What do you think of paying kidney donors?

[missy]

http://www.medscape.com/viewarticle/860800?src=wnl_edit_tpal&uac=96935CJ

http://archsurg.jamanetwork.com/article.aspx?articleid=2505683

Most US Voters Approve of Paying Kidney Donors, Survey Finds

Marcia Frellick
March 23, 2016

Most US voters view living kidney donations positively, according to a telephone survey, and most also said they would be motivated toward such a donation if they received $50,000 in compensation.

A quantitative survey of 1011 registered US voters likely to vote found that 689 people (68%) would donate a kidney to anyone, and 235 (23%) would donate only to certain people; 87 (9%) would not donate.

Moreover, 59% said being paid $50,000 would make them even more likely to donate a kidney, 32% said the compensation did not sway them, and 9% were negatively influenced by payment.

Thomas G. Peters, MD, from the University of Florida College of Medicine in Jacksonville, and colleagues report the survey results in an article published online March 23 in JAMA Surgery.




Given their findings, Dr Peters and colleagues conclude that, "because thousands of lives might be saved should compensation increase the number of transplantable kidneys, laws and regulations prohibiting donor compensation should be modified to allow pilot studies of financial incentives for living kidney donors."

"Our findings refute the assertion that the US public, and particularly the American voter, holds payment for living kidney donation in disdain," they said.

The researchers wanted to gauge interest in donations and the potential influence of compensation, given the dire numbers behind the shortage of kidneys available for transplants, which has resulted in tens of thousands of preventable deaths. From 2004 to 2013, the authors note, 63,742 patients died or became too sick for a transplant while waiting for a kidney.

The current US kidney transplantation list has more than 100,000 names. There are risks with living kidney donations, but the adverse events have been minimal, the authors say. With living donations, the survival rate of the graft is almost twice that of deceased donors.

But such donations currently depend on altruism, because paying any donor is illegal under the National Organ Transplant Act.

There are legal programs that reimburse for donor costs such as lost wages, travel expenses, and follow-up care, but many donors do not qualify. More controversial is the practice of providing financial services such as a contribution to the donor's retirement fund or a tuition voucher.




To learn what US voters think of compensation for kidney donations, the authors had the survey professionally designed and conducted by an international polling firm. They used random digit dialing that selected respondents via both landlines and mobile telephones to improve representation. They also gathered information such as age, sex, and education level.

Young Most Likely to Approve of Pay

Results showed that 53 (78%) of 68 voters aged 18 to 29 years favored payment, which was a significantly higher percentage than in all other age groups (P < .05). However, 68 (63%) of 108 respondents aged 30 to 44 years and 266 of 459 respondents (58%) aged 45 years and older also favored paying living kidney donors.


In an accompanying invited commentary, Marco Del Chiaro, MD, PhD, from the Division of Surgery, Department of Clinical Science, Intervention, and Technology at Karolinska University Hospital in Stockholm, Sweden, and colleagues note that the size of the telephone survey was small, but even so, they found it interesting that the generally favorable attitude toward compensation and current laws do not match.

"Different reasons may account for this gap between legislation and perception (eg, effect of cultural background and different perception of ethics)," they write, "but an important influence may be knowledge of the risk related to kidney donation and the life-saving nature of transplantation in general. Based on the results of this survey, we will probably not witness a change in the current legislation on organ transplantation in the upcoming months, but it certainly carries an important message to society in general, the medical profession, legislators, and ethicists."

The study was supported by the Fair Allocations in Research (FAIR) Foundation, where Dr Peters serves as president and served as a director for more than a decade. The FAIR Foundation promotes access to organ transplants and the equitable distribution of biomedical research funds for all diseases. Dr Peters also worked closely with Penn Schoen Borland staff on statistical content analysis and administrative, technical, and material matters. One coauthor serves as vice president of the FAIR Foundation. The other authors have disclosed no relevant financial relationships.

JAMA Surg. Published online March 23, 2016. Article full text, Commentary

 

[TooPatient]

I said yes to this particular question. A kidney donation is relatively low risk. Heck, they pay for blood and sperm and other stuff.
If it gets more people to donate and saves more lives, then that is a great thing.
Compensating a person for the increased risk to them -- I include the surgery plus the possibility of their single kidney having issues in the future as increased risk -- seems not unreasonable.

