Organomics

most countries are sticking with the worst of all policy options. Governments place the onus on their citizens to volunteer organs. A few European countries, including Spain, manage to push up supply a bit by presuming citizens' consent to having their organs transplanted when they die unless they specify otherwise. Whether or not such presumed consent is morally right, it does not solve the supply problem, in Spain or elsewhere. On the other hand, if just 0.06% of healthy Americans aged between 19 and 65 parted with one kidney, the country would have no waiting list.

The way to encourage this is to legalise the sale of kidneys.

Instinct often trumps logic. Sometimes that's right. But in this case, the instinct that selling bits of oneself is wrong leads to many premature deaths and much suffering. The logical answer, in this case, is the humane one.

Debra Saunders writes in her column today, provocatively titled American Vampire, about the admittedly repugnant practice of transplant tourism.

In a nifty piece of anecdotal journalism which I thought reserved exclusively for global warming alarmists and perpetually aggrieved race hustlers Saunders captures the ethical depravity of incentive-based organ donation by relating the story of an Indian kidney donor who did not receive the compensation promised for her organ donation.

Of course the only conclusion that can be drawn from an unfulfilled contract is... forcibly prohibit all such contracts and turn over all contract oversight to the federal government, whose renown for efficiency, compassion and success is voluminously documented.

Support for her position comes from the apparently confused bioethical nudge, Art Caplan, who equates the voluntary agreement to sell a life-saving organ with mob-enforced collection efforts. How he makes this leap is unclear, but it makes for great (though incoherent) copy.

Naturally, Caplan derides the process as unethical, though both he and Saunders ignore entirely the ethical propriety of a program that allows thousands of people to die, and tens of thousands to linger while waiting for an independently donated organ transplant that is increasingly unlikely to become available. 

The transplant tourism business is deplorable - especially in China, where organs are taken from executed prisoners - but nowhere does Saunders explore the underlying UNOS failures that have compelled desperate Americans to seek alternative life-saving treatments. If we solved our own problems with the introduction of incentives to spur organ donations, the transplant tourism business would disappear. 

Whose Kidney is it Anyway? The New York Court of Appeals issued a ruling last week on an extraordinary case involving the directed donation of a kidney that went horribly wrong.

As the New York Sun reported today:

The case decided yesterday involves two childhood friends from the Bronx. When one of them, died of a stroke on Long Island in 2002, his widow donated his kidneys to the other, Robert Colavito, who was ill with renal disease in Florida. One kidney made it to Colavito, but a doctor found that it was damaged, according to court documents. When Colavito asked for the second kidney, he was told it had already been transplanted into another person.

Despite the initial plausibility of this argument, there are three reasons to reject it. Firstly, the advantages of legalising markets in human kidneys would probably outweigh its possible disadvantages. Secondly, if it is believed that no such coercion can ever be tolerated, markets in only those human kidneys that fail to do away with coercion should be condemned. Finally, if coercion is genuinely opposed, then legalising kidney markets should be supported rather than opposed, for more people would be coerced (ie, into not selling) were such markets to be prohibited.

The American Society of Transplant Surgeons (ASTS) and the University of Michigan (UM) are pleased to announce the receipt of a major grant from the Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services. The 4-year grant will provide reimbursement of travel expenses and subsistence costs for living organ donors, removing an important financial disincentive to living organ donation.

As part of the ASTS Mission to “increase organ donation”, the UM-ASTS project team will work closely with HRSA to develop an efficient nationwide system to identify potential live organ donors who face financial hardship in meeting travel and subsistence expenses associated with the process of evaluation and undergoing live organ donation procedures.

The best answer is by creating a market arrangement to exist in parallel with altruistic giving. Within such a framework, any medical center or physician who objects to the practice of compensating donors can simply opt out of performing transplants that use such organs. Recipients on the list are free to turn down a paid-for organ and wait for one given altruistically. Choice for all—donors, recipients, and physicians—is enhanced. And it is choice in the greater service of diminishing sickness and death.

There is no denying the political and practical challenges that come with introducing payment into a 20-year-old scheme built on the premise that generosity is the only legitimate motive for giving. Yet as death and suffering mount, constructing a market-based incentive program to increase the supply of transplantable organs has become a moral imperative. Its architects must give serious consideration to principled reservations and to concerns about donor safety, but repugnance and caution are not in themselves arguments against innovation. They are only reasons for vigilance and care.

Now the network is drafting a kidney allocation scheme for adults, who account for more than 95% of transplants using kidneys from cadavers. A formal proposal and public hearings are expected next year. The final decision will rest with the U.S. Health Resources and Services Administration.

The reexamination is largely based on a computer analysis of data on more than 300,000 patients placed on kidney waiting lists since 1987 — including age, race, health, body mass index, diagnosis, years on dialysis and years of survival after transplant.

The analysis shows which types of recipients should be favored in order to squeeze the maximum life out of the pool of all available kidneys.

Without a change, proponents say, the current system is headed for collapse.