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Policy: What is a transplant worth? By John Pluenneke

Nearly a hundred thousand Americans are on waiting lists  hoping for organ transplants. Thousands will
die this year alone. Should a free market be allowed to develop to allow those who
can afford to do so to purchase the liver or kidney that will let them to go on
living? 

Rather surprisingly, I find
myself agreeing with an editorial in the San Francisco Chronicle today by David
Holcberg at the Ayn Rand Institute – of all places – who argues that opponents of a legalized
organ trade,  although well-intentioned, have it the wrong way around.   

Poor people, they claim, are
incapable of making rational choices, and so must be protected from themselves.
But the fact is that human beings (poor or rich) do have the capacity of reason
and should be free to exercise it. Of course, the decision to sell an organ
should not be made lightly. That some people might make irrational choices,
however, is no reason to violate the rights of everyone. If the law recognizes
our right to give away an organ, it should also recognize our right to sell one.

There are important questions which Holcberg
does not address. What would such a market look
like?  How would it be regulated, if at
all?  Who among us is to say what the
exact price of a heart should be?  A million
dollars? Two?  What about a kidney?

The implications
for society as a whole are thought-provoking.  The skeptics are
correct of course when they raise questions. Would there be instances in which desperately
ill people were taken advantage of by the greedy and unscrupulous? Clearly, yes.  But then again, that already happens every
day. It’s time for a  sane policy.

UPDATE: The compensation issue is clearly going to get a lot of play after the latest developments in the ethics controversy surrounding the Korean stem cell program. Last week, there was the news that  Korean researchers paid women the equivalent of $1,500 each to donate their eggs to help scientist Dr. Hwang Woo Suk’s research. Then, last night Korean TV broadcast an hour long special in which several women who took part in the experiments say they were under financial pressure at the time. Roh Sung Il, the manager of the Seoul fertility clinic involved, argues the arrangement was not outlawed at the time the donations took place …   

The latest evidence appears to show that Koreans still back Hwang – who is considered a national hero for his work. The Korea Times  has a poll out this morning that claims 2 out of 3 Koreans still support Hwang despite the charges.

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9 replies »

  1. //should the government dictate that a doctor work more shifts, come back in from home, not have the option of not working- to reduce wait times? //
    What the government could do is educate more doctors, lower the cost of medical school at the same time, and then have doctors clamoring to work the ER.
    //Should an orthopedic surgeon be forced to be available at all times//
    Perhaps there should be a med school track for ER doctors: sort of like choosing to become a high school teacher vs. a research professor.
    // doubled oor tripled lab and xray capacity. Should the hospital be forced to spend to build this?//
    If the goal is best medical care, yes. Hospitals as public institutions would obviously have to receive funding from their communities or the government funding to do this, though. You seem to be thinking of hospitals as profit-seeking entities who shouldn’t be “forced” to do something that might lose money. I think of hospitals as public services that should respond to the needs of the public.
    //Finally, who should be in control? The government? Should the government micromanage a doctors work hours/ locations? Control vacations? Determine who gets what treatment when?//
    Wow, then doctors might be subject to poor working conditions like a lot of other people. In all the jobs I’ve held, I worked under scrutiny of management, and my vacation time was controlled by the larger needs of the business. The up side is then doctors might have an interest in fighting for improvement in those working conditions for others. As for who gets treatment, I don’t think government involvement will make things any more exclusionary than they are now.
    //”from those with the greatest ability, to those with the greatest need”//
    This is how society behaves even when they vocally demonize socialism. Look at college lecturers. No one forces them into that career, but once they’ve invested 10 years into their doctorate, they feel obliged to carry it out. Lecturers are hired from semester to semester, often shuttling between several colleges. Their pay certainly doesn’t reflect their experience, expertise, or hard-won knowledge. Yet society has managed to produce plenty of lecturers. If they protest their circumstances, a million moms come out complaining that the lack of altruistic spirit is depriving the children.
    So, somehow, society has imposed socialism on the education system because we all think it’s necessary. It seems to me medicine is just as necessary as education.

