Organ Donation

[Eaquae Legit]

I know we had a thread on this ages and ages ago, but it's a dead thread and frankly I'm lazy.

The British Medical Association is calling for a revision of the guidelines surrounding organ donation. I'm all in favour of an opt-out system which presumes donation unless you state otherwise (and I'll even include the veto of surviving family members mentioned in the article).

But the report says other options could include "mandated choice", where all adults are forced to decide whether they want to become an organ donor; "reciprocity", where those who donate organs, or sign up to donate after their death, receive priority should they themselves require a transplant; or some form of incentive or compensation for donors, for example paying for organs or covering funeral expenses.

I am personally extremely leery of giving any sort of financial incentive to donors, as it leaves the door a bit too wide open to abuse for my comfort. Same with anything that would put undue pressure on families to remove a loved one's life support. I'd need to see as well a tightening of the Do Not Resuscitate order regulations as well - too many horror stories of (well-meaning, I'm sure) nurses/doctors putting them on a patient's chart without consulting the patient or their family.

And this is from a person who is a very strong believer in organ donation. You guys?

[Bean_wannabe]

I'm a firm believer in donation, as I can't see any reason not to be. It's not like I'm going to be using the stuff...

I think that the opt-out idea is the best, as I think it's probably apathy that stops people signing up rather than having anything against it. The financial idea seems infeasible given the NHS's budget as well as the points you made. Mandated choice would have the same problem as the current system in that a fair proportion of the population would still not make a choice one way or the other so it would rely on which option was the default.

[Syphon the Sun]

I'm a donor. Always have been, always will be. Thousands of people die every year waiting for a donation in the U.S. alone, and thousands more are removed from the UNOS list because they've become far too sick to withstand a transplant. The demand is high and the supply is low.

So, how do you increase supply? One way is to compel donation (which is what the opt-out program is ultimately seeking, even if they do stop short of completely mandating donation). Another is to let people use their personal property (which is all that organs really are) as they see fit, including voluntary transactions by donation or sale.

I fall into the latter camp. I've yet to hear an arguments against a competitive market for organs that I find compelling.

[Bean_wannabe]

Wouldn't a competitive market ensure that the rich are more likely to get the organs?

[Syphon the Sun]

I've never found that argument compelling.

1. It assumes that the market would never stabilize. If supply and demand are in equilibrium, there are enough kidneys to go around. Access would improve for everyone. If, on the margin, Bill Gates has a little greater access than I do, that doesn't diminish my increased access. We're both better off than we were before. I'm probably even better off than he is, as he could already afford to buy a kidney, because...

2. The current system creates a thriving black market, which ensures that the problem you think you'll see in a competitive market is already happening. Only it's much more expensive (which means that the poor don't simply have less access on the margin, but have zero access to that market at all), more dangerous, and more likely to use coercion or theft to obtain the goods. Even in the legal donation market, those who are well educated (and therefore wealthier) tend to get their names on the list sooner.

3. The argument implicitly assumes that the categories of "rich" and "poor" are constant or near-constant, when the truth is that they are always in flux. Indeed, most people move up and down the ladder over the course of a decade, let alone over the course of their lifetimes (and most people in the bottom two quintiles move up one or more). Indeed, in a broad sense, the real categories are not "rich" and "poor," but "young" and "old." People generally move up the income ladder as they grow older, while younger people just entering the workforce take their places on the bottom rungs.

4. It assumes that it is better for a bureaucracy to allocate scarce resources than for a market to allocate abundant resources. Even setting aside the fact that supply would increase, however, I have a real problem with the notion that we need the government (or a government-related entity) to make these kind of decisions. It leads to unnecessary rationing, inefficiently allocated resources, and greater corruption.

5. It assumes that banning the sale of organs will reduce inequality, when in fact the opposite is true. The poor will be poorer (because they have been deprived of property they may wish to sell) and both groups will be worse off for having a limited supply of life-saving organs. Given the issues discussed above, the current system actually makes this inequality in supply access worse than a competitive market would, as the supply is smaller and the wealthier already have greater (but riskier) access.

