Organ Donation and Unnecessary Tragedy

sarah062wayLast week a federal judge ordered Health and Human Services (HHS) Secretary Kathleen Sebelius to allow 10-year-old Sarah Murnaghan, who suffers from cystic fibrosis, to be moved to the adult lung transplant list. That gives her a better chance of receiving a potentially lifesaving transplant. Sarah Murnaghan’s fate should force us to examine our organ transplant policy.

There are more than 88,000 Americans on the organ transplant waiting list. Roughly 10 percent of them will die before receiving an organ. These lost lives are not so much an act of God as they are an act of Congress because of its 1984 National Organ Transplant Act, as amended, which prohibits payment to organ donors.

Reliance on voluntary donations has been an abject policy failure. The mindless rhetoric used to support this policy is: “Organ transplantation is built upon altruism and public trust.” It’s noteworthy that everyone involved in the organ transplant business is compensated — that includes hospitals, surgeons, nurses and organ procurement workers. Depending on the organ transplanted, the charges range from a low of $260,000 for a kidney to about a million dollars for a heart or intestines.

Many people are offended by the notion of human body parts becoming commodities for sale. There’s at least a tiny bit of inconsistency because people do sell human blood, semen and hair. But let’s think through the prohibition on organ sales by asking the question: How many other vital things in our lives do we depend on donations to provide? Food is vital, water is vital; so are cars, clothing, housing, electricity and oil. We don’t depend on donations to provide these goods. Just ask yourself whether having a car, clothing or a house should be determined by the same principle governing organ transplants: “altruism and public trust.” If it were, there would be massive shortages.

Why should people have to depend on altruism and voluntary donations to provide something that one day they may need more urgently than food, water, cars, clothing or housing? All objections to organ sales reduce to nonsense, ignorance or arrogance.

Let’s look at some of them.

One argument is that if organs are sold rather than donated, poor people couldn’t afford them. This argument ignores the difference between methods of attaining organs and methods of distributing them. For example, poor people might not be able to afford food, but Congress hasn’t mandated that food be donated instead of sold so that poor people can eat. If Congress did that, there’d be massive shortages, and poor people would probably starve. So instead of relying on “altruism and public trust” to feed poor people, we simply allow the market mechanism to supply food and then subsidize purchases through programs like food stamps. The same principle can be applied to organ transplants: Allow the market to supply organs, and if needed, subsidize or provide them through charity.

Another stated concern is that if there’s a market for organs, poor people will sell their organs and become ill. From an ethical point of view, if people own themselves, they should have a right to dispose of themselves any way they please so long as they do not violate the property rights of others. Of course, if people belong to the government, they have no such right. By the way, most proposals for organ sales are only for cadaver organs.

Some people have argued that an organ transplant market might lead to murder and the sale of the victim’s organs to unscrupulous organ brokers. There are many market transactions that can be abused, such as stock market fraud and product misrepresentation, but we haven’t chosen to outlaw the sale of stock and other products. Murder would remain illegal and punishable.

Finally, there’s the humane question. If you or a loved one were in dire need of a lifesaving kidney or lung transplant, which would you prefer: being placed on an organ transplant waiting list, or having the right to sell assets or take out a loan to purchase an organ?

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  • PhillipGaley

    Food isn’t donated to poor people? What are “foodstamps”? Not saying the entire article is wrong, but, . . . doesn’t the use of logic need to be correct and consistent?

    • CowboyUp

      Foodstamps are a bad example, who “donates” money to the IRS?

      • PhillipGaley

        Upon the fact that, an IRS extraction is oblique to any view of national largess, the objection is not at all on point; and further, while an IRS burden is obligatory, foodstamps are not obligatory—not as deriving through subsidies made through the US Department of Agriculture to participating growers, nor are foodstamps obligatory for the recipient, . . .

        • CowboyUp

          You can try to slip around it, but there’s no such thing as
          government charity.

