Sunday, December 11, 2011

"Altruistic" Donations: In Fact, Payments are Allowed for Kidneys

Perhaps the most controversial kind of organ donation is the live donation, where the organ is harvested from a healthy human and given to someone whose organ has failed, or is about to. Obviously, live donations of a heart is impossible (I did once get back a referee report on a paper where the anonymous reviewer suggested I must have been the first successful live brain donor...). But other kinds of live donation, either a kidney or a portion of a liver, lung, or pancreas, are possible and relatively safe.

The problem is that the person who wants to donate is very unlikely to be a match for the person who needs it. You need a kidney, I want to donate mine, but you can't accept mine. And so we need to build a chain. But the chain is composed of people who, after the first altruistic donor, are all compensated in the sense that they are giving a resource to a family member. As this news story notes, it's actually a "swap," not a voluntary donation. Some background....

This video is quite good. It illustrates the importance of the payments implicit in the chain system, and also the naive insistence that there are no payments.

This letter from the Durham Herald Sun (Dec 10) is quite insightful:

In your editorial "Gift of Life, no death required" (December 6) you appropriately celebrate the rare willingness to be an altruistic kidney donor. You then say that more like the first recipient's daughter "help because someone they love was helped."

A very substantive issue is overlooked in both the editorial and the news stories covering this remarkable event, an event I, as a practicing nephrologist, also celebrate. The Duke transplant of two kidneys is often called "chain donation" and has been as many as 14 donor / recipient transplants of kidneys in other centers. This has become a popular but difficult method of improving the important opportunity to transfer patients away from dialysis to a better life.

But note that both the government and most ethicists have expressed deep concerns about payment to donors, a concern that I think needs reexamination. In these "chains," only the first donor is "altruistic." The others are "bridge donors." These are people who have made a contract to benefit a friend or family member...Clearly this is also a form of payment...I hope that experts will [analyze] the very thin line between this form of payment [and monetary compensation] and perhaps open the possibility of early transplantation for the tens of thousands of dialysis patients currently waiting years.

I am aware of the concern that poor people will be made "vulnerable" by the promise of money, but I also believe that safety and protection could be built into such a system.

Robert Gutman, Durham


A perfect illustation of the problem of euvoluntary exchange. Poor people are made "vulnerable," in point of fact, by being POOR. Selling a kidney would be a way to be less poor. But the medical establishment considers all incentives to be coercive. Poor people must be forced to remain poor, in a kind of human museum of poverty and misery. So they die with healthy kidneys. And wealthy people who would gladly pay hundreds of thousands of dollars for a healthy kidney and a better life must be doomed to live miserably and die young

All so doctors can feel good about themselves as being "ethical?" I just don't get it. Literally no one is benefitted by this system except the consciences of doctors who themselves make huge salaries, but dictate that no one else can get paid because incentives and medicine don't mix.

My good friend Virginia Postrel pretty much nails it here.

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Do you have suggestions on where we could find more examples of this phenomenon?