Is America Ready for an Organ-Donor Market?

Probably not. But, in what is either a very odd coincidence or some kind of concerted effort to get out the organ-market message, there are OpEds in both the N.Y. Times and Wall Street Journal today arguing the case.

The first one, headlined “Death’s Waiting List,” is by Sally Satel, a psychiatrist and American Enterprise Institute scholar. Satel herself received a kidney transplant and is now arguing that the delivery system is terrible and that the Institute of Medicine’s new report, “Organ Donation: Opportunities for Action,” is even worse. “Unfortunately,” Satel writes, “the report more properly should be subtitled ‘Recommendations for Inaction.” Satel’s main point is that the conventional argument against an organ market — i.e., that no part of the human body should ever be “for sale” — has been made obsolete, and then some, by the “markets for human eggs, sperm, and surrogate mothers.”

The WSJ piece, headlined “Kidney Beancounters” (abstract only), is by Richard Epstein, the University of Chicago legal scholar and Hoover Institution fellow. Epstein is even more hostile to the IOM’s report (though maybe the Journal just let him get away with more than the Times let Satel get away with), saying the report is “so narrowminded and unimaginative that it should have been allowed to die inside the IOM.” Epstein writes further that “The major source of future improvement lies only in financial incentives; yet the IOM committee (which contains one lawyer but no economist) dismisses these incentives out of hand … The key lesson in all this is that we should look with deep suspicion on any blanket objection to market incentives — especially from the high-minded moralists who have convinced themselves that their aesthetic sensibilities and instinctive revulsion should trump any humane efforts to save lives.”

Though his OpEd doesn’t say so, I am pretty sure that Epstein is an advisor to LifeSharers, a self-described “non-profit voluntary network of organ donors” that seeks to use non-financial incentives to encourage organ donation. A while ago, we received an e-mail from David Undis, the executive director of LifeSharers. He wrote:

Incentives are missing in organ donation. That’s one of the reasons so many people are dying waiting for organ transplants.

A free market in human organs would save thousands of lives a year, but politically speaking it’s a pipe dream. There’s very little likelihood Congress will legalize buying and selling organs in the foreseeable future.

I formed LifeSharers to introduce a legal non-monetary incentive to donate organs — if you agree to donate your organs when you die then you’ll receive a better chance of getting an organ if you ever need one to live.

It is surprising to me, and to many people much closer to the subject than me, that so little headway has been made in reforming the organ-donation process. I have never heard a single person say they were happy with the way things are — and, while I am sure Undis is right when he writes that a free market in organs is, politically speaking, a pipe dream, it seems that things are starting to move at least a bit in that direction. As Satel writes in her Times piece today, “Ethics committees of the United Network for Organ Sharing, the American Society of Transplant Surgeons and the World Transplant Congress, along with the President’s Council on Bioethics and others, have begun discussing the virtues” of offering organ donors incentives such as “tax breaks, guaranteed health insurance, college scholarships for their children, deposits in their retirement accounts, and so on.”

It is interesting that, while all these incentives are financial, none of them are in the form of cold hard cash, which may make them more palatable.

I wouldn’t be surprised if, between these two OpEds, at least a few minds are changed today.


tdmone

Re anahit's citation of what has been previously identified as an urban legend: that those with donor stickers receive less care so that they will die and MDs can recover their organs....the requirements of organ perfusion to keep an organ viable for transplantation require aggressive medical care, often beyond what one would do for a patient who could actually recover from a devastating brain injury. Thus, this assertion or belief by a medical professional would indicate a grave ignorance of the science and medicine of transplantation.

Beyond the science, there is no incentive for ER staff and trauma surgeons to reduce care, since they don't transplant nor care for waiting transplant recipients.

Frankly, it is the ER and surgery teams' heroic and aggressive efforts to reduce brain swelling to save a life that often thwarts donation. And isn't that a good thing, because it's all about saving lives...starting with the injured...and then, when life is unfortunatley lost, seeking to save the life of those desperately waiting for an organ.

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tdmone

Re jheaney's comments: 1) I have the luxury of more recent data and based on a 2 year moving average, donation is up more than 19%, so "nearly 20%" is a reasonable rounding for blog purposes,

2)I do not quibble with the fact that the waiting lists are growing faster then the donor lists, they always will. The point is simply that there will never be enough deceased donors to provide organs for all of those in desperate need and this will only become a bigger problem as we are able to keep patients alive on artifical livers and lvads...we must focus our investment on science to artficially replace, grow, xeno-transplant, or find ways to resuscitating organs we could never successfully transplant today to ever think that we will catch up with and eliminate the waiting lists...at best we will slow the growth rate. I would offer a reasonable goal is to end deaths on the wait list, because that is achievable.

