Friday, July 10, 2009

Ethics of paying for organ transplants

Apple Inc. CEO Steve Jobs was in the news recently for a liver transplant. He had to travel to Tennessee due to its lesser waiting time. He was lucky, some people like the 11 year old Japanese boy had to travel to another country for his heart transplant. Although there are differences in organ transplant laws, the basic premise is the same. In most countries around the world no one can buy an organ.

This highlights the stupidity of laws which ban consensual dealing between adults. In fact in Japan you can't harvest the organs of a brain dead person even if his relatives consent to it. The cessation of brain function as human death was not accepted by Japan. This resulted in only 11 heart transplants in Japan compared with more than 2,000 in the U.S. A written will is required for organ donations and there is a ban on them from children under 15 - although this law seems set for some changes.

There was a sneaking suspicion that Jobs had paid for his transplant. It is unlikely. What is done by a lot of people is to enter a lot of queues (legal) and it helps to have a jet ready to fly wherever the turn comes up. The key question is if it really such an evil to pay someone for his organ? If the laws were changed to make payments to donors legal, the entire waiting list of 80000 people waiting for a kidney in U.S. would disappear in a matter of a year or so if not a few months and out of 20000 more waiting for other organs a majority would survive. A majority of lives will be saved unlike more than 85,000 U.S. citizens who have died waiting (pdf) for a solid transplant organ since 1995.

Countries like Spain, Norway, and Belgium have a unique solution to this problem. They consider all dead as organ donors unless they have opted out. This "presumed consent" law violates individual rights and don't take into account the individuals who have no intention of become a donor but die suddenly. In countries like India a patient can accept an organ donation only from a close relative unless a non-relative can prove that he is doing it for altruistic reasons and not money. This leads to doctors and agents who recruit kidney donors for patients for up to $10000 and a lot of kidney's being stolen from unsuspecting victims. In China there have been reports of prisoners being executed for their organs.

The Current U.S. Regulatory Framework under National Organ Transplantation Act (NOTA) specifically prohibits the sale of donor organs for transplantation though the ban does not apply to blood, sperm or ova. The solid organ donor program is purely voluntary, both for living and cadaveric (dead body) organ transplantation. The donation of organs by living people is heavily screened and the law says that people who want to donate organs should be either family or close friends. In spite of thousands of people dying waiting for an organ, there are many who see no problems with the present system. This has to do a lot with the altruistic nature of the system which is killing a lot of people.
Dr. Bruce Patsner in his article "Human Organ Transplantation in the U.S. – Crossing New Lines? ” (pdf) mentions some solutions are being implemented and some being proposed. One of them is the recent law by New Jersey which forces people getting driver’s license to make a decision about cadaveric organ donation. This is the altruist way of forcing you to take a decision, and making you feel guilty for saying no. The article mentions a growing movement of surgeons wanting to explore the option of “paying individuals money to provide an incentive for them to donate organs for transplantation after they have died.” Even here a lot of objections are raised - like donors hiding diseases (there are laws to tackle violations of contracts) and the possibility of the payment system extending to living donors.

There is a lot of opposition against the payment for organs to living donors. These are the same arguments given in cases of drug consumption and prostitution (acts between consenting adults.) The prevention of payment for organs is the worst of all violations of individual rights, as the denial of organs is the denial of life. According to Ayn Rand in “The Virtue of Selfishness”:

A “right” is a moral principle defining and sanctioning a man’s freedom of action in a social context. There is only one fundamental right (all the others are its consequences or corollaries): a man’s right to his own life. Life is a process of self-sustaining and self-generated action; the right to life means the right to engage in self-sustaining and self-generated action—which means: the freedom to take all the actions required by the nature of a rational being for the support, the furtherance, the fulfillment and the enjoyment of his own life. (Such is the meaning of the right to life, liberty and the pursuit of happiness.)

The concept of a “right” pertains only to action—specifically, to freedom of action. It means freedom from physical compulsion, coercion or interference by other men.

Update: ...With Functioning Kidneys for All by Virginia Postrel
If transplant centers could pay $25,000 or $50,000 to each living kidney donor, many more people would line up to contribute.

Such payments could even save taxpayers billions of dollars. Long-term dialysis is a federal entitlement. Under a special law, Medicare covers everyone, regardless of age, who has made minimal Social Security tax payments—about 319,000 of the country’s 400,000 dialysis patients. Compared with dialysis payments, every transplant from a living, unrelated donor saves an expected present value of almost $100,000 in medical costs, according to a 2003 American Journal of Transplantation article by Matas and Mark Schnitzler, an economist then at Washington University in St. Louis and now at the Saint Louis University Center for Outcomes Research.
Eliminating the waiting list would thus save taxpayers $8 billion, or $4 billion if each living donor received a lump-sum payment of $50,000.

That purely financial estimate ignores the enormous benefits for the patients’ quality of life, of course. It also excludes the economic gains from returning to productive work—only about 10 percent of dialysis patients are employed even part-time—and the fiscal effects of paying taxes rather than receiving disability payments.
Read the complete article.


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JG said...


Fantastic post. Congrats.

One spell-error I caught- it should be 'dying' and not 'dieing' on fifth para fourth line.

Also thanks for the heads-up on Steyn's article. Reading that article for some unfathomable reason brought to mind what one Objectivist blogger has written "I think foul language possesses utility." -which is the communications style I want to respond with to the prince et al!!


Rajesh Dhawan said...

Thanks Jasmine. It took me quite a while to write the whole thing (not fully satisfied, but had to put it up before the issue went cold.)

The Steyn article was really good. And yes, the contempt I feel matches yours.

Sumantra said...

Hi Rajesh - I am an entrepreneur based in Kolkata and over the last 12 months, I have become a huge fan of objectivism.

I am amazed at the way the principle of the sanctity of individual rights can be used to analyze, and come to the correct decision on, almost every controversial social or economic issue.

Anyway, the reason I am posting this comment is that while I agree completely that paying for organ transplants should be legal, there is 1 comment that you made that I am not too sure about.

You said "Countries like Spain, Norway, and Belgium have a unique solution to this problem. They consider all dead as organ donors unless they have opted out. This "presumed consent" law violates individual rights and don't take into account the individuals who have no intention of become a donor but die suddenly."

However, the way I look at it, rights, by definition, only belong to someone who has the ability to reason. A dead person cannot reason, and therefore cannot have any rights (the same logic applies to animals as well - animals don't have rights because they can't reason).

All rights are derived from the right of a human being to live. But if a human being is already dead, he is no longer alive and therefore loses all his rights.

Now let me address the example you gave about a person dying suddenly without being given the opportunity to opt out from the presumed consent law.

Isn't there a de-facto presumed consent law that already operates in EVERY society regarding the disposal of a dead body?

Currently, the method of disposal of your dead body - i.e. whether your body is disposed of by being buried, burnt or some other means, depends on your religion.

But, by that logic, if a person is automatically buried just because he is a Christian or Muslim, or automatically burnt just because he is a Hindu, wouldn't that violate the individual rights of a person who dies suddenly? Because, after all, it is possible that he may have been a Christian but he may not have been willing to be buried. So, burying him without knowing what his wishes might have been, by this logic, is also a violation of his individual rights.

Therefore, it seems to me that harvesting organs from a dead person unless he/she had opted out of the presumed consent law while he/she was alive, is not a violation of individual rights at all and is compatible with the principles of objectivism.

I would appreciate hearing your views regarding this. If you find any logical flaw in my thinking, I am more than willing to be corrected.


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