Should the Purchase and Sale of Organs for Transplant Surgery be Permitted? BECKER

There were about 50,000 persons on the waiting list for kidney transplants in the United States in the year 2000, but only about 15,000 kidney transplant operations were performed. This implies an average wait of almost four years before a person on the waiting list could receive a kidney transplant. The cumulative gap between demand and supply for livers was over 10,000, which implies an average wait for a liver transplant of a couple of years. In 2000, almost 3000 persons died while waiting for a kidney transplant, and half that number died while waiting for a liver transplant. Many also died in other countries while on the queue waiting for an organ transplant. Some of these people would have died anyway from other causes, but there is little doubt that most died too early because they were unable to replace their defective organs quickly enough. If altruism were sufficiently powerful, the supply of organs would be large enough to satisfy demand, and there would be no need to change the present system. But this is not the case in any country that does a significant number of transplants. While the per capita number of organs donated has grown over time, demand has grown even faster. As a result, the length of the queue for organ transplants has grown significantly over time in most countries, despite exhortations and other attempts to encourage greater giving of organs. In recent years the US has taken several steps to improve the allocation of available organs among those needing them, such as giving greater priority to those who could benefit the most. These steps have helped, but they have not stopped the queues from growing, nor prevented large numbers of persons from dying while waiting for transplants. Some countries use an "opt out" system for organs, which means that cadaveric organs can be used for transplants unless persons who died had indicated that they did not want their organs to be so used. A PhD thesis in progress by Sebastien Gay at Chicago shows that opt out systems may yield somewhat more organs for transplants than the "opt in" systems used by the US and many other nations, but they do not eliminate the long queues for transplants. To an economist, the major reason for the imbalance between demand and supply of organs is that the United States and practically all other countries forbid the purchase and sale of organs. This means that under present laws, people give their organs to be used after they die, or with kidneys and livers also while they are alive, only out of altruism and similar motives. In fact, practically all transplants of kidneys and livers with live donors are from one family member to another member. With live liver transplants, only a portion of the liver of a donor is use, and this grows over time in the donee, while the remaining portion regenerates over time in the donor. If laws were changed so that organs could be purchased and sold, some people would give not out of altruism, but for the financial gain. The result would be an increased supply of organs. In a free market, the prices of organs for transplants would settle at the levels that would eliminate the excess demand for each type of organ. In a paper on the potential of markets for live organ donations, Julio Elias of the University of Buffalo and I estimate that the going price for live transplants would be about $15,000 for kidneys and about $35,000 for livers. We recognize, however, that the data are too limited to be confident that these numbers would be close to equilibrium prices that equate supply and demand-they may be too high or too low. But even if our estimates were only half the actual equilibrium prices, the effect on the total cost of transplants would not be huge since current costs for live transplants in the US are in the range of $100,000 for kidney transplants and $175,000 for liver transplants. An open market in organs would sharply curtail the present black market where some persons in need of transplants have them in poorer countries like Turkey where enforcement against selling organs is slack. Since the quality of the surgeons and hospitals in these countries is much lower than in advanced countries, this often greatly reduces the quality of the organs used and how well they are matched to the organ types of recipients. Still, despite these strong arguments in favor of allowing commercial markets in organs, I do not expect such markets to be permitted any time in the near future because the opposition is fierce. Some critics simply dismiss organ markets as immoral "commodification" of body parts. More thoughtful critics suggest that allowing organs to be bought and sold might actually reduce the total number of organs available for transplants because they claim it would sufficiently lower the number of organs donated from altruistic motives to dominate the increase due to those sold commercially. That scenario, however, is extremely unlikely since presently only a small fraction of potentially useable organs are available for transplants. Compensating persons either for allowing their organs to be used after their death, or for kidneys and livers to be used while they are alive, would enormously widen the scope of the potential organ market. Another set of critics agree with me that the effect on the total supply of organs from allowing them to be purchased and sold would be large and positive, but they object to markets because of a belief that the commercially-motivated part of the organ supply would mainly come from the poor. In effect, they believe the poor would be induced to sell their organs to the middle classes and the rich. It is hard to see any reasons to complain if organs of poor persons were sold with their permission after they died, and the proceeds went as bequests to their parents or children. The complaints would be louder if, for example, mainly poor persons sold one of their kidneys for live kidney transplants, but why would poor donors be better off if this option were taken away from them? If so desired, a quota could be placed on the fraction of organs that could be supplied by persons with incomes below a certain level, but would that improve the welfare of poor persons? Moreover, it is far from certain that a dominant fraction of the organs would come from the poor in a free market. Many of the organs used for live liver or kidney transplants are still likely to be supplied by relatives. In addition, many middle class persons would be willing to have their organs sold after they died if the proceeds went to children, parents, and other relatives. Although this is not an exact analogy, predictions that a voluntary army would be filled mainly with poor persons have turned out to be wrong. Many of the poor do not have the education and other qualifications to be acceptable to the armed forces. In the same way, many poor persons in the US would have organs that would not be acceptable in a market system because of organ damage due to drug use or various diseases. Still another criticism of markets in organs is that people would be kidnapped for their organs, and that totalitarian governments would sell organs of prisoners. This would happen, but not likely on a significant scale since the source of organs offered for sale could be determined in most cases without great difficulty. A criticism particularly of a commercial market for live transplants is that some persons would act impulsively out of short run financial needs, and that they would regret their decision to sell a kidney or allow their liver to be used for a transplant if they had taken more time. I do not know how important such impulsive behavior would be, but it could be sharply reduced by having a month or longer cooling off waiting period between the time someone agrees to supply an organ and the time it can be used. They would be allowed to change their mind during the interim. Many of the arguments against the sale of organs indirectly stem from an influential book in 1971by the British social scientist Richard Titmuss, The Gift Relationship: From Human Blood to Social Policy. He argues against allowing blood to be sold for transfusions, and compares the British system, which did not allow the purchase of blood, with the American system, which did allow its purchase. Titmuss basically ignored that the American system in fact was getting more blood per capita than the British system. Instead, he concentrated on the quality of the blood. Since a significant fraction of the American blood came from individuals with hepatitis and other diseases that could not be screened out, the blood given under the British system tended to be healthier. In the absence of effective screening techniques, perhaps shutting down the commercial market was an effective way then to improve blood quality. But that is no longer the case as highly effective methods have since been developed to determine whether blood is contaminated with various types of hepatitis, the HIV virus, and other transmittable diseases. Under present screening technology, a market in blood yields much more blood, and with enough diligence its quality can be maintained at a high level. My conclusion is that markets in organs are the best available way to enable persons with defective organs to get transplants much more quickly than under the present system. I do not find compelling the arguments against allowing the sale of organs, especially when weighed against the number of lives that would be saved by the increased supply stimulated by financial incentives.