3)spending time in hospitals and with donor families in crisis and with desperate wait-listed patients and grateful recipients is not a terribly insulated existence to me, but it is rewarding, both personally and for the mission and has resulted in a 48% increase in the rate of organs recovered in Southern California and transplanted over the last 6 years and another 30% increase on top of that thus far in 2006.

Bottom line, the real question that jdheany has not addressed is the moral and social costs of offering payment/bribes to incentivize a family to contradict a belief....we have seen the results of this in many countries and with payment for blood in this country. Personally, I do not relish the replication here.

I will spare no expense to show every reluctant family the good that comes from doantion so that they choose to make the decision to "Donate Life" in record and growing numbers, but I am loathe to change our message to "Sell Life"

PS We in donation choose to speak of "deceased donors" and avoid the word "cadavers" as families are uncomfortable hearing their brothers,sisters, fathers, and mothers referred to as if they were the focus of an anatomy class, much like I suspect they would be dislike of them as a commodity.

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jheaney

While Tom Mone demonstrates his personal virtue by spending time in hospitals, his own OPO's performance is failing the patients that he's responsible for.

Under Mone's leadership, the number of deceased kidney donors is 30% below the national average over the past two years (data can be confirmed at www.unos.org/data). And while the number of kidney transplants nationally has increased over 8%, the number of kidney transplants performed under Mone's watchful eye has dropped almost 4%.

This bewildering drop can be attributed entirely to a precipitious decline in living kidney donors on the SoCal transPlantation. While living donors increased nationwide, Mone watched living donors plummet 24%.

One thing is growing, though. And that's the transplant waiting list. Good for Tom.

The drop in living donors in SoCal is no accident. Mone has publicly proclaimed his profound opposition to efforts that focus on increasing living organ donation. Despite his own admission that there will never be enough deceased donor organs to satisfy demand, he remains unalterably opposed to the most likely method to secure sufficient organs and eliminate the transplant waiting list: the introduction of financial incentives for living donors.

Mone might think himself wiser and nobler than the common patient shackled to a draining dialysis machine, but his high-minded morals, when combined with his high-handed diktat reveal the ethically impoverished behavior of a plantation master.

More detail concerning the deplorable state of the current organ procurement system can be found at blog.organomics.org

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jheaney

And just to prove that he's not insulated from other viewpoints or opinions, I received the following message when I sent Tom Mone a brief e-mail:

You are not allowed to send mail to tdmone@onelegacy.org

O, that's a brave man! he writes brave verses, speaks brave words, swears brave oaths, and breaks them bravely.

jamesstaylor

tdmone claims that the effects of organ markets in the third world are disastrous for those who participate in them as vendors. There is indeed a study which supports this, at least in the Indian context: Madhav Goyal et al.s' famous "The Economic and Health Consequences of Selling a Kidney in India." However, two points should be noted here. First, the market studied was an unregulated market, in which the vendors had no legal recourse if they were defrauded. Since one of the primary reasons they did poorly post-sale was that they were typically defrauded of around 1/3 (if memory serves) of the price they were promised for their kidneys and received no post-op care, legalising this market would greatly benefit the vendors. The other country in which payment for kidneys is routine is Iran, and it is not clear what effect the sale of a kidney has on vendors there, largely as there has been to my knowledge no follow-up studies done on them. However, that there is a waiting list to sell kidneys in Iran indicates that in the eyes of the potential vendors, at least, selling is not perceived as a bad thing.

I am also not clear why tdmone thinks that "bribing" or payment is itself a bad thing. After all, we could claim that university professors are bribed into teaching students, surgeons are bribed into performing operations, and Wal-Mart bribes its employees to work in its stores. But noone thinks that there's anything wrong with this--so why should we think that paying for kidneys is any different?

tdmone might claim that the difference lies in the irrevocability of the transaction; that we can't get kidneys back. But we can't get time back, either. The busy executive who works overtime and misses out on seeing his child grow up has sold traded her irreplaceable maternal experiences for cash, but we don't think to prohibit people from becoming busy executives.

Finally, I recommedn three books on this topic to anyone interested. My own *Stakes and Kidneys: Why markets in human body parts are morally imperative*, Mark J. Cherry's *Kidney for Sale By Owner*, and Stephen Wilkinson's *Bodies for Sale*.

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Richard

The original comments by OneLegacy OPO CEO Tom Mone regarding new organ donor policies, including his harsh criticism of Dr. Satel and others who support such policies, was in response to my email to the OneLegacy Director of Communications. You may read my original email as well as my defense of Dr. Satel and other eminent advocates in favor of new OD policies in my letter to Tom below.

Dear Tom,

Your comments below as CEO of our OPO left me speechless and shaking my head in dismay that you would speak so harshly of new organ donor policies, some of which are supported by, not only the respected physician and recent organ recipient, Dr. Satel, who you refer to directly, but also transplant physicians who will be listing more patients for transplant and other eminent individuals who support new donor policies—more on those issues in a minute.

