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If we were to provide some kind of inducement, financial or otherwise, wouldn't that imply transaction rather than donation?

And might the provision of medical insurance for those who had 'donated' a kidney, be thought of as irony?

Just wondering.

Peter, you ask very good questions.

1. The term 'donation' does seem odd in this context. That, however, is the term that is used of other donations in medicine even when payment is involved (e.g, sperm donations, blood donations). I accept that it sounds incongruous.

2. There would be no irony, I think, in medical insurance (within the US context) as an inducement. The donor would exit the operation healthy, and as much in need of insurance (in the US) as anyone else.

"What do you think? Should the law be changed to permit the use of financial inducements to increase the supply of kidney donations..?"

Unless the kidneys belong to the government, then the government has no right to restrict their sale. And, as Drew Carey points out in (a part of his excellent Reason TV series), the doctors get paid, the nurses get paid, the hospital gets paid, the surgeon and anesthesiologist, the janitors - everyone gets paid - except the guy who must live the rest of his life on one remaining kidney; the law stands in his way of being compensated!

It's bizarre, wrong and, as I said, not the government's kidney to dictate the terms of transfer in the first place.

This has echoes of the 1978 film "Coma":

First, John

"everyone gets paid - except the guy who must live the rest of his life on one remaining kidney"

Surely the point is that he doesn't actually have to live the rest of his life with one kidney, he could keep both, presumably he's free to do that.

Then generally:

Let's say I have a kidney to 'donate'. On the basis of the discussion here, I get to feel good, magnanimous even, about donating the said kidney and then, receive a financial reward too. At this point I really want to press home the reality that this is selling, not donating, whatever the semantics of medicine, and as soon as this happens we're in the marketplace.

Let's then imagine another scenario, just before I sign the contract (?) a more wealthy patient offers me double money. What now?

*Ethics* and *window* spring to mind.

The rich win, the poor lose, and the government should be doing something about that.

Peter- Thanks for replying, but....


"Surely the point is that he doesn't actually have to live the rest of his life with one kidney..."

I'm not sure how you intend to engage with my comment by making the point that a donor is free not to donate. Isn't that the very problem that a change in the law would intend to redress? In short, that's as far from being "the point" as possible.


"Let's then imagine another scenario, just before I sign the contract (?) a more wealthy patient offers me double money. What now? .... The rich win, the poor lose, and the government should be doing something about that."

The rich and the poor BOTH lose in the current scenario, since there's a massive shortage in donors. It's difficult to see how you intend to stop the rich coming first in buying power by banning all buying. (?) 'Destroy the market' is your answer? Meantime, people are dying because we don't want to see the rich get the first organs?

And since when was it a surprise that wealthy people are able to enjoy better lifestyles than those who aren't as wealthy? You actually think that's wrong? Wealthy people are wealthy legitimately, Peter, in most cases. They worked for it (or inherited it) and now they have it. I don't begrudge them that in the slightest, nor the increased buying power that the money offers them.

So people with more money get better access to organs. If you think that's an injustice I can't help you, but why you think it means poor people 'lose' is beyond me - in a free market, enough organs are available. The irony is that - as I said above - your answer actually leaves fewer kidneys for transplant than mine!

Peter- *correction/summary*

I should have said that in banning the sale of organs you're certainly achieving your goal of preventing the rich coming first in organ donation (an asinine goal, imo). At the same time, you're also killing off or dramatically decreasing the quality of life of those awaiting a transplant.

I hope the tradeoff is worth it.

Hi John

I engage on this basis.

The ethical question arises because we are asking the question should it be done, as well as asking the question can it be done. Offering money in exchange for human organs, which is the point of the debate, may indeed increase the supply, but that in and of itself does not make the practice ethical. The are other issues to consider, that of availability to all in medical need, being one of them. The rich may well have earned their money legitimately, I have no problem with that, and they may well be able to enjoy a privileged lifestyle, holidays, winter ski lodges etc. but I'm not sure that the ability to buy 'lifestyle' extends to the ability to buy life.

In the end, we are all to some extent, 'the government' and our duty of care extends to all citizens. It's not about stopping the rich coming first, it's about equality. Hence, for all it's failings, the concept of a National Health Service in the UK.

Anyway there are alternatives, such as presumed consent and public education.

As an American, I definitely like the idea of free medical insurance.

an American, I definitely like the idea of free medical insurance.

Despite all the shortcomings, the NHS is an excellent service and far better than the system in the US. I can testify to that as someone who has had to make use of it over the years.