That said, I think it opens the door to other things that are a lot more questionable. How about I donate the organs from my vegetative loved one if a high enough bid comes in? Or what about people desperate enough to care for their family that they want to donate something more serious (like a lung, chunks of liver, what have you).

So..... I don't know. Does the good out weigh the bad?

 

[kenny]

Sure.

 

[ksinger]

That's a good question, but only because it leads to a much broader discussion, of the moral limits of markets. THAT is the real issue, at the core of this and similar issues.

Not surprising anyone I'm sure, that I voted no.

What Money Can't Buy
http://www.amazon.com/What-Money-Cant-Buy-Markets/dp/0374533652

Review:
"A renowned political philosopher rethinks the role that markets and money should play in our society

Should we pay children to read books or to get good grades? Should we put a price on human life to decide how much pollution to allow? Is it ethical to pay people to test risky new drugs or to donate their organs? What about hiring mercenaries to fight our wars, outsourcing inmates to for-profit prisons, auctioning admission to elite universities, or selling citizenship to immigrants willing to pay?

In his New York Times bestseller What Money Can't Buy, Michael J. Sandel takes up one of the biggest ethical questions of our time: Isn't there something wrong with a world in which everything is for sale? If so, how can we prevent market values from reaching into spheres of life where they don't belong? What are the moral limits of markets?

In recent decades, market values have crowded out nonmarket norms in almost every aspect of life. Without quite realizing it, Sandel argues, we have drifted from having a market economy to being a market society. (emphasis mine)

In Justice, an international bestseller, Sandel showed himself to be a master at illuminating, with clarity and verve, the hard moral questions we confront in our everyday lives. Now, in What Money Can't Buy, he provokes a debate that's been missing in our market-driven age: What is the proper role of markets in a democratic society, and how can we protect the moral and civic goods that markets do not honor and money cannot buy?"

 

[kenny]

If buyer and seller are consenting adults, of sound mind and are fully informed then it's not immoral.
All the other scenarios the fear mongers bring up are ... well ... other scenarios.

One person gets to live and the other gets paid their sacrifice to make that possible.
Win win.

It's nobody's business but their own.

 

[ksinger]

If buyer and seller are consenting adults, of sound mind and are fully informed then it's not immoral.
All the other scenarios the fear mongers bring up are ... well ... other scenarios.

One person gets to live and the other gets paid their sacrifice to make that possible.
Win win.

It's nobody's business but their own.

You think then, that I should be able to sell my children that I don't want? I mean, the end result would not necessarily be any worse than me putting the child up for adoption through an agency, and certainly no different in the end result - the kid will end up with someone who wants her (presumably). You could even argue that selling the kid to the highest bidder ensures that the person doing the buying really REALLY wants my kid and will value her more than someone who gets her for free.

If we're going to allow a free market in organ sales, why not babies? There's a demand, there are people willing to sell, why not?

 

[kenny]

If buyer and seller are consenting adults, of sound mind and are fully informed then it's not immoral.
All the other scenarios the fear mongers bring up are ... well ... other scenarios.

One person gets to live and the other gets paid their sacrifice to make that possible.
Win win.

It's nobody's business but their own.

You think then, that I should be able to sell my children that I don't want? I mean, the end result would not necessarily be any worse than me putting the child up for adoption through an agency, and certainly no different in the end result - the kid will end up with someone who wants her (presumably). You could even argue that selling the kid to the highest bidder ensures that the person doing the buying really REALLY wants my kid and will value her more than someone who gets her for free.

If we're going to allow a free market in organ sales, why not babies? There's a demand, there are people willing to sell, why not?

... other scenario.

 

[TooPatient]

If buyer and seller are consenting adults, of sound mind and are fully informed then it's not immoral.
All the other scenarios the fear mongers bring up are ... well ... other scenarios.

One person gets to live and the other gets paid their sacrifice to make that possible.
Win win.

It's nobody's business but their own.