First to clarify: the organ donor policy pilot projects that are supported by many eminent physicians and organ donor advocates on our template letter that is regularly forwarded to President Bush and Congress (view it and its supporters at http://fairfoundation.org/organdonation/contactcongressfororgandonation.htm), are “Presumed Consent” (PC) and “Donation Benefits” (DB) as defined by the American Liver Foundation in our template letter.

I repeat: all we are asking for is trial projects in a State to be determined to statistically prove if these new policies are effective.

Regarding PC, when I asked you in the hallway at the Wong Kerlee Convention Center many months ago if you'd support PC, you said that although you personally supported it, you could not recommend that your organization support it. Well, I thought that was a positive step in the right direction and that you would fight to instill your personal belief into OneLegacy. When I asked you, via Tenaya, to ask your Board of Directors to support the ACOT's (Advisory Committee on Organ Transplantation) recommendation to the HHS Secretary that endorsed a pilot project of PC (as the AMA has done), the silence from your office was deafening.

Regarding Donation Benefits (DB), to suggest that the template letter co-signers who are in favor of providing financial assistance to a donor family for burial expenses in the amount of $10,000 are guilty of endorsing bribery is disrespectful and not conducive to productive discussions. Furthermore, in reference to DB you state, “It would place the family in a position to contradict the known wishes of the individual.” The family has that power now and absolutely no one wants that to happen. DB would only be offered by the OPO coordinator if the wishes of the brain dead patient were unknown.

You lament that under perfect circumstances, the waiting list could be eliminated in five years. I didn't know it could be that short a period of time; my goodness, let's do all we can to achieve that, not bemoan it and criticize, as you did, that transplant surgeons would then place more patients on waiting lists. Great! Get those patients on the list and get them transplanted—more lives saved.

You repeatedly make references to the donor and the “donor families that you work with every day,” but you never mention the patient dying in the ICU and when you do mention a recipient, you refer to him/her as “fortunate” because he/she has “health insurance and stable family/social structures.” Therein lays the failing of OneLegacy and, indeed, of UNOS: you place the well-being of the donor family above the well being of the dying, suffering soul in the intensive care unit and his/her family. You refer to Donation Benefits as a “selfish insult to the values and morals of our community.” Well, in my community, the epitome of “insult” is to display such disrespect for the dying while moralizing on behalf of donor families, many of whom would be most grateful for help in paying their loved one's burial expenses, which are exorbitant these days.

I asked your close employees in charge of communications, Bryan and Tenaya, whom I respect even though they don't support new organ donor policies, if they had ever been in an ICU. The answer was no so I invited them—and I invite you—to come with me so you can see the other side of this equation intimately. Indeed, sit with a dying patient who has been throwing up blood, legs like sausages and unable to move or walk, drifting close to unconsciousness, yellow as a banana, emaciated exactly like an Auschwitz victim, with an abdomen that they just took 12 liters of fluid out of with a very long needle/syringe, then hold their hand while telling them what you told us below, “The future lies in advancements in treatment for organ diseases, artificial organs, cloning, and xeno-transplantation.” I'm sure he or she will be most impressed with your grasp of his/her situation. Dr. Satel said it best in her reply to you, “You need a greater sense of urgency.”

You state “we have seen a huge increase in deceased donation in the last two years” and then you refer to it as “almost 20%.” According to the OPTN, from 2003 to 2004 cadaveric donations increased from 6,457 to 7,150 which is the “almost 11%” HHS refers to (actually 10.7%). The HHS Organ Donation Breakthrough Collaborative is responsible for part of that with the balance the result of dedicated Ambassadors volunteering their time to give thousands of presentations throughout America. Now let's look at 2004 to 2005: from 7,150 donors to 7,593—only a 6.1 increase and again, a significant part of that is due to the OPO staffs and volunteers throughout the USA. The point being, although the Collaborative is a productive policy deserving of credit, it did not come close to repeating its initial success. In 2006 through February 28 the OPTN reports the number of donors is 1,248. Annualized, that would be 7,488 donors. At that rate, 2006 will see a decrease in donors from 2005. Clearly, the huge increases you refer to are not present and during the same time period, thousands more suffering souls were added to the list.

Although it has been difficult for us working together with me in favor of change and you and your associates insisting on the keeping the status quo, it has nevertheless been an honor working for one of our nation's OPO's as an Ambassador. Indeed, Tenaya has provided me with large boxes of brochures and other materials that I have distributed, both locally and nationally, in over 100 speeches; however I must now leave OneLegacy until you or your successor adopt an attitude that is more sympathetic to the dying patient. I wish you the best of luck, Tom, and hope you take me up on my offer to visit the transplant ICU with me soon.

