making the case for allowing a market in live donor kidneys, and calculate that a market price of $15,000/kidney would be enough to clear the organ donation market of the persistent shortage of kidneys.

Of course selling organs is illegal in the United States and many people object to it on moral grounds. In their paper, Becker and Elias argue that allowing people to sell their organs — essentially incur a small health risk for money — is comparable volunteering for the army — also incurring a small health risk for money. Becker and Elias include this chart and a lengthy discussion noting that most of the arguments against a market for organs are analogous to arguments made against a volunteer army,

Payment to Living Donors Voluntary Army
  • “Commodification” of Body Parts.
    		•
  • “Commodification” of life.
  • Worked well.
    		•
  • Mainly Desperate poor donors.
  • If can help poor, Why bad?
    		•
  • Poor ManÂ’s Army.
  • Not really: Healthy poor and middle
    class.
    		•
  • Difficulty in calculating risks, impulsive.
  • Low real risks?
  • Can have cooling-off period, Written
    Consent.
    		•
  • Worked here.
    		•
  • Pay does not prevent other motives, such
    as to help relatives who are sick.
    		•
  • Can volunteer for patriotism.
  • And non-monetary motives
    		•
  • Eliminates “Black Market” in organ
    transplants:
    • Healthier Conditions.
    • Better Matches.
    		  
  • Save lives of those needing transplants,
    Improve quality.
    		•
  • Defend Nation more effectively.
    		•

    Now obviously pacifists and proponents of non-voluntary armies are not going to be persuaded by this comparison, but I agree with Becker, Elias and Alex Tabarrok who pointed out this study, that it seems a consistent supporter of a volunteer armed forces would be inconsistent in opposing a market for organs.

    Organ Donation: Should National Origin Matter?

    I didn’t really follow the Jesica Santillan case very closely, and missed an interesting fact about Santillan — she was apparently in the United States illegally. According to a number of reports, her mother smuggled her into the country hoping that she would receive better care in the United States than in Mexico.

    Doing a Google search on Santillan turns up a number of opinions on this state of affairs. There’s the hardcore anti-immigrant folks who think Santillan’s case is a tragedy because it will just encourage more people from Mexico to take the often dangerous step of illegally crossing the border. There’s also plenty of sentiment that it doesn’t matter — here’s a young woman who needed a transplant, and her nationality be damned.

    Of course Santillan is a very sympathetic figure. In the 1980s, there was less sympathy for a number of wealthy foreign nationals — including the wife of a prominent Saudi Arabian diplomat — who came to the United States for organ transplants.

    In response United Network for Organ Sharing decreed that transplant centers must limit to 5 percent the number of transplants they do for foreign nationals. In 2002, 936 of the 22,709 organ transplants operations in the United States were performed on foreign nationals.

    One of the major problems with this system us that UNOS appears to have no serious guidelines for deciding when an organ should go to a foreign national over a U.S. citizen. The American Society of Transplant Surgeons proposed giving U.S. citizens first shot at any organs, with foreign nationals qualifying only if there were no citizens who could take the organ (and, to be fair, something like that appears to have happened in the Santillan case), but UNOS appears to have never formally adopted that guideline, leaving such decisions up to whatever policies transplant centers themselves want to formulate.

    Sources:

    Immigration, organ issues mix: Medical community faces quandary of who is most deserving recipient. Scott Dodd, Charlotte Observer, February 21, 2003.

    Why I Won’t Donate My Organs

    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.

    Source:

    Transplants and personal responsibility. Jeffrey P. Kahn, CNN, March 5, 2001.