Comments

[Yong]

Organ sale should be treated very differently from the sale of other personal items because, from the donor's point of view, a sale is an irreversible process. Once a kidney is removed from a live body, that body will never be restored to the original state. A wedding ring may be sold in a financial crisis and be purchased back at a later stage when the crisis disappears. The same cannot be said about a vital organ such as a kidney.

[Wes]

Regarding slavery, I consider it slavery that I am unable to sell something that belongs to me, namely my organs.Since it is legal to give away one's organs, the greatest harm that a person can claim by not being allowed to legally sell their organs is the fair market price of their organs.In a free market the price of organs is likely to be only a few thousand dollars (and each organ can only be sold once). If denying someone this profit constitutes a severe hardship for them then they have bigger problems than the inability to legally sell their organs.

[nate]

Chris Laurel:

Thank you for posting the letter. You make interesting comments. Hopefully people listen. Torture is not a great idea, and we still do not have Bin Laden. Focus.

However, you may want to consider ways to be more concise yet convey the same message.

[Chris Laurel]

I wish there was a way to concisely peel the many layers of the onion of the problems our country must begin to face.

Unfortunately, our lack of attention spans has created a situation where our problems and solutions no longer conform to sound bites. I believe this was George Bush's selling point, that he had those. We see where that gets us.

[bc]

yong, I do not see why organ sale should be treated any differently. Isn't the renting out of one's labor and time an irreversible process too? I believe the disquiet about the vendors of organs being predominantly the poor lies in the fact that despite all the economic and social differences between man, our similar biological makeup at least provides a reminder of our common humanity. To "deprive" the have-nots of their organs seems to touch a nerve with those who hold this mentality. Ultimately, however, we have to consider the practical utility forgone in donating a cadaver organ and my belief is that such utility is negligible, which explains why people usually do not make the effort to opt-out in an opt-out program.