          • PhillipGaley

            There is no such thing as governmental charity—exactly like the monetary—or “liquid”—expansion in so-called quantitative easing, foodstamps available in donation to any qualifying recipient is simply an economic dilution, . . .

            Foodstamps are money targeted as allowable in food exchange, and first appearing as a national benefit a long time ago, devised as essential in providing for the nation’s war-capability and preparedness, . . . it was in sound reason upon observation that, boys who grew up without enough food, were too often not physically fit to sustain through the rigors of war. And in that way, not in anywise are foodstamps correctly held to be charity, but rather, simply an essence of the entire nation prov;iding for itself as a whole, . . . but now, of men and women in D. C. (people, and their children, who have plenty to eat, and children who too often skate out of war), in connection with their simplistic ideas of balancing the budget, we hear debate to reduce foodstamps, . . . it’s amazing, . . . the cock-a-mamie and destructive stuff they come up with, . . . simply amazing, . . .

    • davarino

      He is still correct. His point is that the farmers are not expected to give away their food, they are still paid even if their are food stamps. What he is saying is that if the farmer is expected to give his food away then there would be shortage, because who is going to work for nothing. If we allowed people to sell their organs then there will be more of them on the market.

      • PhillipGaley

        The true view—and which correctly obviates discussion about whether the farmer gives food away—is that, growers have chosen to participate in the larger picture which farm economics in Society is. While I cannot say whether all aspects of the farm programs are well-designed or are properly administered (And I do think that, if ethanol is necessary, why then, in the larger world economy, it should be left to the Brazilians.), and whether or not all farmers fully understand the present national system of agricultural production, the fact remains, the farmer is not “giving” anything “away” (except that amount which he is free to donate to some local food bank), but is signatory to benefits—such as crop insurance against failure, disaster, and price inequities, etc.—guarantees and foodstamps are simply a part of the whole, assuring that, whatever the reader chooses to do, it’s pretty sure that, he is free to do that and, without large amounts of his (the reader’s) valuable time to be inefficiently spent in the drudgery which food production, is.

        While, whether or not human organs should be sold, is a separate matter for discussion, food is donated to qualifying recipients, and as a necessity to keep our USA system afloat. The need for such addition at that level of Society was first noted when during WW I, it was found that, simply for inadequate nutrition, the war-effort was limited in available man-power. Naturally, “What do we have to do—simply give people food? How will they ever learn to work?”, was posited as a thing in reason. Eventually, of course, the logic dawned: “Yes, food must be donated to perennially necessitous and otherwise improvident people.”—and if from that example only, as making adjustments to the overall picture of life in the USA, all governmental advisors are not simply daft, . . .

      • PhillipGaley

        And it may be that, for the dearth of human organs “on the market”—but properly, “in the market”—monetary stimlus for growing of human tissue is thereby stimulated, . . .

  • CowboyUp

    What bothers me about the process, and this case, is that it proves that health care is now a political question, and favorable publicity is more important than the ability to pay or the availability of an donor. It’s good the little girl will get her organ, but the actual problem remains and wasn’t even addressed. Having a lobbyist and/or a PR firm is can be the deciding factor to get treatment.

  • EarlyBird

    It is clear Williams is painfully ignorant on the subject of the US organ transplant system, and is simply using the subject as a vehicle to promote the gospel of free markets (he might has well have been writing about automobile manufacturing, or peanut farming). I worked for a few years in one of America’s largest kidney and pancreas transplantation programs and know something about it.
    Williams determines that the current system is an “abject policy failure,” but doesn’t let us know why this is so. Is it the mere fact that the government is involved? We currently transplant about 30,000 organs every year in the US. Is that too low? Are the wrong patients getting transplants? By what metric makes it not only a “failure,” but an “abject” one?