The problem with a health insurance system is this. If your generally well everything is fine. However, start making claims and the premiums will go up, in the same way as all other forms of insurance. In the US I'd probably be uninsurable, or if I did manage to get insured the premiums would probably cost a fortune.

One of the most alarming pieces of news footage I've seen over the last year or so was of a woman in California, wandering the streets and still with a drip attached to her arm, after being discharged from a hospital because she couldn't afford to pay for medical insurance. She was apparently suffering from pneumonia.Aftera while she made her way to a drop in centre where she eventually died. Deplorable for a supposed civilised country.

Peter-

"The are other issues to consider, that of availability to all in medical need, being one of them."

Economics 101, Peter. Better in a free market than in no market at all (as in evidence by the lack of available organs under the current law). And if I badly needed a kidney, frankly £24,000 would be a very fair price to pay.


"It's not about stopping the rich coming first, it's about equality."

I agree. But you want equality of lack rather than equality of plenty. Your position ensures that everyone is equally lacking in organ availability. Mission accomplished? I don't mean to be rude, but Stalin would have loved your way of thinking.


"I'm not sure that the ability to buy 'lifestyle' extends to the ability to buy life."

Clearly you and I look at these issues very differently. Are you a socialist of some kind? Because it seems to me that the logical conclusion of your comments is that maybe the rich shouldn't be allowed to use their wealth to eat better (also an advantage in health) or to buy more relaxing vacations (also an advantage) or to do anything else on behalf of themselves that their larger bank account can sustain. What sets apart their enhanced ability to buy organs as being a source of particular annoyance for you?


"Anyway there are alternatives, such as presumed consent and public education."

We already have public education. It isn't encouraging many people to give up their kidneys. And I can't believe you'd favour presumed consent; if my position is on the pro-liberty side, presumed consent is on the other. (See my colleague Stephen Graham's article on that topic .)

hmmmm £24k thats about half of what you need as a deposit to get a mortgage these days, I'd be tempted.

Lots of people donate kidneys, sadly no where near enough, if you take out the number of people giving them to a close relative how many do we have left? very very very few.

Yes you can theoretically live healthily for the rest of your life on one kidney, but there is a risk.
What if that one fails in later life? What if the operation doesn't go well? people are taking a risk and offering financial compensation could help boost numbers.

In order to solve the rich/poor debate hows about the hospitals pay fixed compensation levels for the donors, and recipient patients can pay/donate what they can afford into hospital funds, Given that processes exist to make organ donation anonymous this shouldn't be difficult to achieve?

"In order to solve the rich/poor debate hows about the hospitals pay fixed compensation levels for the donors, and recipient patients can pay/donate what they can afford into hospital funds..."

Okay, the latter part of this will yield little in the way of funding, since you actually don't have to pay anything to get a kidney (the government will tax others to do it for you, no?).

The first part sounds okay in the UK since you citizens are already being taxed out the ass for the NHS anyway; what's another few zeros on the end of that bill for buying organs?

On a side note, I didn't know there was this many people that resentful of people wealthier than them. It is perfectly logical to me that wealthy people have greater buying power and I don't have a problem with that in the slightest. I hope to increase my own buying power throughout my life (and will probably accomplish this quicker than those who do nothing but complain about the wealthy).

And it is fallacious to characterise this as a 'rich/poor debate' - as if by having better access to organs the rich would take them ALL, leaving NONE for average people - average people, as demonstrated above, will pay for an organ, since it effects the small matter of whether they live or die. People in GENUINE POVERTY are already covered by many government programs and it wouldn't be hard to create another for the few in real hardship who need an organ (by the way about half of US citizens are already covered by the government for their healthcare, contrary to what morons like Moore would have you believe - - in other words, those who really need it and can't afford it ARE GIVEN IT ALREADY - - this wouldn't change in the matter of organs which would be purchased by Medicare or Medicaid on their behalf).

Hi John

No I am not a socialist, however I find your suggestion enlightening, as are the comments, 'I didn't know there was this many people that resentful of people wealthier than them' and 'And it is fallacious to characterise this as a 'rich/poor debate'.

First of all, from what I can see, no one has spoken of resentment; rather some have spoken up for the poor, this is something different. It is called responsibility, or social conscience, and it is altogether different from socialism. Nor do you know how wealthy any of us are, nor do you know how hard we work. The ratio of high earning to hard work is not always a direct correlation. I would be interested to know if you extend your argument to, say for example, education. Ought the state to refuse to teach those who cannot pay. Maybe we ought to teach them to count, but not to read.