  2. // in which people die who otherwise wouldn’t. //
    I don’t think sacrifice of other lives is a moral improvement. Let’s find other ways. I do support stem cell reseach. Let’s develop better medicines and artificial organs.
    //assume a legalized organ trade would be completely unregulated//
    I think that social pressure could build against the “less valuable” people even if it were regulated.
    //your ability to rationaly address this problem.//
    That’s an insult. I’m a rational person.
    //eliminate the black market in countries like Pakistan and India, //
    Why would legalizing the sale of organs eliminate the black market? Third world countries would continue to offer cheaper organs.
    //Are there any controls that would satisfy you?//
    No, I’m sure of my position on this one. But as a member of the exploitable class, my “unreasonable” vote doesn’t count for much.

  3. Gadfly- impressive that you are taking on two parallel lines of questioning…
    I will persist because I believe that something at the heart of what you are implying in your arguments is the fatal flaw in the national/ universal/ centrally managed healthcare system.
    As an aside, we cannot compare to other countries very well because the expectations of the public will never be brought in line with those of other countries (not to mention medical liability changes, who pays for education, etc.).
    You place the rights of a person who ‘needs’ healthcare above the rights of the providers. Let’s look at an issue that does exist: wait times in emergency rooms. This could in part be alleviated if more doctors were on shift at any given time. If the rights of those in need are supreme, should the government dictate that a doctor work more shifts, come back in from home, not have the option of not working- to reduce wait times? Should an orthopedic surgeon be forced to be available at all times to take care of problems that come in, even if it is not really his area of expertise? For that matter, the wait time would be reduced if the hospital doubled oor tripled lab and xray capacity. Should the hospital be forced to spend to build this?
    Finally, who should be in control? The government? Should the government micromanage a doctors work hours/ locations? Control vacations? Determine who gets what treatment when?
    I sense a “”from those with the greatest ability, to those with the greatest need”

  4. In retrospect, I think I probably should have left the heart line out of it. It’s more than a little distracting…
    I think we should concentrate on organs that it is possible to do without, to keep things a little more straightforward. So I retract that …
    Several points Gadfly:
    1. Your quest to prevent exploitation leads to a situation in which people die who otherwise wouldn’t.
    You haven’t answered the key question. What about the people who are dying?
    2. You assume a legalized organ trade would be completely unregulated, which is obviously not the way the situation should be approached. Tight regulation is clearly needed.
    3. Your vendetta against “Reason and the Market” – your words, not mine – undermines your ability to rationaly address this problem. Granted ,it’s annoying to hear people who are well-off grandly mutter that people “should be reasonable” and that the market is the solution to all problems. The market approach doesn’t work for everybody. That’s why a safety net is needed.
    4. Your concern about exploitation leads to a situation in which people ARE exploited every day, and in circumstances which are truly horrible. You ignore the fact that legalizing and controlling the sale of organs (again, non-vital ones) would eliminate the black market in countries like Pakistan and India, where people are doing this in back allies – literally.
    5. The more I think about this, the more it seems to me that sensible controls like a mandatory waiting period and perhaps even a minimum income test would be necessary to address these questions. Are there any controls that would satisfy you?

  5. //”sell” his or her blood or plasma //
    My understanding is that blood renews itself, though I do think selling it is a bit ghoulish. I do wonder about whether there are longterm consequences in regard to giving marrow or a kidney. Even when there’s no money involved, I wonder if the entire medical profession downplays the sacrifice that might be involved in order to get the organ they need right now.
    //the people who ‘need’ doctors, or the right of doctors to choose when and where their intellectual property is used?//
    No questions, hands down, I believe the right to medical care comes before financial interests of any sort. Medical care is not just a private good: it’s a public good in terms of contagion control, productivity, and avoiding the bad feeling that comes from watching people disintegrate and die in the street. There’s also violence prevention. Do you think all those people who can’t afford what doctor’s want to demand are just going to shuffle off and pout? No, they are eventually going to come back and fight for what they need. Medical care isn’t a trivial issue: it’s life or death.
    I don’t believe doctors should work for free, but I don’t think they should set their own price, either. After all, the price for life could be infinite. I think doctors should be treated like teachers: they should be rolled into public institutions and be paid on the scale of other public employees. They can be over-produced and incentivized just like teachers are. The “best” doctors will continue to be attracted into their field just as the “best” physicists are attracted to particular universities: through endowed chairs.

