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"Let’s Donate A Kidney!"
It’s the organ donation version of “Let’s Make A Deal!” From a story by Kate Connolly in The Guardian:

A Dutch reality television show in which a terminally ill woman is to select one of three contestants to receive her kidneys when she dies is to air this week despite criticism that it pushes the boundaries of the format too far.

The government has called for De Grote Donorshow (The Big Donor show) to be dropped because it is "unethical" and "wretched" but the broadcaster BNN said it would go ahead to highlight the difficulties of searching for kidney donors.

In the show, due to be broadcast on Friday, a woman identified only as Lisa, 37, will select a recipient based on their history, profile and conversations with their families and friends. Throughout the 80-minute show, viewers will be invited to send Lisa text messages to advise her.

The ruling coalition parties the Christian Democrats and the Christian Union have condemned the show.

But BNN's chairman, Laurens Drillich, said the show would increase by a third the participants' chances of getting a new kidney. "The chance for a kidney for the contestants is 33%," he said. "This is much higher than that for people on a waiting list. You would expect it to be better, but it is worse."

It’s your body…I think you should be able to sell it or give it away if you want to. Is it…tacky…to do it this way? Well, maybe what’s really tacky is dying without an organ transplant because your government thinks it’s tacky, or somehow otherwise wrong, to buy and sell organs. Or just rent access to your vagina for an hour or so.

Here’s an article by Dr. Sally Satel, one of the lucky Americans to get a donated kidney (from my pal Virginia Postrel), who says allowing organ sales is the best way the provide more donated organs:

The chasm between the number of available kidneys and the number of people needing one will widen each year. This is due to our misplaced faith in the power of altruism. The “transplant community,” as it is called—organizations that encourage funding and gifts of organs, and many surgeons and nephrologists—expects people, both living donors and loved ones of the deceased, to give a body part and to receive nothing in return. In fact, it is illegal in the United States to receive money or anything of value (“valuable consideration”) in exchange for an organ, a principle set down by Congress in 1984 in the National Organ Transplantation Act.

Don’t get me wrong. Altruism is a beautiful thing—it’s the reason I have a new kidney—but altruism alone cannot resolve the organ shortage. For that reason, more and more physicians, ethicists, economists, and legal scholars are urging the legalization of payments for organs in order to generate more kidneys for transplantation. One doesn’t need to be Milton Friedman to know that a price of zero for anything virtually guarantees its shortage.

“Is it wrong for an individual…who wishes to utilize part of his body for the benefit of another [to] be provided with financial compensation that could obliterate a life of destitution for the individual and his family?” asked Dr. Richard Fine, president of the American Society of Transplantation, in his address to the World Transplant Congress this year.

Supporters of experimenting with a market for organs encounter an array of objections, theoretical and practical. One popular argument, first advanced by Richard M. Titmuss, professor of social administration at the London School of Economics, is that altruism is the sole legitimate impulse behind organ donation. In 1971, Titmuss, a dedicated socialist and member of the Fabian Society, published The Gift Relationship: From Human Blood to Social Policy, which rapidly became a U.S. bestseller. He argued that altruistic acts are among the most sensitive indicators of the quality of human relationships and values in a society. Capitalism, on the other hand, is morally bankrupt.

This ethic is very much alive among the bureaucrats that run the United Network for Organ Sharing, which manages the transplant list. “Organ transplantation is built upon altruism and public trust. If anything shakes that trust, then everyone loses,” says the UNOS website. Yet the trust is already badly rattled. “The current system has degenerated into an equal opportunity to die on the waiting list,” observes nephrologist Benjamin Hippen, who advocated compensating donors (or perhaps they should be called “vendors”) before the President’s Council on Bioethics this summer.

Another theoretical objection to compensating donors is the notion that it will “commodify” the body and thus dehumanize the rest of us, let alone the person who gives his kidney in exchange for “valuable consideration.” Yet with proper respect for donors and informed consent, it strikes me that careful engagement in financial arrangements is far less distasteful than allowing people to suffer and die. These are not abstract people, mind you, like the ones who may well be helped by stem cell discoveries years down the road, but live humans like the 49-year-old former secretary from the Pentagon I met last summer. For four years now, every Monday, Wednesday, and Friday, she has been sitting in Chair No. 7 in the dialysis center a few blocks from our offices.

… Perhaps the most vocal critic of compensating donors is the National Kidney Foundation.

