On organ trafficking.

Michael Smith of Bloomberg.com recently wrote an article about the underground market for organs. Click here to read it. Smith tells the tale of those desperate enough to pay for organs and those desperate enough to sell them. According to the article, those in dire need of an organ are victims:

“With all the anxiety in getting a transplant, they exploit the patient,” says [Dr. Francis] Delmonico [of Harvard Medical School], who is president-elect of the Montreal-based Transplantation Society, which lobbies governments to crack down on trafficking.

But wait… according to Dr. Delmonico, those willing to sell the organs are also victims:

“The problem is that you have so many people who are desperate for a transplant and willing to pay for one and so many poor people who need the money and can be exploited,” he says.

So if both the buyer and seller are exploited, who precisely is taking advantage of them? The article mentions organ brokers and traffickers, but what characteristic makes them fundamentally different from those who manage legitimate transplant lists? Do they work pro bono? Do the surgeons? Do the hospital staff? If not, is that exploitation?

The article mentions that “legal transplants have a high probability of success.” There is no mention of the survival rate after illegal transplants, but I’d bet it’s higher than the survival rate of those who need but never receive a transplant. Let’s assume that the illegal transplants are more dangerous than the legal transplants. Why are they more dangerous?

The illicit organ trade is dangerous for the donor and patient because criminals take shortcuts, such as accepting organs from people who are sick and wouldn’t be approved by hospitals in the U.S., says Gabriel Danovitch, medical director of the kidney and pancreas transplant program at the University of California, Los Angeles.

Perhaps I construct a straw man here, but if the dangerous part of the “illicit organ trade” is the failure to screen donors for diseases, then why is the entire market illegal? Why not legalize the organ market and simply require medical testing before an organ can be bought or sold (the efficiency of the regulation is another debate for another day)? That would certainly lead to healthier results than we’re seeing in today’s underground organ markets, and it would probably lead to shorter waiting lists for kidneys.*

I suspect it’s because in some people’s minds, health is not the only issue. Some people find the very concept of selling organs to be immoral or distasteful. They believe it that organs should be donated out of love or altruism, and never for any other purpose. Here’s Danovitch on the illicit organ trade:

“It’s a filthy business in the same subcategory as the sex trade and child pornography,” Danovitch says. “That is why it has to be stopped.”

Get that? This guy just compared “peacefully buying (or selling) an organ to save (or improve) your own life” to child pornography. Health is not the main issue for him– I’m sure he wouldn’t endorse the “subcategory” even if it were medically safe– it’s the morality of the act. He places the act of organ donation on some high moral shelf that money would only bring crashing down. Not the money that pays for the surgical team, or the equipment they use, or the drugs they administer, or the hospital they operate in, or the staff and management of the hospital; that money’s kosher. But in Danovitch’s mind, the money going from patient to donor somehow turns the whole operation into the moral equivalent of prostitution and the sexual exploitation of minors.

Seriously, I think Danovitch and Delmonico mean well but are badly confused about morality. Aside from religious objections that some may have about sullying bodily purity, what is inherently immoral about paying for an organ donation? It is a peaceful transaction. It is inherently risky, but if buyer and/or seller don’t know the risks, don’t ban the whole practice. Just tell them the risks and then let them decide whether to go about their business.

If I ever need an kidney transplant, or if my wife or kid or a relative needs one, I will go about trying to secure that kidney through all peaceful means. That may well include trying to purchase a kidney. Hopefully, whoever tries to stop me will be a blood and tissue match because he will have unwittingly volunteered his organs, gratis.

* According to the article, Iran is the only country that allows you to pay a donor for an kidney. A study claimed that as recently as 2006, Iran had “no renal transplant waiting lists.” I never thought I’d say this, but I wish we would follow Iran’s lead on this one.

23 comments

  1. Very intriguing, never thought of it this way. I’m curious if you feel similarly about legalization of drugs like marijuana; I was never able to bring it up at school for obvious reasons. I know it’s far from a life or death issue but I think some of the principles behind the issue are the same. The freedom to make a risky, potentially harmful decision assuming one knows the risks and whatnot.