[ben]

there is the problem that rich people are going to be buying the organs and poor people are going to be selling the organs

A number of commenters have made this objection. These commenters overlook the role that insurers play, which is to smooth costs over time and across populations. As with medical procedures currently available, insured persons only pay up front a fraction of the cost of each procedure. Public health sets a low price but rations via waiting lists. There is no reason to believe that these institutions will not purchase organs for their clients and make organs available to as much of the population as other high-cost procedures like heart surgery are now.

Forcing the market for organs underground penalizes the poor because it eliminates insurers and public health providers from the process. Only those capable of paying the full cost of the procedure can then participate.

In the current system, some people miss out on health care. But this is not a reason to abandon any existing procedures: to do so would needlessly condemn people to ill-health and an early death. Eliminating the market for organs is costly in precisely the same way.

[Yong]

BC,

Organ sale can bring irreversible harm. Consider the following scenario. A poor man sells his right kidney in order to cover some financial emergency. He spends the money and the emergency disappears. Then his left kidney is damaged when he gets hit by a car from the left. He is now facing death but no longer has the money to pay for a transplant, a situation he would not have faced had he not sold the right kidney.

[Wes]

There is no reason to believe that these [insurance] institutions will not purchase organs for their [poor] clients and make organs available to as much of the population as other high-cost procedures like heart surgery are now.That's a good point. I would definitely be more comfortable with the sale of organs if it was subsidized to the extent that organ transplants were equally available to everyone regardless of their financial resources.Under the current health care system in the United States it is unlikely that people who would need a (one-time) payment of a few thousand dollars badly enough to sell their organs would be able to afford a level of insurance that would provide them with organ transplants.On the other hand, if the government were to completely subsidize organ transplants (including purchasing the organs) then that would undermine any free market aspects of organ sales.

[Bill Churchill]

The question of the sale of organs goes to the heart of property rights and the meaning of ìpropertyî itself. There are a variety of definitions of ìproperty,î but they mostly fall under the rubric of either ìattributeî or ìpossession.î To argue that either aspect applies better to ALL situations than the other is to argue for the absurd. It would be like arguing whether manís altruistic or selfish impulse should be made to predominate in his character (or in deciding ALL matters of public policy), or whether ìextroversionî (understood here to mean, ìgregariousnessî) is better than ìintroversionî (understood here to mean, ìpersonal reflectionî) in judging ALL matters related to ìmental health.î These are all ontological scales that apply in varying degrees to all situations--and which exhibit attributes that accrue various benefits and detriments depending on HOW, rather than IF they are applied. This is especially true of ìproperty.î

Attribution vs. Possession is a valid basis for an ontological dichotomic scale related to the concept of ìpropertyî in that we usually assign the relational concept of ìpropertyî based on the degree of ìlegitimacyî involved, which is itself intimately related to the issue of personal privacy and its effects on outward (public) policy. Immanuel Kant argued well that policy should be guided by matters that are not restricted by their unilaterally ìprivateî nature. Thus, it is considered illegitimate to pass tithing laws in order to support a priesthood based on some individual private religious experience, but it is legitimate to pass tax and funding laws to maintain a court system to resolve disputes and preserve public order.

The Attribution side of a ìProperty Scaleî would have the greatest legitimacy as it would more closely be based on demonstrable factors related to the subject matter itself. (For instance, water has the attribute that it freezes at 32 degrees F at sea levelóthis is a ìpropertyî of water.) The ìpossessionî side of the scale, while still legitimate, is less so in that assigns property-ness based on assignment ìdriversî (ìreasons forî possession) rather than attributes intrinsic to the subject itself. Thus, the ìpropertiesî of water are higher on the ìProperty Scaleî than oneís having ìearned it,î which is in turn higher than oneís possession of ìpropertyî due to his divine right as a king. The former properties (of water) are more publicly legitimate than the latter two, which are based on ìprivateî possession.

Although Spin can blur the publicís perceptions of the particular scale level of a given ìproperty rightî, the underlying dichotomic scale of ìproperty-nessî remains intact as a valid concept. This said, we are dealing with two points on this scale, set in paradoxical conflict, when we discuss that matter of organ sales.

