Kidney Donations

EconTalk Extra
by Amy Willis
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Sally Satel on Organ Donation... Alex Guarnaschelli on Food...

A special thank you to Alice Temnick for creating this week's Extra.

kidney%20transplant2.jpgDo you or have you known someone who has donated, is in need of, or has received a transplanted organ? If so, how has that association shaped your thinking about organ donations and the illegality of organ markets?

Whether you have or have not been exposed to the current arguments for and against potential donor compensation, we hope this conversation with Sally Satel will encourage you to share your thoughts about this.

1. Sally Satel presents the multiple costs (and benefits) donors face, from the pre-surgery preparation work, the recovery, the psychological effect of donating and family influences. Are there other costs that might influence potential donors?

2. With a waiting list of 80,000 and 12 people dying daily as they wait for a kidney, directed donations from living donors are a patient's best hope. Satel indicates that a thriving black market exists globally. Who is helped or harmed by this?

3. Sally Satel discusses the opposing argument to a classic free market in kidneys and the need for paternalistic compensation proposals such as delayed payments, tax credits, loan forgiveness and more. What other payment plans might "dampen the magnitude of the incentive" for those seeking immediate compensation? Which ideas do you believe might best appease the opposition to a market for kidneys?

4. Russ acknowledged the potential of falling charitable donations as a possible consequence of a market for kidneys. How likely is this or the further concern stated by the National Kidney Foundation that it could crowd out altruistic giving in general? Would direct donations be effected? How?

5. Consider the term commodification. If this term suggests an immoral connotation of paying money for a body part, do Satel's four points of her plan address that? (ensuring that the donor has the capacity to make the decision, gives their informed consent, has their health protected, and is amply rewarded)

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Dr Golabki writes:

5. Consider the term commodification. If this term suggests an immoral connotation of paying money for a body part, do Satel's four points of her plan address that? (ensuring that the donor has the capacity to make the decision, gives their informed consent, has their health protected, and is amply rewarded)
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When people use words like "commodification", I believe they are saying "I'm uncomfortable with (or even offended by) the idea of financial transactions in this sector." I think there's two things involved with that discomfort:

1. There's a sanctity of life and body that should (arguably) be above financial transactions. As an atheist I don't find this terribly convincing, but it's a legitimate point of view. I also think there's clearly a difference between a surgeon renting his hands out for a surgery and a person selling a part of their body. For one, the surgeon is only needed temporarily and never looses control of his hands. Organ transplant, by contrast, is permanent and complete. I think Russ was a bit flippant on this point. The prohibition on prostitution might be a good comparison (although there's other factors at play there).

I don't think Satel's points address #1 at all. Rather, I think they are directed at #2...

2a. The issue of class. In a capitalist world the scope of opportunities available to an individual is largely based on how much money they have. We (at least Americans) are largely comfortable with that if we are talking about luxuries. For example, if a rich person can buy a nice beach house as a second home, but a poor person cannot, that seems fine. That's less true for things we view as necessities... like for example, life saving surgery. This problem is compounded (at least in terms of how it "feels") if a direct transfer from a poor to rich person is involved. Russ's example of a person who sells his kidney to pay for his child's education shows this nicely. If a person is on such a different financial level that they have to sell a physical part of their body to pay for something like education, it makes the inequality uncomfortably apparent.

2b. Related to "2a", there's also the slippery slop argument. If selling ones kidney is okay, are there any contracts that would be too close to our humanity to be allowed? Prostitution is one thing, but you can imagine some fringe examples. Should I be able to sell my heart and lungs? I'd die but maybe I care more about giving the money to a family member. Should a rich sadist be able to pay a poor person to consent to torture? These examples are a bit silly, but potentially helpful in understanding where the discomfort comes from.

Stale's points would seem designed to alleviate concerns on #2a and b. I think they do a decent job here, although concepts like equality are so squishy it's hard to answer it in a practical way.

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