Secondly Economics 101 is about rich and poor, as it is about supply and demand.

You can't believe that I would consider presumed consent. John you're going to have to help me out here. You argue that those who are no longer in need of perfectly useful organs i.e. dead people, be allowed to exercise their liberty beyond the grave to deny others the chance of life, yet you argue for the provision of more donor organs via the free market. I mean, the idea that I will sell someone my organ, but under no circumstances will I countenance donating it, even after death, is hard to follow. Which is more benign?

Thanks for the link to the article by Stephen Graham, good article, but he quotes, in disagreement, "Given that 1000 people in this country die every year waiting for organs, and we have a relatively low level of donation, anything we can do to get those numbers up must be right", and the difference between this and your position of, "your answer actually leaves fewer kidneys for transplant than mine!", is?

Here the trade off is between people (dead people) who do not need their (is there a their anymore) kidneys and people who need surgery. Is this worth it?

The basic difference in our points of view appears to be that of personal liberty. But no one exercises liberty to its logical conclusion, there are always limits, self imposed or otherwise. There is also a middle ground between the free market and socialism. One in defining the difference between human body parts and ipods, and secondly in the provision of health care for all, based on the concept of human dignity. Furthermore I do not distance myself from the government in the way Stephen suggested. As I have said, we are all, to some extent, the government. If we were merely a bunch of individuals there would be no such thing as nation and it would also be difficult to see how any concept of human rights could be worked out without a degree of consensus. That is what the NHS is all about, and no I don't feel as if I am "already being taxed out the ass"



"Universal Declaration of Human Rights

Article 25

(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."

What without so called government 'interference'?

Peter-

Thanks for the conversation. You make a useful observation which is that our main disagreement is about personal liberty (and the rights therewith). You're right. You say there are limits to liberty. I agree. But those limits cannot be set arbitrarily by government OR people, issue-by-issue; they're already set by the concept of natural rights (rights which each individual takes INTO the political process).

That's where we dissent: where I believe that Adam's liver is his own to sell and that Eve's money is her own to spend on Adam's liver, you believe Adam and Eve should both have to answer to 'government' or 'society' or 'the collective' or 'the commune' (whatever you prefer) instead, an entity which may choose to infringe upon that peaceful transaction. What I'm arguing in this thread is that the law set by government should reflect a right that already exists.


Now, about the rich:

"First of all, from what I can see, no one has spoken of resentment; rather some have spoken up for the poor, this is something different."

It is. But arguing against an organ market is not speaking up for the poor; at worst an organ market would cater only to the rich without affecting the position of the poor whatsoever (though both you and I have said we'd pay 24k for a kidney if we needed it - I'm not rich, are you?).


"Nor do you know how wealthy any of us are, nor do you know how hard we work. The ratio of high earning to hard work is not always a direct correlation."

I agree, it's not always, although I must say that every high-earner I know works their ass off to earn that salary (my point being that, at least anecdotally, there is a very very high degree of correlation, and I'd suspect political motivation in an attempt to minimise the impact of that correlation upon a discussion like this).


"I would be interested to know if you extend your argument to, say for example, education. Ought the state to refuse to teach those who cannot pay."

The state shouldn't be teaching in the first place. Schools in America until fairly recently were private, and parents paid the school directly rather than in taxes; for those who couldn't afford it, nonprofit organisations, charities and churches ran schools funded by donations. Of course this sounds alien to you so you'll find a way to deny that it ever worked and defend the status-quo (which, of course, is without any problems whatsoever).


"Secondly Economics 101 is about rich and poor, as it is about supply and demand."

Rich and poor are not static quantities. The nations with the highest degrees of personal liberty are the nations with the most prosperity, the largest middle classes and the smallest amount of real poverty.


About presumed consent:

"You argue that those who are no longer in need of perfectly useful organs i.e. dead people, be allowed to exercise their liberty beyond the grave to deny others the chance of life, yet you argue for the provision of more donor organs via the free market."

Beyond the grave? You won't even let them get in the grave! And this sentence is telling: "...be allowed to..."


"I mean, the idea that I will sell someone my organ, but under no circumstances will I countenance donating it, even after death, is hard to follow. Which is more benign?"

Hold now. You've set up, 'No donating it under any circumstances' against 'I'll sell it', when in fact the presumed consent concept we're discussing would in reality set up, 'We'll take it out of your cold corpse no matter your family's wishes to the contrary' against 'I'll sell it by an act of real consent when I'm still alive!' Which is more benign?