People will do what they can with what they possess. This doesnít make it rightóor wrong. But there are consequences-and far-reaching economic externalizations, the nature of which cannot be escaped except through the ìspinî factor. An organ is an attribute of the human body, and medical science (while having achieved much) is still in the stone ages when it comes to understanding WHAT the human body is. This is also true of human society, of which humans (and their bodies) are a partóand, it is held by most people to be a given that the social sciences are likewise stuck in the stone agesóeven more so than the so-called ìhard sciences.î

The hashing process of millions of years of evolution has gone into the process of the development of the human body. Likewise, human society has also undergone a similar development whose relation to the individualís human body is integral, though not at all clearly understood. Mary Shelly was right in admonishing us to take responsibility for our creations. It would be foolish at this point in the history of our scientific development to begin a policy of ìallowingî persons to buy and sell body parts based on the legitimacy of ìpossessionî as this would fly in the face of our lack of knowledge about many of the very basics of the bodyís attributes. Where does the Mind lay? Do we have a soul? What is the organic epistemology of human ìreason and experienceî of the world? Are we machines? Are we living souls? Are there Uber-men who have the right to buy and sell their fellows and their fellowsí bodies? What would be the basis of such a right, except that possession has been misguidedly raised to the level of an intrinsic absolute? We cannot even begin to answer these questions with anything more than our fantasies.)

Though I am the first to regard as ìdivineî those rights granted by reason to dispose of what we understand (as we understand it), I am opposed to the cavalier disposal of what we donít understand out of some misguided ideology of ìproperty rights.î Granted, Karl Marx was an idiot in this realmóbut so was Ayn Rand. In dealing with matters on the ìProperty Scaleî it is better to defer to ìattributionî over ìpossession,î and to behave with the discretion that such deference would demand in the face of a lack of knowledge. Just because we own a building, with certain rights based on the ìpossessionî of same, does not mean we have the ability to jump off its roof based on those same rights without regard to the attributes of gravity. Likewise, if we start cutting off body parts in order to sell them; we are using possession as a ìrightî that trumps attribute.

We posses our bodies, but we do not posses them in isolation. As we do not understand even the rudiments of the consequences of turning our most private possessions (our bodies) into commodities, we should be cautious of how move into this Brave New World. What we do know is that commodities essentially lose their value relative to other ìgoodsî and become fully fungibleónot a fate I wish to enjoy. We also know that our unique human dignity as individuals is a human attribute that, when reduced to being a mere possession, eventually becomes a commodity. Only commodities should be commodities.

Posted by Bill Churchill

[logicnazi]

The core question everyone seems to be circling around is whether or not a market in organs would create a substantial risk of organ theft. I think the answer is a qualified yes, but even if it is a no one must still consider the harm of public fear of organ theft.

Of course I don't think the sort of urban legend scare stories (man found in bathtub missing kidneys) are realistic dangers. While possible I also think the idea of healthy people truly being murdered for organs is also unrealistic. All of these methods of organ harvesting are less efficent than just going to a poor country and paying people. Also harvesting organs is not something one does with an exacto knife and some ice.

HOWEVER, there is a real risk of more subtle forms of organ theft. If there is a market for organs someone is getting paid to provide them, the most obvious canidate is hospitals since this is where people die but in any case the hospital is going to end up being compensated for providing the organs. So what happens when a hospital makes money by being a net organ donor? Is their subtle pressure on the doctors to get more organs donated, do they get bonuses for more organs?

I think the idea that being an organ donor now means your doctor is somehow going to let you die is pretty absurd. I suspect this preception exists because sometimes a doctor will know that a person has no hope of surviving and starts suggesting donation to the family who isn't emotionally able to accept their loved one's death is a medical certainty. However, if doctors start having financial interests in or job pressures relating to organ donation this gets to be a bit more plausible though still highly unlikely. In any case though this fear serves to diminish the supply of organs so even if in reality there is no danger of doctors making deciscions that are worse for the patient but better for the organs just by raising the spector of it causes problems for a market in organs.

What I suspect would be more likely is theft not by killing the person but by munging their records to make them an organ donor. Sure you might have some national database of donors and only these people are supposed to have their organs harvested on death but once their is a financial interest corruption enters the picture. What prevents people from harvesting organs from someone who doesn't agree and pretending they are from a valid donor who died in the same hospital?