[buckshot]

I recall a show on PBS about the organ selling going on in Iran. The show featured several people on all sides of the question and of course they were all poor. As expected the desperate people selling could'nt sell their parts for enough money to get out of debt and around every corner some doctor, med supply dealer, hospital offical or government deal broker was tacking on a fee for something.I don't see how we could ever do such a thing here without someone being hurt. I am and have been a donor for many years and feel strongly it's a good thing but respect those who don't for whatever reason.

[Rei]

a competitive market for organs

I'll be honest, this phrase is for me a sufficiently compelling reason against it. It reduces human beings down to individual components which may be auctioned off at will instead of treating people as living, sapient creatures in their entirety. To view humans as organ farms is something I cannot reconcile and utterly repulses me.

[Syphon the Sun]

I'll be honest, this phrase is for me a sufficiently compelling reason against it. It reduces human beings down to individual components which may be auctioned off at will instead of treating people as living, sapient creatures in their entirety. To view humans as organ farms is something I cannot reconcile and utterly repulses me.

This seems like a strange statement to me. You call human sapient creatures, but simultaneously endorse a "father knows best" (or, in this case, "government knows best") attitude toward human beings and their rights to do with their bodies as they please. I don't see how you can reconcile those. Living, sapient creatures have autonomy. We have the freedom to do with our bodies what we please, so long as it does not hurt others or infringe on their rights to do the same. Except, according to you, when it comes to compensation for actions you're already permitted to do without compensation.

Nor do I really understand what you're trying to say about humans losing their personhood. Wouldn't these same objections apply to donation? (Indeed, there are some groups who believe organ donation is wrong for just this reason.) Living people donate organs all the time. (Which is good, because organs from living donors tend to be much better for the recipient.) Is that morally wrong, as well?

What, exactly, is the difference between a living donor offering a kidney for altruistic reasons and one offering a kidney for compensation? Am I morally bankrupt if I want to offer a kidney to a dying person but can't afford to take time off work for recovery? It seems to me that the only difference between donation and sale is the compensation. Is that, by itself, enough to make it morally repulsive? Why?

Does money make morally acceptable acts suddenly unacceptable? If I'm paid for running a soup kitchen, does that become unacceptable? If I'm paid to provide health care to the very poor and very sick, does that become unacceptable? When and how does compensation for otherwise good acts make the acts bad?

[Rei]

I can reconcile sapience with a "father knows best" mindset (as you put it) because people are cruel and have a hard time walking a mile in someone else's shoes. You say there would be no reduction of personhood, but how long would it take to see a person begging for money and overhear someone tell them to just sell a kidney if they're so poor? Why should I offer money to someone too proud to do whatever it takes to survive, even if that means selling organs? This does not apply to donation but could only apply when there is monetary compensation. The slope from encouraging more donations to encouraging people to die (which already happens far too frequently for the purpose of getting donations) to expecting poorer people to sell off as many organs as necessary to support themselves is incredibly slippery and incredibly steep.

[Syphon the Sun]

I can reconcile sapience with a "father knows best" mindset (as you put it) because people are cruel and have a hard time walking a mile in someone else's shoes. You say there would be no reduction of personhood, but how long would it take to see a person begging for money and overhear someone tell them to just sell a kidney if they're so poor? Why should I offer money to someone too proud to do whatever it takes to survive, even if that means selling organs? This does not apply to donation but could only apply when there is monetary compensation. The slope from encouraging more donations to encouraging people to die (which already happens far too frequently for the purpose of getting donations) to expecting poorer people to sell off as many organs as necessary to support themselves is incredibly slippery and incredibly steep.

I'm afraid I don't follow. Nothing you've said really reconciles the two. It seems (to me) to simply say: "I believe X, except when I don't."