"Thanks for the link to the article by Stephen Graham, good article, but he quotes, in disagreement, 'Given that 1000 people in this country die every year waiting for organs, and we have a relatively low level of donation, anything we can do to get those numbers up must be right', and the difference between this and your position of, 'your answer actually leaves fewer kidneys for transplant than mine!', is?"

I'm happy to point out the difference. Stephen took issue with the sentence disagreeing that "...anything we can do...must be right." He disagreed with that pragmatic approach to politics (a utilitarian approach) in which the position advocated is the position which will yield the best results (in this case presumed consent is advocated because it will give us a truckload of kidneys).

But my position is based on rights, not pragmatism. A rights-based approach yields the answer that no matter the practical results, rights should be upheld (in this case, rights to buy or sell organs). Let's assume for a second that allowing people to buy or sell their own organs would produce horrible results (for instance that we know people would sell their eyes and walk around blind, for the money). Would I still advocate the position? Yes, because their rights dictate the position, not some utilitarian logic.

This is not unusual. People do risky things all the time because it is their right to do so. Is the net result of playing rugby good or bad, overall? So many injuries on the field, so much junk food and beer in the stands, so much carbon being emitted. It would be easy to make a utilitarian case against rugby, as it is to make a utilitarian case for presumed consent.

Anyway, in asserting that your position leaves fewer kidneys for transplant than my own, I'm merely pointing out that the practical results (the utilitarian factors) are better in addition to the fact that it upholds rights. And thus a utilitarian like you - however philosophically addled! - and a libertarian like me - however arrogant! - should both be able to agree on a position advocating a market for human organs.

John

Interesting conversation.

A few reflections.

Natural rights. I think it would be helpful to me if you outlined more fully the basis on which you hold this view. I still prefer to think in terms of the benefit of the individual *and* the group. Checks and balances, if you like.

I agree, an organ market is unlikely to affect the position of the poor, hence the consideration of presumed consent. We disagree, I know, probably on the basis of our initial paradigms.

I am not rich, unless an average Western citizen is compared with a citizen the 'developing world'. Of course Western civilisation is not the only model of 'society' which works. Nor am I sure that I said I would pay for a kidney.

The notion of the state not providing education is not foreign to me, historically that was pretty much the position here to, however we are in the interesting situation here of people arguing against non-profit organisations, particularly churches, being involved in education. If you are suggesting that government interference should be a light as possible, yes I agree, but, I also believe that part of it's function is check and balance. We are the government remember.

On the issue of which is more benign, I think our emphasis merely reflects our initial stance.

Your view is that rights dictate. I ask, am I really all that free? It's cheeky question I know, but I’m asking it anyway.

I do not, for one moment believe you to be arrogant!

Peter- If only all discussions were as intelligent and all points as well-argued as this.


"Natural rights. I think it would be helpful to me if you outlined more fully the basis on which you hold this view."

Well the Wikipedia page on natural rights; I think everyone believes in at least some natural rights - the right to life, for instance. Personally I hold it on the basis of egoism and manifesting in the political philosophy of libertarianism. my primer page on that, which basically says that all human actions should be free unless they infringe on the equal rights of others.


"I agree, an organ market is unlikely to affect the position of the poor, hence the consideration of presumed consent."

But then you wouldn't be against forming an organ market.


...we are in the interesting situation here of people arguing against non-profit organisations, particularly churches, being involved in education..."

I wouldn't send my child to a school which taught creationism, though I'd send my child to a school connected with a church which had a 'secular' attitude to education.


"Your view is that rights dictate. I ask, am I really all that free? It's cheeky question I know, but I?m asking it anyway."

It's a decidedly relevant question. I don't think I am all that free. That's why I'm a libertarian!

Hi John

Thanks for the conversation.

I'll check out the links you gave, read up a bit, an hopefully learn something new.

It's a bad day when there's nothing new to learn!

Peter- Agree :)

"One of the most alarming pieces of news footage I've seen over the last year or so was of a woman in California, wandering the streets and still with a drip attached to her arm, after being discharged from a hospital because she couldn't afford to pay for medical insurance. She was apparently suffering from pneumonia. After a while she made her way to a drop in centre where she eventually died. Deplorable for a supposed civilised country. "

This story is bollocks. If she fell below the poverty line she would have been covered by Medicaid. If she was a senior citizen she'd have been covered by Medicare. The idea that America doesn't have government healthcare is an urban myth. In fact about half of Americans are insured by the US government for the value of more money than the whole UK GDP.

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