Since you are posting regular responses to those who disagree with you online at the Freakonomics Blogs Organomics and, I will post this at the former and all recipients of this email can go there to read your response.

Sincerely,

Richard

Dr. Richard Darling, DDS: National Public Citizen of the Year (NASW-03)
President and CEO: The FAIR Foundation
Founder: The Coachella Valley Hepatitis C, Liver Disease & Transplant Support Group
Board of Directors: United Organ Transplant Association
Ambassador: OneLegacy, a transplant donor network
Author: Coma Life, an autobiographical memoir of life "within" coma and survival over hepatitis C induced liver cancer, three liver transplants, heart attack, diabetes
Address: 78629 Bougainvillea Drive, Palm Desert, CA 92211 Ph: 760-200-2766
________________________________________
From: Tom Mone [mailto:tmone@onelegacy.org]
[CEO, OneLegacy, 2200 W. 3rd Street, Suite 400, Los Angeles, CA 90057]

Sent: Tuesday, May 16, 2006 4:32 PM
To: Richard Darling, DDS
Subject: NY Times Op Ed: Death's Waiting List

Dear Dr Darling:
The first three definitions of "Radical" in my dictionary are:
1. Arising from or going to a root or source; basic: proposed a radical solution to the problem.
2. Departing markedly from the usual or customary; extreme: radical opinions on education.
3. Favoring or effecting fundamental or revolutionary changes in current practices, conditions, or institutions
By any of these definitions, the proposal to create a market for organs is "radical" and that is not a terribly judgmental comment, but rather a factual description.
As for the Op-Ed pieces in the Times and Journal, I would offer that they are severely under-researched, laden with inaccuracies (please see my comments in red amidst the Satel article), and side-step the social consequences of their suggestions.
To approach a family of a deceased individual and offer them cash in exchange for their consent to a donation that they would otherwise not consent to is tantamount to a bribe. To place the family in a position to contradict the known wishes of the individual or their own values is a selfish insult to the values and morals of our community. The likely social consequences of such a market-based approach is the creation of a social caste of the destitute, bribed to become paid donor families or living donors whose body parts (the term “gifts” would be antiquated) benefit those fortunate enough to have the health insurance and stable family/social structures that are required to ensure the organ is cared for.
We have seen the result of paying for organs in third world countries, and we saw the results of paying for blood in this country; neither was pretty nor good for the health of the donors and recipients in the long run.
Fundamentally, we have a very real organ shortage which would remain in perpetuity even if every one of the 13,000 who suffer brain death, plus the estimated 1,300 potential Donors after Cardiac Death—each year could and did donate. First, it would take five years to catch up with the existing waiting lists. More importantly, as more organs became available, transplant physicians would list more patients—patients for whom they have no hope for an organ today, but might if rates moved from today's nearly 60% consent rate range to 100%. Some cardiologists have estimated that if enough hearts were available there would be 250,000 heart transplants a year!
Unfortunately, the solution is beyond payment and it is beyond a perfectly benevolent and generous community. The future lies in advancements in treatment for organ diseases, artificial organs, cloning, and xeno-transplantation. Meanwhile, we professionals work with families every day to help them see the good that we know comes from the decision to donate life. Across the country, we have seen a huge increase in deceased donation the past two years as a result of the HHS Organ Donation Breakthrough Collaborative.
Let's keep putting our energies into tactics that have raised donation rates nearly 20% in the past 2 years and encourage the approximately 5,200 non-consenting eligible deceased donor families per annum to say “yes” to donation. These tactics include expanded public education that inspires people to register on their state donor registries; instituting the processes (e.g. DMV linkage) that make such registration easy and accessible for all; training family care coordinators who approach families; and expanding the Collaborative's best practices to all hospitals. And by encouraging the development of transplant center-based paired kidney exchanges that cross-match pairs of incompatible family members so both families can benefit from living donation, many more kidney transplants will be enabled. Initiatives like these are achievable, have track records of success, and do not impose radical change on a system that has heretofore enabled hundreds of thousands of people to live longer, fuller lives through transplantation.
The tactics above are preferable to creating a class of organ breeders who sell their body parts—who sell a part of themselves that they can never, ever get back—simply for economic gain. We owe it to our good nature—our capacity to help and give to one another, across ethnic and class lines, freely and without expectation of reward other than the joy that it brings to others and ourselves—to aim higher than that. In 2005, the capacity to give inspired nearly 7,600 deceased donors/families and almost 6,900 living donors to help those in need. And that kind of giving is something we should all be thankful for, one family, one individual and one legacy at a time.