Either we're sapient, or we're not. If we are, then we have certain inherent rights, particularly over our own bodies. Chief among them, I would think, is the right to use our bodies in any way we please so long as it does not interfere with the rights of others. That means we can exclude people from using our bodies (e.g., reflected in such things as the prohibitions on rape and slavery), grant others the permission to use our bodies for specified purposes (e.g., by granting informed consent to invasive surgical procedures to remove cancer cells), or otherwise use our bodies as we please.

Either we have those rights or we don't. If we don't, then the government is free not only to prohibit us from organ compensation, but from any other activity they wish. And, even worse, they can compel us to perform any activity they wish, including organ donation. The can implement the Organ Tax: upon your 21st birthday, you must donate a kidney under penalty of law. This whole idea that the government must step in and control us for our own good isn't just silly, it's morally bankrupt. If we have no freedom to make bad choices, we have no freedom.

And I don't really understand what you're trying to say about personhood, I guess. What you're describing happens every day. People tell beggars to get a job all the time. And, yet, others are still charitable. Will this worsen if people can be compensated for their organs? And does personhood really play a part in this? Do these people lose their personhood when people tell them to get a job? If so, and if we use organ sale prohibitions as a guide, wouldn't the next step be to prohibit compensation for everything? I guess what I'm getting at is this: what makes compensation for organ donations so intrinsically different that we have to set up new rules to infringe on fundamental liberties?

At any rate, this (new) argument you've posed is one about poverty, not about liberty. But prohibiting the sale of organs does nothing to alleviate that problem. Indeed, it makes it worse by limiting the options of the poor. It's certainly no more reasonable than prohibiting all high-risk jobs. The poor often find themselves in military service or working in mines, for example, and their compensation is typically more than they would receive doing low-risk jobs. But doesn't mean such compensation is inherently wrong, does it? Because the poor are more often to fill those jobs, should the jobs be prohibited? People wouldn't tell the homeless they should join the army or work the coal mine (which, according to my understanding of what you're saying, would seem to imply a loss of personhood).

So what does the prohibition really accomplish? More people will suffer and die because they can't get a needed organ. The poor will still be poor, but have fewer means of escaping their situation. It would be wonderful if those desperate situations didn't exist, but the prohibition does nothing to help that problem. Instead, it just traps them there. But don't worry, it's "for their own good." I'm sure Grindelwald would be proud.

[Rei]

At no point have I been speaking about liberty. That would be you, and I think the stakes are far higher than individual rights at all costs (hard to accept, I know). I am also not speaking about poverty, although I pulled up that example because the poor are one of the first groups who would be affected.

What matters to me in this issue is the value of human life--the value of ALL human life, be it a beggar in the streets, a child in a coma, anyone else in a difficult position where it may be encouraged to sell off a "spare part" or in the case of the hospital bound, where they may have a DNR put on their chart, even though there may otherwise be a good chance of them pulling through. Yes, this happens. Family members are encouraged to pull the plug on their loved ones or put a DNR on the chart so that they can be farmed out for parts. I'm sure the doctors and nurses are not attempting to be cruel through this, but they are diminishing the value of a human being whether they recognise it or not.

Yes, people diminish the humanity of others all the time, every day. Why should we give them a more extreme and more venomous insult? It's bad enough that many people view the poor as all being lazy; how much worse is it to view them all as proud and lazy cowards? Just because we dehumanise people all the time doesn't mean we can say in for a penny, in for a pound, and strip every possible vestige of humanity from others. And no, providing this other possible income will not solve the issue, because throwing money at people who have poor money habits does not fix the habits. It just means they sell off as much of their bodies as they can until they can't and they're still where they were, only now stripped down for petty recompense.

