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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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Eric NovackgadflyJohn Pluennekegadly Recent comment authors
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gadfly
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gadfly

//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.… Read more »

gadfly
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gadfly

// 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… Read more »

Eric Novack
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Eric Novack

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… Read more »

John Pluenneke
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John Pluenneke

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… Read more »

gadfly
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gadfly

//”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… Read more »

Eric Novack
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Eric Novack

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?

gadfly
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gadfly

//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… Read more »

John Pluenneke
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John Pluenneke

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… Read more »

gadly
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gadly

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… Read more »