In short there are all sorts of corruption and diversion possible once there is a market price for organs. It isn't the scary stuff of urban legend organ murders but it still has the possibility to cause devote families severe pain and just the spector of influencing medical deciscions may scare away many potential donors. Still I agree with the poster who pointed out that not encouraging donations with money is effectively murdering thousands of people a year. So if our only choice was creating something like a regulated market in organs and leaving the system as it is now I would agree with Becker. Luckily, though, I think my proposal of giving individuals who make a binding commitment to donate their organs if they die inside the year a tax break avoids these problems while still achieving all the benefits.

In fact I actually think registering on a tax form is likely to get the *most* organ donations for a given price. I don't know about everyone else but I would be willing to check a box on my tax returns agreeing to donate organs without much thought but if I had to sign a contract with a private organ donation company I would be much more hesitant. Also since I have to fill out my taxes every year anyway I'm no discouraged by the effort involved as I would if I had to go make seperate arrangements.

[logicnazi]

The minimizing of exploitation of the poor is also troubling. Would poor people and rich people be equally likely to sell organs? Obviously the incentives are far different. Is it just that poor people will sell their organs, but be unable to afford transplants for themselves or their families?

So when I first saw these concerns about the rich and the poor I thought they were ridiculous. The fact that the poor are more likely to sell their organs than the rich is no different than the fact that the poor are more likely to work in the fields picking fruit or other hard and dangerous jobs. The burden on the poor is their poverty not their option to relieve that poverty by organ sales. Unless you think the poor are just stupid the reason they are selling their organs for money is because having the money is a better situation for them then having the organ.

I think we like to pretend that it is the program that offers poor people money for organs, or money to be sterilized or whatever that is the horrible burden inflicted on the poor. If we admit that being poor is actually worse than having only one kidney then we have to face up to all the pain we cause by not being more generous to the poor.

However, I realized that the commentaters worried about the poor may be imagining a market in organs differently than I am. In particular if we not only pay people to donate their organs but also allow people who need organs to bid on them there is a danger that the poor will end up on the short end of the stick. In particular if the price of an organ rises above the price insurance companies are willing to pay those without sufficent financial resources may be left out in the cold.

For these reasons I think there are big problems in allowing the purchase of organs to work as an unrestrained free market. If it turns out there is a greater demand for organs than supply medicaid and insurers can't pay arbitrarily high sums for organs and people will be forced to shell out of their own resources. Instead I was imagining a fixed maximum price that could be paid for an organ (e.g. the price that medicaid and insurers would be covering) and then a free market in aquiring these organs (e.g. various companies paying people some fraction of the final price to donate).

Anyway I think some of the confusion comes from a misunderstanding of what type of free market in organs we are considering. I was considering one with a fixed maximum price like the one above. This is one of the reasons that I suggested the government should just directly provide tax breaks instead of allowing a market. Once the government is capping the max price as well as who gets to recieve the organ there seems to be little benefit in not directly paying the providers for the organs rather than going through a market of middlemen.

However, if other people are considering the type of free market where the organ consumers are free to bid arbitrary amounts for organs I have serious objections. First of all such a situation is likely to amount in waste. For instance old rich people getting a kidney when they will only live another year at most. Of course current organ donation already results in waste (I don't even know if they demote you for being old or otherwise likely to die as they should) but this would only increase it. More importantly though is the deep feeling of unfairness and hate people would feel if rich people got organs while the poor did not. I think the harms of this are clearly enough that we should first try to pursue other approaches to get sufficent organs.

Ohh and in response to another poster how is this an issue which can't be analyzed in a utilitarian way? You can analyze anything in this fashion, utilitarianism is just a moral framework which says one ought to maximize happiness. Either this is right, in which case it ought to be applied in every situation, or it isn't right. I think perhaps what you meant was that this is an issue where a correct utilitarian analysis would have to look at many more issues than just how many organs are donated and who gets them. As my arguments above illustrate I agree with this point and think people's emotional reactions to these issues are significant enough that they can't be disregarded. However, just because we consider the impact of organ donation on people who have strong religious feelings about it doesn't mean we have to take those feelings seriously. In other words we can just count up how much suffering people experience when they believe various things without needing to take those beliefs as serious contenders for truth.

[GregW]

A number of commenters have made this objection. These commenters overlook the role that insurers play, which is to smooth costs over time and across populations.

You're assuming that poor people and wealthy people are equally likely to have health insurance. In fact, millions of Americans are uninsured, and those most likely to sell their organs would be least likely to have insurance to pay for their own transplants.