[Syphon the Sun]

You're right: you haven't really talked about liberty. I have, from pretty much the beginning. And for good reason: that's the biggest issue underlying the whole debate. It isn't about poverty or inequality of results, it isn't about the evils of compensation, and it isn't about whether the underlying transfer of organs with or without compensation is immoral. It isn't even about savings lives. It's about being able to decide, for yourself, how to use your body. If it saves hundreds of thousands of lives every year, by increasing the supply of much-needed organs and scaling up the economy of transplant services to reduce procedure costs: great. That is a wonderful result. But, at a fundamental level, it's an argument about liberty. And that frames the whole issue. Because if you don't believe in individual liberty, then it's a no brainer: prohibiting the sale of organs is just fine because we don't have the right to determine how our bodies are used in the first place. But if you do believe in liberty, then it's another question entirely: why should that liberty be infringed in this instance?

I believe we have the right to decide how we use our bodies (insofar as it does not harm others' rights to do the same). You don't. Or, if you do, you believe there is a compelling reason that such liberty must be sacrificed in this instance. But, if that's the case, you haven't actually offered that reason. The fact that you think something is for someone else's own good doesn't mean you have the right to deprive them of their liberty. It would be for my own good that I eat brussel sprouts. That doesn't mean you get to force feed me brussel sprouts. It would be for my own good that I don't eat Oreos. That doesn't mean you get to steal them from my house or ban them from the market. Nor have you offered a single distinguishing characteristic that makes this different. And if it isn't sufficiently different, why bother to stop there at all? For someone so apparently concerned about slippery slopes, you sure don't seem to notice many.

And you insist that what matters is the value of human life... sometimes. The value of the lives of those suffering and dying while waiting for organ transplants seemingly don't matter. The value of the lives of those you've taken away a means of escape seemingly don't matter. It sure doesn't seem like that's what matters to you. It seems like what matters is what makes you feel good. And you feel good by forcing choices upon others because they're "for their own good."

People sometimes make bad choices, or they make desperate choices because they're in desperate situations. That doesn't mean we should steal those choices from them. And if we steal this choice, what next? What makes this so fundamentally different that other choices cannot and should not be taken away following the same reasoning? You certainly haven't offered anything to date.

Don't get me wrong, your excuses are bold. But I don't think you've bothered to actually think them through. Why don't we ban all high-risk jobs because they are too attractive to the poor? Why don't we ban all monetary charity to the poor because they will not spend it wisely? Why don't we take away other forms of compensation (or all forms) that might be attractive to them because they will not spend what they earn wisely?

Why don't we ban people from thinking bad things? That is, after all, the real issue you're trying to solve. People think bad things about the poor, so we have to protect them by not letting them make decisions and taking away a chance of escape because not everyone will escape and people will think bad things (maybe even more bad things) about those that don't. Why not take away compensation for everything? Everyone pools the resources together and it gets distributed evenly between everyone. Everyone's equal. They're equally poor, equally unproductive, and equally disincentivized from innovation and value creation, but hey, at least you don't have someone thinking bad things about someone else poorer than them.

But I don't think you understand. I'm not trying to prove that everyone will be better off if a legal organ market existed. I don't need to prove that, even if I believe it. The natural state is that we're free to use our bodies how we please. If you want to deprive someone of that freedom, you generally need a good reason. Even those laws to which courts give great deference (e.g., those that do not infringe upon a fundamental liberties) must be rationally related to a legitimate government interest. You've offered neither a legitimate interest, nor how the prohibition of an open organ market is rationally related to achieving any such interest.

And when such laws involve fundamental liberty interests, there must be a compelling government interest and the law must be narrowly tailored to that interest in the least restrictive means. I think it's quite clear that it fails on all three counts.

[Syphon the Sun]

New poll: 55% of Americans favor letting people sell their organs to patients who need them. Among 18-29 year olds, that support is a whopping 73%. (That last part doesn't really surprise me, given that young people tend to drift more libertarian.)

[Gravity Defier]

When I die, I will give mine freely and if it ever became a market, I'd be sure, however I could, to make sure mine went to po' people.