Thomas Mone
CEO
OneLegacy
2200 W. 3rd Street, Suite 400
Los Angeles, CA 90057
O: 213-401-1204
C: 213-447-0774

________________________________________
From: Richard Darling, DDS [mailto:rdarling1@dc.rr.com]
Sent: Mon 5/15/2006 8:41 PM
To: Bryan Stewart
Cc: Sally Satel; mhonohan@aopo.org; Tenaya Wallace; Tom Mone;
Subject: RE: NY Times Op Ed: Death's Waiting List
Hi Bryan, as Director of Communications for our OPO your words carry great weight. When you sent out the Todd Zwillich report (attached) that originated from Melissa Honohan, Policy and Program Manager Association of Organ Procurement Organizations and that had negative comments regarding new organ donor policies, you characterized the new incentives to donation in question in your introductory text as “radical.” I am writing to ask that your resend your most recent notice on new organ donor policies (below and attached) to all previous recipients for two reasons: 1) it is a corrected copy of today's NY Times OP-ED that has been issued by the author, Sally Satel, M.D., who is a psychiatrist and resident scholar at the American Enterprise Institute, and 2) to provide fair balance to your past “radical” comment by including this introductory text:: “This NY Times Editorial (below and attached) speaks in favor of new organ donor policies and speaks in opposition to the Institute of Medicine report.

In addition, I am asking that you also include the attached Op-ed from today's Wall Street Journal that also speaks in favor of new organ donor policies and strongly refutes the policy statement by the Institute of Medicine. It is written by Richard Epstein, an author and the James Parker Hall Distinguished Service Professor at the University of Chicago Law School and the Peter and Kirsten Bedford Senior Fellow at the Hoover Institution.

Thank you for your consideration of providing this full report to the OneLegacy Ambassadors and others on your mailing list who received your notices on these important issues.

Sincerely and with great respect for your efforts, I am,

Richard, one of your Ambassadors

Richard Darling, DDS: National Public Citizen of the Year (NASW-03)
President and CEO: The FAIR Foundation
Founder: The Coachella Valley Hepatitis C, Liver Disease & Transplant Support Group
Board of Directors: United Organ Transplant Association
Ambassador: OneLegacy, a transplant donor network
Author: Coma Life, an autobiographical memoir of life "within" coma and survival over hepatitis C induced liver cancer, three liver transplants, heart attack, diabetes

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Don_Emerson

Basically what I am seeing is that only Doctor's, Hospitals and Insurance Company's are permitted to make a profit on the transplanting of organs, the donor is just a piece of meat as is the recipient, and as such they should be glad they will be permitted to pay for the procedure.

We'll ignore that those with the big bucks to pay for a transplant will take themselves off of the free lists for regular transpalnts, thus freeing up the limited supply for those who can't pay. GASP!! What a concept. Also we'll ignore that as the supply rises the cost goes down.

Also, let's look at donations, you need to go through a battery of tests to find out if you are compatible with said recipient. John Q Public on the street is NOT going to be finding himself mugged for his kideny and the hospital or doctor standing there with a bag of cash, hoping a random organ will show up, but, that's what the naysayers predict will happen, tossing common sense right out the window.

It's sad how in this country we must take the most farsical negative view on things and say that if you change the laws it's guaranteed it will happen.

Oh I am just your average blue collar schlep who has an opinion on this issue and is more than happy to vent it.

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tdmone

Because we ask families why they have chosen to not donate, we have substantial data on the reasons that families make that choice. Fundamentally, their reasons focus on religious belief or misunderstanding of their religion's position on donation, a general discomfort with the act of recovering organs, or a sense that the deceased would not have wanted to donate. If these reasons are sincere, and the grieving tend to be in the most sincere moment of their lives, then any offer of payment, on its own really constitutes a bribe to convince someone to disregard a fundamental belief and value. I do object to this practice and I do not believe it will be successful in increasing the deceased donor pool.

So, it might be entirely reasonable to characterize my concerns as purely pragmatic: I do not want to harm what is working (and over the last 28 months deceased donation in the US has risen some 19.2%, which includes more recent data than the general public yet has access). For that matter, deceased donation in OneLegacy increased 36% over the past 6 years (and organs transplanted 48%), 13.7% in the past 2 years and another 30% in the first 4 months of 2006. With these increases in donation I am loathe to offer support for untested proposals that are in fact in violation to current public policy and law. I am firmly convinced that we can continue to increase donation here and across the nation at a faster rate than we can by offering payment.

What I do support is focused research, by independent agencies on the topics of payment for donation and presumed consent and, if they generate positive results, narrowly defined trials of payments for deceased donor families and presumed consent if it is in fact possible to legally define a test population.