You think then, that I should be able to sell my children that I don't want? I mean, the end result would not necessarily be any worse than me putting the child up for adoption through an agency, and certainly no different in the end result - the kid will end up with someone who wants her (presumably). You could even argue that selling the kid to the highest bidder ensures that the person doing the buying really REALLY wants my kid and will value her more than someone who gets her for free.

If we're going to allow a free market in organ sales, why not babies? There's a demand, there are people willing to sell, why not?

There is sort of that already. There are adoptions arranged privately. At least one that I know of involved money trading hands.

I'm not saying that is right. This is what I included in my slippery slope statement.


This is a tricky topic! Lives can be lost or saved based on how this is dealt with. It does also open the discussion on other things too. Good or bad, I don't know.

I used to think that if I met someone who needed a kidney and mine was a match, I would just give it to them. No matter who they were. Simply because another person needed help and I could offer.
Now that I have a house and family and job and bills, that is not as obvious to me. Yes, I would like to be able to do that simply because it is the right thing to do (in my mind).... but what about the rest of life? A surgery like that would take me out of my job for at least a couple of weeks. No income. Could jeopardize my family's health insurance if it took long enough to recover. Also, as I start to have more stuff go on with my body I realize that it doesn't all just keep working forever. Giving a kidney away today could mean dying on the wait list next year. (while so sick I couldn't work)
So I guess, realistically, I would want to have some sort of financial cushion to absorb at least the immediate expenses.

 

[momhappy]

If buyer and seller are consenting adults, of sound mind and are fully informed then it's not immoral.
All the other scenarios the fear mongers bring up are ... well ... other scenarios.

One person gets to live and the other gets paid their sacrifice to make that possible.
Win win.

It's nobody's business but their own.

You think then, that I should be able to sell my children that I don't want? I mean, the end result would not necessarily be any worse than me putting the child up for adoption through an agency, and certainly no different in the end result - the kid will end up with someone who wants her (presumably). You could even argue that selling the kid to the highest bidder ensures that the person doing the buying really REALLY wants my kid and will value her more than someone who gets her for free.

If we're going to allow a free market in organ sales, why not babies? There's a demand, there are people willing to sell, why not?

Because organs aren't people....
As far as the topic is concerned, I agree with kenny and don't have an issue with it if it's two consenting adults.

 

[Laila619]

If we pay people to donate eggs and sperm, I certainly don't see why a kidney should be different.

 

[ksinger]

If buyer and seller are consenting adults, of sound mind and are fully informed then it's not immoral.
All the other scenarios the fear mongers bring up are ... well ... other scenarios.

One person gets to live and the other gets paid their sacrifice to make that possible.
Win win.

It's nobody's business but their own.

You think then, that I should be able to sell my children that I don't want? I mean, the end result would not necessarily be any worse than me putting the child up for adoption through an agency, and certainly no different in the end result - the kid will end up with someone who wants her (presumably). You could even argue that selling the kid to the highest bidder ensures that the person doing the buying really REALLY wants my kid and will value her more than someone who gets her for free.

If we're going to allow a free market in organ sales, why not babies? There's a demand, there are people willing to sell, why not?

... other scenario.

Roll your eyes all you want. This is not an out there scenario presented to derail the discussion, in spite of what you think.

People, perfectly decent, caring and desperate people, effectively “buy” babies all the time, even though it IS illegal. Why is that? Maybe because there is a moral component to markets? Maybe because making people or parts of people? into commodities to be sold to the highest bidder is morally repugnant?

“Or consider baby selling. Some years ago, Judg Richard Posner, a leading figure in the “law and economics” movement, proposed the use of markets to allocate babies to be put up for adoption. He acknowledged that more desirable babies would command higher prices than less desirable ones. But he argued that the free market would do a better system of allocating babies than the current system of adoption, which allows adoption agencies to charge certain fees, but not to auction babies or charge a market price.”


The author goes on to say that many people disagree with this, even if the market might be very efficient. Selling babies is like the market in kidneys, says he, neither one would dissolve the good the buyers’ seek to aquire - the kidney would still work and the baby will theirs.

So why don’t we allow either?

 

[kenny]

Other scenario.