[Jack Kleinman]

Some of the arguments in favor of a market do not reflect medical reality, which I point out as a practicing academic nephrologist. First, it is far from certain that contracting to donate one's organs after death will actually increase the supply of donatable organs, since most people do not die in a manner (brain death on vital function support) that permits successful organ donation. Thus, it may be argued that paying for living donations is more likely to be successful, but that would likely do little to satisfy the need for organs necessary for life, such as hearts. Finally, there is another problem with inducing the poor, which in our society includes large numbers of members of racial minorities. This is the fact that there is a fairly substantial likelihood that these individuals will need all the function of the organ that they can retain, having high rates of disease in the common transplantable organs, such as kidney & liver.

[Joe Merchant]

lincoln: Thanks for the Niven correction - it's been over a decade since I read them.

One point that I feel is being overlooked here is the increased cost to society of performing organ transplants in the first place. The transplant itself is costly, but as far as I know, most major organ transplants (not cornea, but kidney, liver, heart, etc.) require the recipient to go on a more or less permanent regimen of immunosupressants. Never mind that the recipient was probably in the liability column on health care costs vs insurance premiums in the first place. Can these organ recipients really return value to society in excess of what they will be costing?

I'm all for respect of the elderly and passing down of wisdom and so on, but Darwinianly speaking, these folks might be unlucky - but on average they will represent a group that hasn't made the best choices in their life to end up in the state where they need a lung or liver or heart, or all three.

Comoditizing organ transplants would have the effect of increasing the quantity of organ transplants practiced, I'm sure that I don't want to look forward to a future where I will spend my retirement savings paying for spare parts from the young and less fortunate, my choice to opt out, but I'd rather live in a society that expends that kind of effort on bettering this world and exploring others, rather than extending life a few more years at any cost.

[NLL]

For the record, I would sell my liver to pay off my college and law school loans. This is not because I am destitute but because the loans are a significant and long-term financial burden, and I believe that donating part of my liver to save a person's life would be a merely physical and ultimately less significant burden. In addition, the burden of undergoing surgery would be offset by the emotional benefit of having done a terrifically good deed.

So it seems to me that those who view these hypothetical organ sales as inherently exploitative need to reflect on the basis of their assumptions. In fact, I believe that the poor would actually be somewhat less likely to sell their organs than better-educated and wealthier persons, for the following reasons:

1) The poorer are less likely you are to have regular interaction with medical professionals, and are therefore less likely to trust them and to credit their expertise. I think of my grandparents, who were poor and more or less terrified of doctors. I doubt they would ever have considered selling their organs for this reason.

2) The poorer a person is, the less likely they are to be well educated. This means less ability to assess the potential risks and benefits of an organ sale--and less chance that the person will go to the trouble to seriously consider the option.

In closing, I would like to cite the well-known fact that the vast majority of sperm donors are med students. I'm not sure anyone knows why this is, but I would wager that it is because they are educated, comfortable with the hospital milieu, and possess more status than money. (Again, note the incentive of mitigating staggering educational costs.) Finally, their product is desirable from a genetic/social status standpoint. I think the participants in a market for organs would for the most part be similarly higher-status, though not necessarily wealthy.

[ben]

if the government were to completely subsidize organ transplants (including purchasing the organs) then that would undermine any free market aspects of organ sales.

Actually the supply side effect persists with government subsidies. Because organ donors are paid, undersupply can be relieved. Provided government pays a price for organs high enough to clear the market then government intervention, though unnecessary, fixes a problem.

[ben]

Bill Churchill

There are two fundamental problems in your thesis. One, while you point to uncertainties, you don't identify any outcomes from allowing an organs market so serious as to justify (with certainty) killing thousands every year by banning it.

Two, if trade in organs is permitted then people uncomfortable with the uncertainties, as you are, are entitled not to participate.

Since many thousands certainly die each year as a result of banning organs markets, the benefits of a ban should be large and fairly certain. You haven't said what they are.

GregW

You're assuming that poor people and wealthy people are equally likely to have health insurance.

Actually I didn't asume that. Nobody has explained why public health care will not purchase organs on their patients' behalf. Public providers already fund other expensive operations. You may object to this tiered system, but that is unrelated to whether trade in organs should be allowed. If you believe organs trade should be banned because not every one has insurance, it follows that all high-cost surgery should go.

[ben]

Joe Merchant

Can these organ recipients really return value to society in excess of what they will be costing?