The research is needed because of a fundamental issue: current donation practice is defined in public policy and law and reflects the beliefs, morals and values of the people and our representatives from across the country. The fundamental federal law is NOTA, the National Organ Transplant Act and the guiding state laws are the individually passed Uniform Anatomical Gift Acts. Each expressly prohibit the sales of organs and the remuneration of donors and families. This prohibition was passed by each of the 50 states and the Congress and signed by the President because it reflects the balance of perspectives of religious, medical, ethical, moral, economic, and innumerable beliefs that make up the American culture and nation. In making this decision, the needs of the few (the desperately ill waiting for a life-saving gift) were weighed against the precedence of law and the moral and religious and ethical beliefs of the nation. And, as in most such political balancing acts in this country, the rights of the individual were judged to carry more weight than the rights of a class of people. So the rights of families to decide the fate of their loved one's organs were determined to supercede the right to transplantation for the desperately ill. This of course, is a very black and white presentation of the civics behind the issue, but it is applied very clearly in the issue of "Presumed Consent" where this fundamental respect for the rights of the individual are seldom compromised, even when that compromise, as in this case, is to simply require they descent rather than consent....the default is no action that would affect a mother or father or sister or brother one for the potential benefit of a class of people: those on a waiting list.

As for payment, the presumption is that the right of religious and moral belief should not be tainted by the power of money; that is, the personal choice that would have been made without the offer of cash should prevail and not contradicted by that lure. There is little doubt that the role of religious belief in the American culture and value system is strong, and in many surveys appears to becoming stronger (see stem cells and abortion as key examples). It is as if the law says there should be no commerce in the "temple" in this case the "temple " of the human body. Why the law allows an opening for the donation of human eggs and sperm remains an interesting contradiction and may be a an area of research of its extension to living donation.

However, with these as underpinnings of the public policy and juxtaposed against the rather ugly examples of payment for organs in China, Turkey, and India, and the uninspired donation rates of all but one presumed consent country (Spain that also spends millions in public education and donatin team staffing of hospitals) do you think the American public will embrace payment or presumed consent? Simply stated, I do not think support for payment for organs nor presumed consent exists in this country at this time.

Now, if blinded, multi-cultural, multi-religious, and economically diverse populations are surveyed by an independent, non-governmental agency and they identify a fundamental public perception and value shift away from that which existed in this country when NOTA and the UAGAs were passed strongly support presumed consent and payment for donation, then I feel assured in predicting that the organ donation and transplantation communities would be receptive to policy and practice change. So, my recommendation would be that those who support presumed consent and payment for organs make the effort to seek independent research to assess their hypotheses and if they are supported, to bring this research to the donation and transplantation communities and to the Congress and their local representatives.

It is entirely understandable that those whose lives and health and families depend on transplantation would feel frustrated and willing to do anything to get a transplant, including going so far as to accept the organs of prisoners and the poor from third world countries and also lashing out in anger and desperation at what they see as complacency. However, railing against the agencies and individuals who spend their days with families in immediate crisis and in hospitals that also house those waiting for a transplant because they are working as hard as they can within the legal and moral construct of donation and transplantation; is to bite the hand that feeds. I can guarantee you that everyone I know in our field has heard the voices of recipients, both waiting and transplanted and knows their pain and need...and they also know the pain and need of donor families and how much they loved their child, wife, husband. They also have heard potential donor families' mistrust and ignorance of the truths of donation and know first hand (especially when they are threatened for even entering a room or raising the subject of donation) that these are potent forces. Potent forces that are saying, "don't treat my loved one like a commodity, don't take away from me the only tiny piece of control I have left, don't ask me to do something that my God says I cannot." Our job is to help these people see the religious and personal good in the decision to donate and to help them find the control they regain by doing so, and across the country focused efforts are making a remarkable impact (just 5 years donation rates were stagnating at 2-3% increases?). It is my belief, but a belief founded on research and experience, that we can continue and further increase donation through education both on the general level and in the one-on-one interventions we have with the families whose decision is essential to life for someone waiting tonight and that payment and presumed consent will slow us down or reduce donation rates..

Then again, like all areas of public policy and medicine, if research shows a new and possible better way, the field will figure out how to embrace it. But first, somebody had better do the research and share the results because unsupported advocacy is at best a distraction and at worse fractures a valuable coalition of forces needed for success and inevitably undermines the shared and noble cause.

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jamesstaylor

Please correct me if I'm wrong, tdmone, but it seems that your last post represents a significant shift from those that went before it. It seems that now you are saying that your only opposition to allowing markets for human organs is pragmatic. I take it, then, that you have no *principled* objections to such markets?

Whether this is so or not, I think that the so-called pragmatic opponents of organ markets have a considerable amount of work to do to defend their position. This is because if you (and please note this is the generis "you") oppose organ markets not because you think that they are immoral, but ecause you think that *others* believe that they are and that this belief will lead to deliterious consequences upon their legalization, you have the responsibility to support your view. Moreover, even if you are right (and I am not conceding here that such persns are right), if you cannot support the prejudice against markets that you have identified through reasoned argument you have the responsibility to explain why we should form public policy on the basis of unreasoned prejudice. It seems to me that a rationally defensible policy would be much more beneficial in the long run--especially if part of its defense is (as is the case for markets in huamn organs) that it would make people better off in the long run.