    He blithely compares selling of blood, semen and hair to the selling of kidneys, lungs, parts of a liver or pancreas, or colon. He doesn’t understand that living donors of these vital organs are considered heroes because they have accepted future health complications of their own, and often shorter lifespans of their own. In many instances, they need to be on medications for the rest of their lives to counter the effects of say, living with a partial liver.

    The problem which exists now is not having enough organs available – not only in terms of overall numbers, but having the right “match” among available organs. So, those evil people in the “government!” have codified the ethical standards developed in the field of organ transplant to set up rules about who gets these limited organs. Rules and guidelines exists so that a liver goes to a child who will live a long healthy life with that liver, as opposed to transplanting it into an 85 year old chronic alcoholic (decisions doctors have made forever and which Williams and Sarah Palin would call “death panels!”).

    Williams’ meat-for-sale approach may expand the number of total available organs, but not by much. And what it would do is allow that 85 year old alcoholic to buy that one liver which also happens to be a match for that less-wealthy little kid, who will die. The free market approach Williams suggest obliterates any consideration of human ethics. Oh, and I LOVE his sudden faith in government – which in other parts of Williams’ world can’t do anything right – to be able to subsidize and properly take care of the poor patients who can’t buy their live-saving organs, so that nobody gets left out. Yeah sure.

    Williams’ thoughtless article reads as if he’s doing a send-up of rapacious capitalists. Free markets are wonderful, but they are not the answer to every human problem, and in many instances we can and should do better than simply “what the market will bear.”

  • EarlyBird

    Anyone with even a casual understanding of how the US transplant organ distribution system works can see that Williams is laughably ignorant about the subject, and is merely using it as another vehicle to spread the gospel of free markets. As someone who worked for years in one of America’s largest kidney and pancreas transplant programs, I know what I’m talking about.

    Williams claims that the dearth of viable transplant organs represents an “abject policy failure,” but doesn’t bother to say why. Merely because the government is involved with it? What metric is Williams using?

    Williams compares donation of blood, semen and hair to the donation of kidneys, lungs, parts of livers, colons and spleens. He does not seem to know that living organ donors are heroes because by donating they not only save another person’s life, but often accept long-term health problems which are likely to shorten their own, and often need to take medications the rest of their lives to deal with say, only a partial pancreas.

    Currently, the government codifies into law ethical rules designed by the transplant community itself, for the distribution of limited organs. A liver which comes available would be given to the boy whose life will be long and healthy with that transplant, for instance, rather than the 85 year old chronic alcoholic with diabetes and congestive heart failure. Such ethical decisions are made all the time by doctors (decisions which Sarah Palin would call a “death panel!”).

    Williams’ human meat-for-sale proposal may add somewhat to the over all number of available organs, as desparately poor people sell organs to wealthy patients, but such a market would obliterate the entire ethical approach to distributing organs, and end up with wealthy 85 year old alcoholics extending their lives for a year or two while less wealthy boys who could have lived long and healthy with that organ, die.
    The real zinger is that Williams suddenly puts enormous trust in the government – the one which apparently can’t do anything right – to properly subsidize and look after the poor who need to buy organs under his tissue market proposal.

    Williams’ article reads like a send-up of rapacious capitalism. Free markets are wonderful systems for the trade of goods and services, but they are not ethical systems in and of themselves, and surely don’t solve every human problem. There are some things that the market should not bear.

  • BraddockGold

    For some reason I can follow Williams laughable ignorance more easily than your insider’s explanation.

  • stone7

    I have no solution to offer, only an observation.

    Of corse free markets are the best solution to allocating scarce resources.

    But for human organs and all things regarding human health, the the future is here now. If not, 2 or 4 or 6 years from now.

    With the decoding of the human genome and all the follow on research. We now are close to regenerative medicine. Which will render all the questions of scarce resources moot.

    It’s not a satisfying solution. But the point is soon moot.

    All my people are already dead. And that makes it easy to be casual.

    In the mean time, there’s intravenous vitamin C and all the rest.

    Good luck.

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