This thread asked one question.

 

[ksinger]

Other scenario.

This thread asked one question.

Right. The Thread Stay ONLY on Topic Net Nanny Kenny just showed up. God forbid we talk about anything but THE question.

right back atcha.

 

[kenny]

The OP asked one simple question.
My answer has nothing to do with the price of eggs in Ethiopia.
... but nice try.

Go ahead and talk about anything on this thread.

But, what you tried to get away with was ... Kenny if you think X then you must also think Y.

BS on that.
I won't play.

 

[missy]

When I started this thread it was the moral and ethical implications involved that was on my mind and what makes this a difficult issue with no real right or wrong answer IMO. As with many issues that involve ethical dilemmas the potential for abuse is real and terrible. Is there a right way to do this? I don't know. I see both sides of the argument.

http://news.harvard.edu/gazette/story/2008/02/ethicists-philosophers-discuss-selling-of-human-organs/

Philosopher Samuel Kerstein, post-doctoral fellow in Harvard’s Program in Ethics and Health, was wary of markets for organs because of Immanuel Kant’s “Formula of Humanity” — in summary, “Act always in a way that expresses respect for the value of humanity.”

“To have value as a person is to have incomparable worth,” said Kerstein – so a market for organs that treats the poor as “tools available for the right price” is wrong.


Today, said Kerstein, “selling organs is wrong in the current context it is likely to occur.” That is — with little respect for human dignity, particularly for the dignity of the poor.

http://www.medscape.org/viewarticle/465200_4

Over time, the ethical questions that have remained fall into 3 general categories. First, some believe a commercial process would prey upon the disfranchised and poor by creating incentives that manipulate or coerce their inclination to donate, and that an unequal bargaining situation would be created that persistently disadvantaged those of meager means. Second, critics argue that putting a purchase "price" on a body part is akin to slavery and relegates humans to a subhuman status, and that our society should shun any attempt to dehumanize people. And finally, opponents of buying and selling organs for transplantation are concerned that a business arrangement of any sort would lead to the misrepresentation of medical information, especially if the donor were in dire circumstances or need of money.

 

[ksinger]

When I started this thread it was the moral and ethical implications involved that was on my mind and what makes this a difficult issue with no real right or wrong answer IMO. As with many issues that involve ethical dilemmas the potential for abuse is real and terrible. Is there a right way to do this? I don't know. I see both sides of the argument.

http://news.harvard.edu/gazette/story/2008/02/ethicists-philosophers-discuss-selling-of-human-organs/

Philosopher Samuel Kerstein, post-doctoral fellow in Harvard’s Program in Ethics and Health, was wary of markets for organs because of Immanuel Kant’s “Formula of Humanity” — in summary, “Act always in a way that expresses respect for the value of humanity.”

“To have value as a person is to have incomparable worth,” said Kerstein – so a market for organs that treats the poor as “tools available for the right price” is wrong.


Today, said Kerstein, “selling organs is wrong in the current context it is likely to occur.” That is — with little respect for human dignity, particularly for the dignity of the poor.

http://www.medscape.org/viewarticle/465200_4

Over time, the ethical questions that have remained fall into 3 general categories. First, some believe a commercial process would prey upon the disfranchised and poor by creating incentives that manipulate or coerce their inclination to donate, and that an unequal bargaining situation would be created that persistently disadvantaged those of meager means. Second, critics argue that putting a purchase "price" on a body part is akin to slavery and relegates humans to a subhuman status, and that our society should shun any attempt to dehumanize people. And finally, opponents of buying and selling organs for transplantation are concerned that a business arrangement of any sort would lead to the misrepresentation of medical information, especially if the donor were in dire circumstances or need of money.

Missy, I'm sorry. Discussion of or consideration of the moral thinking behind our societal choices to allow or not allow certain things to be sold, has been declared off limits.

 

[missy]

LOL Karen.

Has anyone watched the movie Dirty Pretty Things? Really good movie.
http://www.rogerebert.com/reviews/dirty-pretty-things-2003

And it has something to do with organ transplants so hope it's OK sharing I'm sharing it here. It is worth watching.