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ThinkingAboutIt

I'm a potential kidney donor. I have completed almost all of the testing. So tell me, one who is ready to get cut open and have a perfectly good organ removed and given to another person, why I should not be allowed to receive money? My recipient is not family. We met on one of the websites mentioned in the articles. I have not made a penny so far. And I won't. My recipient does not have the funds to compensate me. However, if it were legal, I'd take money in a heartbeat.

Consider some of these points. As stated in the reply before this one, the hospital stands to make money when I give my kidney to this person. The surgeon won't be operating for free. The nurses take home a paycheck. The drugs he will require will boost profits for some company. So everyone involved in the transplant is allowed and expected to make a profit. Except for me. This is fair?

There are people who need organs and take their pleas to the internet, newspapers, etc. Fund raisers are held for these people. The person can use that money to pay for their transplant costs that are not covered by insurance. Or for the costs if they don't have insurance. The funds can be used to pay their bills while they are sick. For just about any living expense they have - there are no limits.

As a donor, I am not allowed to receive a single penny over the actual costs I might incur. No one holds a fund raiser for me to pay my bills. I'll go to prison if I allow someone to pay my mortgage or car payment so that I can take the time to donate. I know, the law does allow me to be compensated for the time I miss working due to donation. What if recovery time goes beyond the expected few weeks? Too bad for me. What if my recipient can't pay these costs? Too bad. No one can step in and help out. Who would want to? And the fear that someone might actually think that I've made a profit is very real. I don't need strangers accusing me, prying into my finances, checking my bank account to see if there's an extra dollar in there somewhere that doesn't look legitimate. Five years in prison for me then.

It's my kidney. It's healthy and perfectly happy where it is right now. To even think about donating is opening myself to a whole host of problems and accusations. What incentives are there for me to save someone else's life? OK, a good feeling in the end. Assuming all goes just fine. Why is payment for me so wrong? Or for any donor?

If allowing payment would give preference to those with money, so be it. Let those who can afford to buy their organs do so, and free up donated organs for those who cannot afford to pay for them. What's so wrong with that?

Let's say there are 90,000 people waiting for an organ. If 30,000 can afford to buy their organs from a living donor, that certainly isn't bad news for those who can't afford to buy and remain on the list. If you were #25,000 on a list and learned that the first 24,000 had purchased an organ and been removed from the list would you be complaining?

'You' want me to step up and be a hero. Save a life. I don't mind, no one is forcing me to do this. Imagine how many others would step up if they could walk away in the end with a profit. It's the law of supply and demand, right? At the present time the demand is much higher than the supply. So remove some of the obstacles to getting a good supply, and voila! The market evens out. Imagine the possibilities for those on the waiting list. Cadaver organs would be available for those who could not pay, just as they are now for everyone. Only the demand for these would not be as intense. Who loses in this scenario? More organs = more transplants = more lives saved. And this is wrong?

The idea of paying a deceased's family for an organ is great. Bet there would be a lot more donors then. Free funeral for organs. And that is bad how?

But what about those of us who are living donors? Why punish us? As it stands right now, I may have to back out of donating because of lack of funds. My recipient simply does not have the money to cover my time lost from work to recover. Simple as that. He'll end up waiting for a cadaver. I cannot afford the extra costs. Period. So if I could be paid by a person who is higher up on the transplant list than he is, he'd move up. Each purchased organ removes a person from the waiting list. I don't see where the unfair advantage is for the wealthy. If someone has the means to provide for themselves why should it be illegal for them to do so? Why punish someone with millions of dollars for having the money and the means to save their life? Better to force them to a black market? How is A buying a kidney from B affecting my potential recipient?

I don't want to have to back out after all we've been through. Surgery could be in just a couple of weeks. But he doesn't have the money to pay my expenses. What if I were allowed to profit and a wealthy friend of his, who wants to help, could step in and make this easier for us? As it stands right now, all three of us risk prosecution, jail, etc if we try this. Me more than anyone else. If I knew that all my expenses would be covered I wouldn't have a problem. I'm talking about ALL my expenses. I can accept money for travel, lodging, and lost time from work. That doesn't cover the other expenses. What if I am not able to properly care for my children while I am recovering? I'm a mother. I can't afford to hire someone to watch them, and a recipient cannot provide the funds for that even if he has them. If I'm stuck in bed I can't hire someone to cook for my children. My husband can stay home from work and help, but then he doesn't get paid, and a recipient can't replace his salary legally. If a recipient agrees to pay 4 weeks worth of my lost wages and I develop any complications and recovery takes 8 weeks, what then?