It is offended by the idea that a donor might benefit in ways other than the psychic reward of pure giving. States NKF chairman Charles Fruit, “Families decide to donate the organs of a loved one for altruistic reasons. Payment is an affront to those who have already donated.”[ii] Virginia, a take-no-prisoners journalist, responded pointedly to Fruit on her website, . “The argument that paying organ donors is ‘an affront’ to unpaid donors is disgusting. Are unpaid donors giving organs to save lives or just to make themselves feel morally superior? Even in the latter case, they shouldn’t care if other people get paid.”

Posted by aalkon at May 29, 2007 11:07 AM

Comments

An interesting tinge of hypocrisy. I can't be compensated for donating a kidney, which is a major surgery on my part, but will save somebody's life. However, I can drive ten minutes up the road and (following a few weeks of hormone shots) sell my eggs for three thousand dollars. Which is an inconvenience on my part, but will allow a wealthy couple to have a child when they might otherwise have had to improve a child's life through adoption.

There is something wrong here . . . . . .

Posted by: Elle at May 29, 2007 7:01 AM

By all means, let's have a game show where the losing contestants will die. I don't think it needs repeating how sick in the head television producers can be.

Stephen Dubner mentioned what i think is most practical by far, which is not compensation but changing "opt in" to "opt out."

Posted by: Jennifer Emick at May 29, 2007 7:02 AM

I have your signature right here on a form that says you've donated a kidney, a lung and your heart.

Pony up.

Posted by: Radwaste at May 29, 2007 7:53 AM

>> By all means, let's have a game show where the losing contestants will die.

Maybe that is what it will take to get some people to check the little "donor" box...

Posted by: eric at May 29, 2007 9:52 AM

I think I was ten when I told my Mom that if anything ever happened to me I wanted her to donate my organs. I'd probably just seen an after-school special or something. When I was of legal age I signed the donor card and both of my husbands have known my wishes.

What's surprised me over the years is how many conversations I've had with seemingly intelligent, rational people who've warned me that the doctors would let me die to get at my organs. Umm, yeah, all right.

I found out when I was 31, during an ultrasound for gallstones, that I have only one kidney. One really BIG, healthy kidney, but still. So now I really worry about the way people are ready to believe the worst.

While I have NO problems with paying people for donated organs, I worry what that would do to the public's already skewed perceptions of organ donation. I think the money factor would increase organ donations dramatically, but am not sure if that would increase the paranoia or reduce it by making it a commercial transaction, something we seem to understand better than altruism. Either way, as long as organ donations increase, it's worth it.

Posted by: Kimberly at May 29, 2007 2:51 PM

I think people should be able to sell their organs; why not? And personally, I do not have a problem with the game show. Or, rather, only a problem that we're going to watch other people's misery when they don't win. That's tough, and of course, I am sure part of the reason why people will tune in.
I write all this as someone who recently underwent many tests in order to be a kidney donor for my mom, but in the end, could not.

Posted by: nancy at May 29, 2007 3:04 PM

But Amy, the thought of people selling their organs is just icky. And we all know that public policy should be determined by what is icky and what is not.

"What's surprised me over the years is how many conversations I've had with seemingly intelligent, rational people who've warned me that the doctors would let me die to get at my organs."

I think that's an offshoot of this belief that many people have, secretly, that somehow they can live forever, if certain pesky evil forces don't get in the way. I'd say it's an American thing, but from what I understand, organ donation rates are even lower in Europe than they are here.

Y'know, if you're in a state in which you're in danger of dying but your organs might still be usable, there's a decent chance that your brain is permanently shot - you may survive, but there's a difference between surviving and returning to full brainpower. I, personally, would rather go ahead and die than live 40 years with a *severely* disabled brain. I certainly don't expect everyone to feel the same way, and I am fully aware that this does not represent every potential organ donation situation, but it is something I think about. God knows I would never tell someone to let their loved one die rather than risking having said loved one live 50 years with a barely-functioning brain...but I do think the subject in its many permutations is something that ALL of us should discuss with our probable medical decision-makers before the time comes. I've discussed it with mine.

Posted by: marion at May 29, 2007 4:29 PM

If altruism could fix the organ shortage, the shortage wouldn't exist in the first place. With the transplant waiting list approaching 100,000 people, isn't it time to use incentives to supplement altruism?

A monetary incentive would save thousands of lives every year. Unfortunately, there is no reason to think Congress will legalize monetary incentives in the foreseeable future.