Back to the topic. I was hoping we would be discussing the morality of this issue as well as analogous dilemmas. Nothing is off topic as far as I'm concerned and anyway I don't think it is off topic.

 

[kenny]

Discussion of or consideration of the moral thinking behind our societal choices to allow or not allow certain things to be sold, has been declared off limits.

Says who?
Not me.

Discussion not off limits.
Discuss away.

I'm just not going to let someone manipulate me with BS garbage masquerading as debate.

But by all means, discuss away.

 

[MrsWhitney]

Couldn't agree more Kenny.

Discussion of or consideration of the moral thinking behind our societal choices to allow or not allow certain things to be sold, has been declared off limits.

Says who?
Not me.

Discussion not off limits.
Discuss away.

I'm just not going to let someone manipulate me with BS garbage masquerading as debate.

But by all means, discuss away.

 

[TooPatient]

When I started this thread it was the moral and ethical implications involved that was on my mind and what makes this a difficult issue with no real right or wrong answer IMO. As with many issues that involve ethical dilemmas the potential for abuse is real and terrible. Is there a right way to do this? I don't know. I see both sides of the argument.

http://news.harvard.edu/gazette/story/2008/02/ethicists-philosophers-discuss-selling-of-human-organs/

Philosopher Samuel Kerstein, post-doctoral fellow in Harvard’s Program in Ethics and Health, was wary of markets for organs because of Immanuel Kant’s “Formula of Humanity” — in summary, “Act always in a way that expresses respect for the value of humanity.”

“To have value as a person is to have incomparable worth,” said Kerstein – so a market for organs that treats the poor as “tools available for the right price” is wrong.


Today, said Kerstein, “selling organs is wrong in the current context it is likely to occur.” That is — with little respect for human dignity, particularly for the dignity of the poor.

http://www.medscape.org/viewarticle/465200_4

Over time, the ethical questions that have remained fall into 3 general categories. First, some believe a commercial process would prey upon the disfranchised and poor by creating incentives that manipulate or coerce their inclination to donate, and that an unequal bargaining situation would be created that persistently disadvantaged those of meager means. Second, critics argue that putting a purchase "price" on a body part is akin to slavery and relegates humans to a subhuman status, and that our society should shun any attempt to dehumanize people. And finally, opponents of buying and selling organs for transplantation are concerned that a business arrangement of any sort would lead to the misrepresentation of medical information, especially if the donor were in dire circumstances or need of money.

Great sources. The implications of this being okay or not are huge. Is a part of a body just a thing to be sold? Is it giving wealthy people an unfair advantage in that they can purchase organs to save their lives while the less well off are forced to sell just to try to make ends meet? I think the answer, in my mind, is yes to both questions.

Removing a piece of my body (assuming it does not end my life) if I am consenting to give to another in hopes of saving their life is a great thing. Some incentive to get more people to take the risks and donate while living has the potential to save many lives.
That said, it has been a very difficult few years. I have, on multiple occasions, followed up on things I had heard. Had there been any monetary incentive, I would have donated any bit of my body I could spare. (those bits that they want have such a long screening process and advance paperwork and small pay that nothing was worth it to me) I don't know if this would have been entirely bad. Having a chunk of money would have saved us huge stress and difficult decisions. There were days I didn't know how we would eat.

There are great advances being made in creating organs or growing them from other tissues. I hope that one day those will be so widely available and successful that there is no need for humans to donate. Until then, we need to improve the system. People are dying. I think a good balance needs to be reached so that we do not detract from the value of humans while doing so but.... What is a human life worth if we just let it end rather than do what we can to preserve it?

 

[ksinger]

LOL Karen.

Has anyone watched the movie Dirty Pretty Things? Really good movie.
http://www.rogerebert.com/reviews/dirty-pretty-things-2003

And it has something to do with organ transplants so hope it's OK sharing I'm sharing it here. It is worth watching.

Back to the topic. I was hoping we would be discussing the morality of this issue as well as analogous dilemmas. Nothing is off topic as far as I'm concerned and anyway I don't think it is off topic.

