Monday, December 7, 2009

Why Not an Open Market for Organ Transplantation?

I was having a conversation with a friend about organ transplantation. The conversation actually followed the post I link to, so this is a bit out-of-sequence. To paraphrase his question, he asks why there is not an open market for people to sell their own organs as they wish?

My short answer is, it is not ethical. Organ transplantation is a difficult decision all around, for the patient, and the doctor, and the donor (at least a live donor). There is great potential to do harm even when the intentions are good. Doctors are pretty serious about "do no harm", and for good reasons. I'm no expert ethicist, but since HIPAA anyone who works with confidential medical information goes through some basic ethics training. I've collected a few articles and a video that describe this in more detail, and also what happens when the intentions maybe be less than pure.

Sanjay Nagral
No other field of medicine has raised so many ethical, moral, legal and social issues as has organ transplantation. Many more areas for ethical debate are likely to emerge.
At present the very term transplant is likely to conjure up an image of shady and dangerous dealings in India. If we wish to improve upon the current situation, the first step is total transparency on the part of the medical profession and open, public, debate on this and related issues. Medical professionals must set ethical guidelines and take action against violators. Representatives of the common people must be included on the committees that will oversee these operations.
We must restore organ transplantation to where it really belongs - not as an example of all that is unethical and commercial but as a modern medical advance permitting one human being to make the gift of life to another.

Here are three article which discuss some of the ethical issues involved with human organ transplantation.

The Ethics of Organ Donation by Living Donors

Ethics of Organ Transplants (Why this is listed under agnosticism and atheism I do not know).


Ethics of organ transplantation, an except of which is quoted above.

Finally, here is an example of everything that transplantation should not be: A negotiable commodity available to wealthy criminals.





The rules for organ transplantation are restrictive because they need to be. I do understand the appeal of the "open market" option that my friend likes, but it opens the door to many evils as well.
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5 comments:

  1. This is a fascinating area of discussion, in part because people disagree so strongly on what constitutes "ethics". For example, the author of your first link says:

    Organ donation by living donors presents a unique ethical dilemma, in that physicians must risk the life of a healthy person to save or improve the life of a patient.

    This is only a dilemma if the risk for the donor is greater than the risk for the recipient. Most of the time this is not the case: liver donation carries a 0.5-1% chance of premature death, while a potential recipient faces a 100% chance of premature death.

    He continues:

    physicians are obligated to prevent people from making potentially life-threatening sacrifices unless the chance of success is proportionately large

    I disagree with the word "prevent". Physicians are obligated to advise, and they are allowed to recuse themselves, but they are not the decision makers. For a physician to impose their beliefs on a patient who disagrees is the height of arrogance. It is more ethical to allow informed patients (donors are patients too) to make their own decisions.

    Most of the ethical issues identified in these links disappear with a small number of guiding principles: a person's body is her own, to do with as she pleases, and if you don't like what she chooses, you are free to choose differently for yourself.

    Unfortunately, these links don't really discuss ethical problems of legalized organ sales. Indeed, legalized organ sales would solve a variety of problems. Black markets would disappear, people would no longer be kidnapped for their organs, and long wait times would be reduced if not eliminated. Health care costs would go down as well: kidney dialysis is very expensive, and insurance companies gladly pay for kidney transplants. Most importantly, thousands of human lives would be saved every year.

    What is certainly unethical about the current situation is that everyone profits financially from organ donation except for the donor herself.

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  2. As the death toll from the organ shortage mounts, public opinion will eventually support an organ market. Changes in public policy will then follow.

    In the mean time, there is an already-legal way to put a big dent in the organ shortage -- allocate donated organs first to people who have agreed to donate their own organs when they die. UNOS, which manages the national organ allocation system, has the power to make this simple policy change. No legislative action is required.

    Americans who want to donate their organs to other registered organ donors don't have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

    Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. Non-donors should go to the back of the waiting list as long as there is a shortage of organs.

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  3. TPL mentioned kidney dialysis, it is worthwhile to mention that dialysis is considered to be at the high-end of expensive medical treatments (at least among those I discuss such things with). If a treatment is more expensive than dialysis in terms of cost per patient-life-saved/year, then it may not be a wise use of resources (patient/insurance money, and hospital time-effort).

    Dave, thanks for stopping by and offering your comments. Can I still join LifeSharers if I have already signed other documents agreeing to organ donation (or the back of my driver's license)?

    I still have considerable doubts about the open market solution. How does this not put undue pressure on the poor and destitute to donate their organs? How does this prevent the rich and powerful from getting priority over those in need? Before I start an argument, those are intended as rhetorical questions; I expect the answer will be complicated and require time and thought to ensure the proper safeguards. I don't think that is an impossible goal, just that we need to be careful how we get there.

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  4. You're correct that your question about undue pressure on the poor does not have an easy answer. I suggest, though, that one of the key words in that phrase is "undue". The poor are already under great financial pressure. For someone who is just barely scraping by, a few thousand dollars is a big deal. For some it might make a college education affordable, or pay for a car that enables them to have a job. For others it might mean a big screen TV; that's not the choice I would make, but it's not my place to judge how someone spends their money.

    It's also possible that legalization would increase the number of organs that are recovered from cadavers. Not every cadaver is suitable for donation, but if there's money in it for the grieving (or grinning) relatives, that number will increase.

    I've read that kidney transplant surgery plus a lifetime's supply of anti-rejection drugs cost about as much as three years of dialysis.

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  5. Frankly I think the best method would be lottery. People could enter the lottery offering up certain organs, by chance. Or there could be a still deeper lottery where people don't know which organs will be put in the final lottery.

    Hi goodbye,
    NS

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