Fortunately, there is an already-legal incentive that can put a big dent in the organ shortage -- allocate donated organs first to people who have agreed to donate their own organs when they die. The United Network for Organ Sharing, which manages the national organ allocation system, has the power to make this simple policy change. No legislative approval is required.

Americans who want to donate their organs to other registered organ donors don't have to wait for UNOS to act. They can join LifeSharers. a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren't willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

Posted by: Dave Undis at May 29, 2007 5:32 PM

I brought a shitload of work home with me tonight, so I didn't have time to read all of the above as thoroughly as I shouldn've. But here's my very brief 2 cents: There's not a whole lot of available kidneys around, and if they all go up for sale, the prices will be pretty steep and income/wealth will become the decisive factor in who gets a kidney -- and, perhaps, who lives. I think I'd rather see organs distributed according to severity of need rather than ability to pay.

PS: Sally Satel cited my work in her paper "Are Doctors Biased?" Lick me!

Posted by: Lena at May 29, 2007 7:53 PM

They should pay for partial liver transplants as well as kidney. Your liver regenerates, and you can live very well on half a liver for the 2 months it takes to regenerate.

And for those that claim you'll just be saving those that drink, there are plenty of diseases that destroy a liver, not including cancer.

Posted by: pixilated at May 29, 2007 11:27 PM

"I think I'd rather see organs distributed according to severity of need rather than ability to pay."

Even if the tradeoff is that far fewer organs are available to distribute? Because that is the tradeoff we're discussing, IMHO, and it's a severe one. Also, not sure if this is the right comparison, but it's fairly easy to find an entity that will pay you to donate blood/plasma...and yet, I the hungry, currently non-paid capitalist find myself giving this precious substance away a few times a year. And I'm not the only one. And while that may seem like a stretch as a comparison, you make new blood, whereas you don't make new kidneys, so while you may be able to get much more for a kidney, you'll have to weigh that against potential long-term health issues. Because of that, I tend to think that the only people who might donate for money would be people who wouldn't have donated anyway, whereas people who would have donated anyway won't be doing it for the money, so it might well be possible to have a multi-tiered compensation system of some sort.

I'd be in favor of a two-tiered system - next of kin of cadaver kidney donors receive only compensation of costs plus a nominal fee, with a sliding scale for the rest, with a 22-year-old donor bursting with health and possessing a rare blood type getting the highest compensation. If you are going to put a price on organs, then be honest about the fact that some are more valuable than others. But that's just one suggestion. And possibly I'm way too trusting in the innate goodness of humanity. But, even if payment is received, donating a kidney is inherently a selfless act, given that you're betting that you won't need that kidney in 30 years or so OR that science will come up with a better replacement than dialysis. Take altruism out of the equation completely, and you have very few kidneys available. I do think, though, that you can mix altruism with compensation. Hey, I know - give people under a certain income level $$, give people over that income level a tax break, with potentially some combination of that in the middle. That's one idea, anyway...

Posted by: marion at May 30, 2007 12:25 AM

I suppose nobody noticed...

Where is the consumer protection, to see that "donation" is in fact just that?

NPR ran a piece so stupid as to have me shouting at the radio; they featured a Brazilian idiot who found he could sell a kidney in South Africa from somebody in a bar. He flew there, had one removed, came back to Brazil, and was robbed of his cash at the airport gates; since organ selling is illegal in Brazil (probably to keep their people from being flim-flammed in just this manner), he was arrested. Then, of course, there were complications from the meatball surgery. He's dying.

Good idea, huh?

Posted by: Radwaste at May 30, 2007 7:42 AM

"Where is the consumer protection, to see that "donation" is in fact just that?"

In the U.S.? Presumably from the highly trained surgeons who have multiple consultations with prospective live donors of any stripe, as they do right now, if only to see if the person in question appears to be a drug user/chronic liar/crazy. Not to mention a more-than-robust malpractice system that punishes doctors pretty severely for negative outcomes that result from insufficient due diligence.

Outside the U.S.? Good question...but what is there now? Not sure how making selling legal inside the U.S. would worsen the situation in, say, South Africa.

Posted by: marion at May 30, 2007 2:18 PM

"Presumably". Hey, I have your signature on this form, right here, and it's notarized. Give up your organs. You promised.

Malpractice, like other forms of insurance, talks about making the victim "whole" again - but it doesn't.

Posted by: Radwaste at May 30, 2007 4:39 PM

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