Well in spite of Kenny's assuming a nefarious plan on my part to engage him in BS masquerading as debate and to MAKE him think like me, I was not. Here is a bit more from the beginning of the chapter I originally quoted from:

"...the more challenging question that concerns us: Are there some things that money can buy but shouldn't? Consider a good that can be bought but whose buying and selling is morally controversial-- a human kidney, for example. Some people defend markets in organs for transplantation, others find such markets morally objectionable.....So to determine whether kidneys should or shouldn't be up for sale, we have to engage in a moral inquiry. We have to examine the arguments for and against organ sales and determine which are more persuasive."

Sound anything like what you were after?

It is a fascinating book, addressed organ sales (your issue) and many others, and is thus a good jumping off point for discussion of the moral facets of your thread topic.

 

[kenny]

Well in spite of Kenny's assuming a nefarious plan on my part to engage him in BS masquerading as debate and to MAKE him think like me, I was not.

Another post worthy of only ...

 

[lambskin]

I just renewed my drivers license today and I have always been a organ donor.

 

[Resonance.Of.Life]

I said yes to this particular question. A kidney donation is relatively low risk. Heck, they pay for blood and sperm and other stuff.
If it gets more people to donate and saves more lives, then that is a great thing.
Compensating a person for the increased risk to them -- I include the surgery plus the possibility of their single kidney having issues in the future as increased risk -- seems not unreasonable.

That said, I think it opens the door to other things that are a lot more questionable. How about I donate the organs from my vegetative loved one if a high enough bid comes in? Or what about people desperate enough to care for their family that they want to donate something more serious (like a lung, chunks of liver, what have you).

So..... I don't know. Does the good out weigh the bad?

Actually, you cannot get paid to donate blood. You can get paid to donate plasma, but that is strictly for research purposes. Any blood product that actually gets transfused into a patient, cannot be obtained by paying a donor. It is strictly voluntary as allowing for donors to be paid for these blood donations will increase the likelihood that people will be dishonest in the screening process and put the blood supply at risk. I've worked previously for both a major blood bank (biggest one there is in the US) and for a major trauma 1 hospital's own blood bank and there are very strict regulations even regarding compensation such as "free ice cream coupons" in return for donating your time.

And while, many donors are honest, some are dishonest and it comes out when they tell me AFTER they've donated the unit that they wanted to know when they could get the test results for the HIV testing we do since they spent the weekend in Vegas after having had unprotected sex. SMH We immediately tag the unit for disposal. We can no longer trust that their questions were answered truthfully and will not risk introducing that into the blood supply.

I can see why I would be weary of someone getting paid to donate a kidney-- the same concerns for the blood supply would apply here. While testing is very accurate, there is still a window in which an person infection with HIV, HEPC, and/or HEPB can test negative with NAT testing. Working in the ICU now, I directly see the effects of transplants and blood donations (for all blood products) and I cannot stress how important it is to donate blood. Please, do consider being an organ donor as well.

 

[TooPatient]

I said yes to this particular question. A kidney donation is relatively low risk. Heck, they pay for blood and sperm and other stuff.
If it gets more people to donate and saves more lives, then that is a great thing.
Compensating a person for the increased risk to them -- I include the surgery plus the possibility of their single kidney having issues in the future as increased risk -- seems not unreasonable.

That said, I think it opens the door to other things that are a lot more questionable. How about I donate the organs from my vegetative loved one if a high enough bid comes in? Or what about people desperate enough to care for their family that they want to donate something more serious (like a lung, chunks of liver, what have you).

So..... I don't know. Does the good out weigh the bad?

Actually, you cannot get paid to donate blood. You can get paid to donate plasma, but that is strictly for research purposes. Any blood product that actually gets transfused into a patient, cannot be obtained by paying a donor. It is strictly voluntary as allowing for donors to be paid for these blood donations will increase the likelihood that people will be dishonest in the screening process and put the blood supply at risk. I've worked previously for both a major blood bank (biggest one there is in the US) and for a major trauma 1 hospital's own blood bank and there are very strict regulations even regarding compensation such as "free ice cream coupons" in return for donating your time.