Yes. Because those opting to participate in the system bear the cost of doing so. They will only participate if they value a longer expected life more than the cost.

[albatross]

Joe Merchant:

Wouldn't the same argument about seriously ill people being expensive apply to any medical treatment that left people needing expensive maintenance care? Two obvious examples (at least one doctor is taking part in the discussion, he can surely come up with many more) are AIDS and diabetes. In both cases, I gather there are reasonably effective treatments for extending the patient's life, more-or-less indefinitely, but they involve continuous monitoring by doctors, continuous use of medicines, and high expected health costs.

Indeed, old age is another example. You'd probably save a lot of resources if you'd politely drop dead at age 65, since by then you're unlikely to contribute much more to GDP, but you're likely to need expensive medical care. But maybe you think you exist for some reason other than to produce resources for others....

[Bill Churchill]

In response to: ìPosted by ben at January 6, 2006 02:44 AMî

You state that I ìdon't identify any outcomes from allowing an organs market so serious as to justify (with certainty) killing thousands every year by banning it.î

This is typical of modern political (attack) ìrhetoricî in that it puts words in my mouth rather than addressing the issues I have raised. Though I do not agree with what appears to be this personís position on the issue of the traffic in body organs, nowhere did I justify ìkilling thousands every year,î nor anything else positive about the marketing of human life other than to state that it is important that we donít just jump into such a serious cultural and international policy overhaul without giving the issues involved their due (i.e., thorough) consideration.

What we are talking about here is the trafficking in the sale of body partsóparts that any physician worth his salt will admit we know little about in any wholistic sense. Yes, their sale can save lives. Yes, they can be (and have been) sold already.

We do not consider the cow when we eat the hamburger. However, though I am a meat eater, I will not eat a fellow human if I can possibly avoid it. I hope that I will never have to make that decisionóor have such an ìalternativeî easily and cheaply available--There are usually other more creative means of sustaining life and its quality, while preserving the dignity of all involved. I hope I am not the kind of person who would do such things to my fellow human beingsóor to otherwise treat my fellows as beings less ìdeservingî of life based on some ideological claptrap.

What is at issue here is not whether there should be a ìban.î Bans are merely the policy expressions of the underlying will of a critical mass of a public constituency (in whatever form that critical mass is realized). People wil1 do what they will do in spite of ìlawsîóand what they will do will shape laws. The problem is whether we will reach a critical mass that pushes us towards the Brave New World that Huxley and Hugo warned us to avoidóone in which life is but a cheap commodity.

We cannot buy and sell the fact that we are all responsible for our individual philosophies and decisions, and that our level of humanity is derived from the quality of our decisions and the issues that we consider important in arriving at them. Our decisions matter. Our collective decisions are but an aggregation of our individual decisions. We can begin to address the problem of organ shortages by donating our own organs upon our deathóas I have. We can buy and sell organsówhich I have not (and hopefully will never) do. We can not escape who we areóand who we are is intimately connected with how rashly we decide issues. I never want to know that an eye I may have received came from someone who sold it to get a few weeks wages to feed their family or buy medical care for their grandmother. I am not such a ìGod!î We must preserve our humanity and an occasional sense of revulsion to the type of cavalier attitudes that would rashly pass laws that destroy that humanity.

Revulsion is a good thingóit has been naturally selected for in most societies and its presence is a sign of the prosperity that underlies the availability of choices in the face of hard alternatives. The market works, but ONLY within limits and according to its nature. It should never be held up as a utopian panacea that answers all situations. Like anything else in nature, it has its upside and downsideóits successes and its failures. When we turn it into an over-reaching paradigm, we risk blinding ourselves to a wider realityóto a wider humanity.

Culture presupposes communityóas well as individuality. The issue of the sale and purchase of that which makes us human is not a right-wing or left-wing one. It is not an issue of religion vs. secularism. Such are all cool-aide peddling arch-philosophies,(ala, Jim Jones in Guyana), that have hurt too many people throughout history.

We must strive to not loose our humanity in a world where anyone will try to sell us anythingóincluding each otherófor dinner.

Posted By: Bill Churchill

[ben]

Bill Churchill

You use the word "we" often, but shouldn't it be "I"? Otherwise what you are doing is taking your values and refering to them as humanity's, implying that a preference for organs trade undermines humanity. Since I am a part of humanity, why is my value set, which says such trade (regulated to avoid excess) is ok, any less a part of humanity than yours?