So to all of you who are so adamant about not allowing payment for organs - can you give me one good reason, I mean one GOOD reason, why I am not allowed to make a profit? If it were my car, no problem. My house. Anything I own can be sold. But my kidney can't. And that makes sense?

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Rajasekar

I am a physician and a transplant surgeon. I have the privilege of having the global view on the subject of incentivised organ donation. Interestingly my own prfessional cycle has been a pendulum as I started my career in a developing country trained and worked in Europe and the US and finally tracked my way back to where I started. My views have also swayed with the environment. having seen it all- you can bet that transplantation is a multibillion dollar industry. Be it the pharmaceuticals, hospitals, physicians- are all in the game atleast partly because of good profits or salaries. one cannot control the destiny of the donated organs- it may go to a criminal, a lowsy sod, alcoholic or worst to a politician! But there are also students, children, professionals (except lawyers) who defenitely deserve a second lease of life from an organ transplant. In my country I know for a fact that even transplants amongst relatives are compensated for discretely. So wherever you look there is a great interplay of money and no one is doing this for charity. It is the greatest hipocracy of mankind, to close our mind to all these aspects and to argue that incentivising cadaver donations is unethical- IN WHAT WAY?? Why not the family of the donor also share some of the financial benefits. What about CHINA- the stae is making burgers out of convicts (political or otherwise)- There are a whole load of wealthy arabs and westerners who que up for that piece of human flesh. Why is that we as a human race cannot raise our voice against such an overt attrocity. At the end of the day we were the chosen selfish survivors in our evolutionary cycle and will not hesitate to cannabalize for the ultimate race for survival (of the haves).
After all this ramble- I think it is prudent to address this issue pragmatically. Incentives for cadaver donation should be optional for the donor family to choose to avail at anytime in that generation.( we obviously cannot bring to halt an entire multibillion industry). Donations by convicts in authoratarian states should be stopped. In a devloped society voluntary donations which involve finanial transaction acn be allowed if- only if the donor is educated and understands all morbidity and mortality issues related to live donation and if the transaction of sum is made transparent to the ethics committee which approves such a transplant. We need to evolve to accept these necessary changes to our human ethics and morals as these can never be a constant.
You never know - 100 years from now it may be ethical to grow humans sans nervous sytems in a organ farm in China. Prepare your future generations for what we may consider today as horrors of science!!

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disappointed

i am doing a report in my health class on this topic about organ donation i disagree morally.

jors alcantara

gud pm. will u please send to my email an article about the selling of an organ. preferably at least with the minimum of 20 pages. do you have any recent article about it? thanks a lot. bye

Bob

ThinkingAboutIt is right. That "other people may choose to do evil things" is irrelevant to the fact that I own my kidneys. I do not exist to be used by society in whatever way happens to benefit society at large. If I want to sell my kidney I have every right to do so, and no one has any right to stop me. That the state has the gall to interfere with the private sale of private property is just more evidence that it believes itself to be the true owner of my person. It already won't let me treat myself for medical conditions, or even choose who cleans my teeth. Welcome to America. None are more hopelessly enslaved than those who falsely believe they are free.

Alan

interesting..

nolan mitchell

I would be more inclined to donate a kidney to some one I know for free. But I don't know anyone that needs one.But I would Sell one to anyone for the right price.So that shows people that there would be more donors like me, and i'm not any different than alot of people. I'm not saying to the highest bidder that wood not be fair,but the Doctors could pitch in some of there money to if they cared??

Lyne

I had a personal experience with One Legacy last year, they just helped themselves to my mothers tissue against her will and mine, and lied about it. It has taken me this long to even come about and talk about it, I just do not know where to go...it is an interesting story

JT

Lyne,

Can you tell please tell us more about your experience with One Legacy?

vrimj

Wasn't there a study where blood donations fell when donors were paid?

Economic incentives might harm the donor market.

Incentives in the organ market might make more sense, I like the idea of priority for regestered donors. A really strict varient would be a totally opt-in market, an adult must have been regestered for at least one year to qualify for any donation. This also has a certian "rightness" since it doesn't seem fair to allow people to benift from something they are unwilling to do.

StCheryl

The dysfunctional state of the human organ market also points out additional reasons to support stem cell research. Setting aside the problem of the organ shortage and its myriad causes, organ transplants carry with them the risk of rejection. Thus, anyone who has an organ transplant now (and for the foreseeable future) must take powerful immunosuppressant drugs for the rest of their life, thus compromising their immune system. Transplantable organs created from people's own stem cells might not create a rejection risk; but even if that problem is not overcome, creating organs for transplant from stem cells could eliminate the availability problem.