And while, many donors are honest, some are dishonest and it comes out when they tell me AFTER they've donated the unit that they wanted to know when they could get the test results for the HIV testing we do since they spent the weekend in Vegas after having had unprotected sex. SMH We immediately tag the unit for disposal. We can no longer trust that their questions were answered truthfully and will not risk introducing that into the blood supply.

I can see why I would be weary of someone getting paid to donate a kidney-- the same concerns for the blood supply would apply here. While testing is very accurate, there is still a window in which an person infection with HIV, HEPC, and/or HEPB can test negative with NAT testing. Working in the ICU now, I directly see the effects of transplants and blood donations (for all blood products) and I cannot stress how important it is to donate blood. Please, do consider being an organ donor as well.

Interesting!

I am embarrassed to say that I have never donated as I am terribly afraid of needles. Thank you for clarifying as I only have what other people have said to go on (and even that is very spotty as I don't like to hear about things with needles!).

That is a different point of view than I had heard before and certainly something I never would have thought of. I'm sorry people do that. I'm sure it makes all sorts of problems for those working in the system doing their best to screen for that sort of thing and also those receiving treatments having to wonder.

 

[missy]

LOL Karen.

Has anyone watched the movie Dirty Pretty Things? Really good movie.
http://www.rogerebert.com/reviews/dirty-pretty-things-2003

And it has something to do with organ transplants so hope it's OK sharing I'm sharing it here. It is worth watching.

Back to the topic. I was hoping we would be discussing the morality of this issue as well as analogous dilemmas. Nothing is off topic as far as I'm concerned and anyway I don't think it is off topic.

Well in spite of Kenny's assuming a nefarious plan on my part to engage him in BS masquerading as debate and to MAKE him think like me, I was not. Here is a bit more from the beginning of the chapter I originally quoted from:

"...the more challenging question that concerns us: Are there some things that money can buy but shouldn't? Consider a good that can be bought but whose buying and selling is morally controversial-- a human kidney, for example. Some people defend markets in organs for transplantation, others find such markets morally objectionable.....So to determine whether kidneys should or shouldn't be up for sale, we have to engage in a moral inquiry. We have to examine the arguments for and against organ sales and determine which are more persuasive."

Sound anything like what you were after?

It is a fascinating book, addressed organ sales (your issue) and many others, and is thus a good jumping off point for discussion of the moral facets of your thread topic.

Yes exactly. Thanks Karen. I don't think one can consider this issue without thinking about the whole picture and the potential for abuse inherent in these issues.

I know if I had a loved one for whom getting a kidney was a life and death issue and where time was paramount I would want to be able to procure one for them in the quickest best way possible. But having said that the moral implications are far reaching and should not be considered lightly. Is there a right way to make more kidneys available for those who so desperately need them without these ethical dilemmas that most definitely exist? I cannot figure it out right now but hopefully smarter minds can and will.

 

[missy]

I said yes to this particular question. A kidney donation is relatively low risk. Heck, they pay for blood and sperm and other stuff.
If it gets more people to donate and saves more lives, then that is a great thing.
Compensating a person for the increased risk to them -- I include the surgery plus the possibility of their single kidney having issues in the future as increased risk -- seems not unreasonable.

That said, I think it opens the door to other things that are a lot more questionable. How about I donate the organs from my vegetative loved one if a high enough bid comes in? Or what about people desperate enough to care for their family that they want to donate something more serious (like a lung, chunks of liver, what have you).

So..... I don't know. Does the good out weigh the bad?

Actually, you cannot get paid to donate blood. You can get paid to donate plasma, but that is strictly for research purposes. Any blood product that actually gets transfused into a patient, cannot be obtained by paying a donor. It is strictly voluntary as allowing for donors to be paid for these blood donations will increase the likelihood that people will be dishonest in the screening process and put the blood supply at risk. I've worked previously for both a major blood bank (biggest one there is in the US) and for a major trauma 1 hospital's own blood bank and there are very strict regulations even regarding compensation such as "free ice cream coupons" in return for donating your time.

And while, many donors are honest, some are dishonest and it comes out when they tell me AFTER they've donated the unit that they wanted to know when they could get the test results for the HIV testing we do since they spent the weekend in Vegas after having had unprotected sex. SMH We immediately tag the unit for disposal. We can no longer trust that their questions were answered truthfully and will not risk introducing that into the blood supply.