  6. Gadfly- In many areas, people are allowed to “sell” his or her blood or plasma for money.
    Does this fit in as “ok” in your set of “moral principles”?
    Many physicians believe they ought to be paid to be “on-call” to cover emergency rooms. Due to a variety of issues, there is a growing local/ national shortage of specialist coverage of emergency rooms.
    In your set of “moral principles”, whose rights take precedence: the people who ‘need’ doctors, or the right of doctors to choose when and where their intellectual property is used?

  7. //idea of a market-based economy//
    Market-based economies do not exclude regulation for the public good or consideration of moral ideas. Right or Left, you can’t put Reason/Market before the suffering, pain, and death of the expendable individuals without raising the moral issue. The people you plan to expend will talk back. Forget suicide bomber’s – I’m going to take the hit for Godwin’s Law and bring up the eugenics logic behind concentration camps.
    //What about their right to live?//
    I don’t think we should go down the path of weighing the relative value of human lives. What we’re talking about here is not one person’s right to live, but the relative value of lives in trade. Inevitably, poor, weak, and “burdensome” people will be valued less in a contest for “right to live”. How long before “rational choice” becomes social pressure and duty to die? Two words: soylent green.
    I’m not conservative. I’m not against abortion. I acknowledge the complexities of the Right to Die argument for terminal illness, though I’m suspicious about where that may lead. But as a lifelong denizen of the underclass, I’m tired of pundits telling me that my only path to self-respect is to agree that Reason and the Market trumps all, and I should be proud to be a casualty for someone else’s vision of civilization. Screw that. I’m bringing moral principles to the table, and I’m saying it’s wrong to place economically vulnerable people in a position where selling off their body parts is a “rational parts”.

  8. Gadfly,
    Hold on a second before you break out the suicide bombers on slippery slopes argument …
    Clearly if you’re one of those people who disagree with the idea of a market-based economy on a fundamental level, you’re not going to be enthusiastic about any idea like this.
    The real question is this: are there any situations in which society should allow a transaction like this to take place? You – and a lot of other people – say no.
    I’m not sure I know the answer.
    I think we need to think that proposition through carefully. Thousands of people are on waiting lists.
    What about their right to live? If it’s possible to save lives, I think we should do whatever needs to be done. This seems like common sense to me.
    I’m not sure its wise to talk about “moral principles” while in the same breath denying somebody else a chance to live …

  9. I strongly disagree.
    Economic deprivation is a form of coercement. Decisions made at the point of a sword are not free decisions. Of course the poor are rational human beings: many are smart and even highly educated. However, giving people the “freedom” to sell their organs is the first step on the slippery slope toward total devaluation of human life. The person who got the money to support their families may have shortened their lifespan or deprived themselves of quality of life to make this “rational choice”. Thus the ultimate rational choice, longterm self-preservation, may be circumvented in favor of social pressures, family loyalties, or short-term self-preservation.
    Think of it this way: when a person becomes a suicide bomber, they often do it to support their families as well as for the greater glory of God. Under the Ayn Rand philosophy, they made the reasonable decision to sacrifice their lives for the survival of their family and for a cause. Are we now going to rush out and legalize suicide bombing in order to respect the reasoning capabilities of the poor?
    As long as the market system holds basic survival over people’s heads, then the public has to draw lines to protect certain moral principles. Perhaps a far right conservative will sit up and take notice if I say VALUES. If we throw out the value of human life, we throw out humanity itself.

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