Your whole argument, I think, is that such trade offends your morals, society needs a set of minimum moral standards, and we should be drawing the line somewhere above trade in organs. But, because organs trade occurs between consenting adults (or their legal agents) and imposes no tangible externality on anyone else, doesn't your argument fall over the moment an informed, consenting and rational donor and informed, consenting and rational recipient are paired? If it's ok with their morals, what business is it of yours?

I can accept that there is an externality in that people whose ethics are offended by this practice would prefer not to be surrounded by people engaging in this conduct. But I believe this offense cannot be compared with the daily offensiveness of a child needlessly dying because the organ it needed could not be located as a direct consequence of the values you espouse being quite arbitrarily imposed on others.

[Bill Churchill]

I am one of the last people who would ever arrogate to himself the right and responsibility of making personal decisions on behalf of others over their objections, and I certainly would not do so based on ìarbitrary mores.î Nevertheless, the fact that such mores exist, points to the fact that their existence and content needs examination. This is true because nothing exists in nature (even in ìhumanî nature) that is truly ìarbitrary.î

Nature has selected for mores in every societyóeven ìarbitraryî mores. Why? Perhaps they act as a check on the disasters that may arise from our becoming overly committed to the latest fads and ìfactsîóeven fads and ìfactsî based on valid discoveries. Perhaps our analogy centered thinking modality makes us vulnerable to the abuse of metaphor. The Free Market is, like everything that our minds embrace, a metaphorical constructóand like all metaphors, it too has its limitationsóand can, and has been abused.

Metaphors are representations of realityóthey are not reality. Herein lies the limits of the minds of men, that to truly embrace reality, you must embrace all of it at the same time from the same ìgraspîóan act only possible to an omniscient God (the existenceóor non-existence of which is a whole other can of worms that I will not get into here). We cannot escape the fact that life is a koan--an ultimately unfathomable paradox.

I am neither committing to a ìbanî on organ marketing, nor am I embracing it. I am merely suggesting that we hold as valid that some of the moral objections that are raised against the idea of it may be valid. I am also suggesting that, we really donít have enough of a grasp of what these organs ultimately ìdoî (both to the individual and to his condition as a participant within the social milieu) to arbitrarily commit ourselves to the policy of ìmarketingî them as if they were automobile parts.

ìReasonî usually follows, rather than leads our ìgraspî of ìthe factsî--We often ìknowî (i.e., understand) things before we ìknowî (i.e., can communicate) them. We often knee-jerk object to things out of the necessity to maintain a conservancy of the personal and social organism and out of a deep down knowledge that we donít always have ìthe rest of the story.î The facts arenít as ìinî about the ìfree marketî in organs as its proponents would have us believe.

What I can say with some certainty is that moral squeamishness has served humanity well in the past. Remember Eugenics? Remember how it was touted as a ìscience?î Remember the castrations, forced abortions and euthanasia?--Some ìscience.î Many people were morally squeamish about eugenics when it came out. Iíll take a little old fashioned moral squeamishness over such ìsciencesî as eugenics any day. We are not above falling victim to our own arrogance about what we ìknowîówe are not safe from ourselves at times.

Nature has fortunately selected for ìmoresî in order to restrain (in some measure) this danger. The study of the fact and benefit of the obstructive function of ìmoresî is a valid study for the science of economics because it goes to the heart of human behavior in the face of new discovery--behavior which should not be summarily dismissed as the meager product of ìparochialî attitudes.

Posted By Bill Churchill (January 7, 2006)

[ben]

Bill, I hear what you are saying. I only want to comment on one part of your response, which is the reference to eugenics.

I share your distaste of eugenics, but your analogy is the wrong way around. Eugenics and a ban on trade in organs share a key property, which is the over-riding of minority individuals' free will by some self-serving group who bears none of the costs of their views. Both practices see the many inflict tremendous harm on the few.

If the source of your moral squeamishness about eugenics is the physical harm and injustice inflicted on its victims, shouldn't you feel the same way about killing people by preventing trade in organs?

[HispanicPundit]

Great post, very well thought out!!!

[Medo]

Be sure Mr Becker: Your precious organs won't be stolen or purchased or other.
In fact, Your brain containing this inhuman project demonstrates the signs of Your staggering elderness.