I can see why I would be weary of someone getting paid to donate a kidney-- the same concerns for the blood supply would apply here. While testing is very accurate, there is still a window in which an person infection with HIV, HEPC, and/or HEPB can test negative with NAT testing. Working in the ICU now, I directly see the effects of transplants and blood donations (for all blood products) and I cannot stress how important it is to donate blood. Please, do consider being an organ donor as well.

Thanks for sharing ROL. Important points and it illustrates how complex this situation is.

 

[missy]

When I started this thread it was the moral and ethical implications involved that was on my mind and what makes this a difficult issue with no real right or wrong answer IMO. As with many issues that involve ethical dilemmas the potential for abuse is real and terrible. Is there a right way to do this? I don't know. I see both sides of the argument.

http://news.harvard.edu/gazette/story/2008/02/ethicists-philosophers-discuss-selling-of-human-organs/

Philosopher Samuel Kerstein, post-doctoral fellow in Harvard’s Program in Ethics and Health, was wary of markets for organs because of Immanuel Kant’s “Formula of Humanity” — in summary, “Act always in a way that expresses respect for the value of humanity.”

“To have value as a person is to have incomparable worth,” said Kerstein – so a market for organs that treats the poor as “tools available for the right price” is wrong.


Today, said Kerstein, “selling organs is wrong in the current context it is likely to occur.” That is — with little respect for human dignity, particularly for the dignity of the poor.

http://www.medscape.org/viewarticle/465200_4

Over time, the ethical questions that have remained fall into 3 general categories. First, some believe a commercial process would prey upon the disfranchised and poor by creating incentives that manipulate or coerce their inclination to donate, and that an unequal bargaining situation would be created that persistently disadvantaged those of meager means. Second, critics argue that putting a purchase "price" on a body part is akin to slavery and relegates humans to a subhuman status, and that our society should shun any attempt to dehumanize people. And finally, opponents of buying and selling organs for transplantation are concerned that a business arrangement of any sort would lead to the misrepresentation of medical information, especially if the donor were in dire circumstances or need of money.

Great sources. The implications of this being okay or not are huge. Is a part of a body just a thing to be sold? Is it giving wealthy people an unfair advantage in that they can purchase organs to save their lives while the less well off are forced to sell just to try to make ends meet? I think the answer, in my mind, is yes to both questions.

Removing a piece of my body (assuming it does not end my life) if I am consenting to give to another in hopes of saving their life is a great thing. Some incentive to get more people to take the risks and donate while living has the potential to save many lives.
That said, it has been a very difficult few years. I have, on multiple occasions, followed up on things I had heard. Had there been any monetary incentive, I would have donated any bit of my body I could spare. (those bits that they want have such a long screening process and advance paperwork and small pay that nothing was worth it to me) I don't know if this would have been entirely bad. Having a chunk of money would have saved us huge stress and difficult decisions. There were days I didn't know how we would eat.

There are great advances being made in creating organs or growing them from other tissues. I hope that one day those will be so widely available and successful that there is no need for humans to donate. Until then, we need to improve the system. People are dying. I think a good balance needs to be reached so that we do not detract from the value of humans while doing so but.... What is a human life worth if we just let it end rather than do what we can to preserve it?

Yes, what is the answer? Does the weight of saving some outweigh the potential damage to others? The ethical and moral issues that cannot be ignored?

 

[wildcat03]

I live in an urban area where there there are a lot of poor people who get little or no primary care who end up on dialysis. I HATE the idea of paying for a kidney. Why? Because those who are already financially downtrodden will be most likely to try to sell their kidney. And then they'll go 20-30 years without ever seeing another doctor, during which time their raging hypertension or undetected diabetes mellitus will kill their kidneys. So, instead of having poor kidney function and scraping by without dialysis, they'll now need dialysis. All so some wealthy person (who paid for the kidney) could avoid dialysis.

 

[WeeOui]

Man, this is an interesting question. I would have sold mine in my twenties for some good seats at a Pearl Jam concert.