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  2. Scenario 1 (organ transactions are legal):
    Joe is poor but healthy and needs to pay off a mob debt.
    Sally is upper class income but will die without a kidney.
    Joe sells his kidney to Sally for the price of the debt and then some.
    Joe gets to live and is a bit richer.
    Sally gets to live but it a bit poorer.
    Both are now morally bankrupt and will possibly need years of therapy to cope with the evil exchange they have participated in…

    Scenario 2 (organ transactions are illegal):
    Joe, cannot sell his kidney and is killed by the mob for the bad debt.
    Sally cannot buy a kidney and dies due to organ failure.
    Society rejoices because morality has been upheld…

    Thank you Michael Smith for helping us realize the superiority of option two. In fact, we should place a death penalty on all people seeking to involve themselves in such moraly depraved transactions…and once their dead, make sure to burn their organs…you can never be TOO careful.

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  3. Ever see “Coma?” There will always be exploiters. As an industry, it will have to be controlled. The question is, by whom?

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  4. Organ sales may be illegal in the US. However, there is now effectively an organ bartering system, at least for kidneys.

    Say your spouse needs a kidney, and your kidneys are not compatible. You decide to donate your kidney and get involved in a kidney transplant chain. Get enough people involved, and then 10-12 people can get kidneys.

    A couple of examples:

    http://www.myfoxtwincities.com/dpp/news/minnesota/10-people-kidney-transplant-chain-july-22-2010

    http://www.boston.com/news/health/blog/2009/03/it_began_in_200.html

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  5. W&S: I think the argument against drug legalization is stronger than that against organ brokering. If I buy your kidney, no one aside from you and me is affected in any meaningful way. You get some cash, and I get a kidney. A plump, juicy, ripe kidney. However, if I ingest certain drugs, I may be putting others in immediate physical danger. Let me simply say that there’s a lot of room for improvement in drug policy. Also, I think most teachers and admins would’ve been fine with discussing the matter, so long as it was relevant to the course. If you were to talk about the benefits and costs of legalizing meth during, say, Chorus, then you might be a bit off topic.

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  6. Noutheteo, I’m so proud of your example I could cry.

    MTD, I have seen Coma. If memory serves, the bad guys were kidnapping folks and faking their deaths to harvest their organs in an illegal underground market (forgive the redundancy). That kind of exploitation is generally only possible in underground markets, because in legal markets there’s generally not enough profit to entice people to violate the law in so blatant and expensive a manner. The so-called “exploiters” in the article did nothing close to what the bad guys in Coma did; they simply connected buyer and seller.

    DHPhDPE, nice articles. Kidney bartering is a positive but inadequate development.

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  7. I would agree that in selling your organs to another is not immoral. However, from a strict Jewish/Christian, it is immoral simply because it goes against the law of the land. So once it is legal, then it is moral.
    BTW: If it were immoral to make money by helping people while giving up small comforts, then those working for the foodbank are immoral because they are giving up there time- in my opinion: Time is much more valuable and non-refundable than an organ. You are never 18 years, 7 months, 14 days, 6 hours and 2 minutes once, but, if need be, you could always buy another organ with the money you sold yours with. An eye for an eye!!!

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  8. What about the scenario where Joe needs money and has a kidney, and two people wish to buy it?

    Organ sales (if legalized) will inevitably end up in an auction envirionment. I foresee many problems arising from that market when you’re literally bidding in a life-or-death situation.

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  9. Volleyed and Thundered: That’s what makes the system so much better: you have a product others want. If person B raised only $500 for his life saving but Person A has raised $100,000, would you really say Person A should not be able to use the money because he actually shows fiscal responsibility when person B doesn’t?

    Supply and demand: basic economics in a high school macro class.

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  10. V&T: I don’t mean to sound smart-alecky, but are those problems you foresee any worse than the problems that currently exist in that market, i.e., kidney shortages? And I say markets are, by definition, auction environments. Buyers try to get a low price, sellers try to get a high price, availability plays a role, productivity plays a role, demand plays a role, etc.

    (Wait, I just thought of something obnoxious but understandable to say: “I’d rather take my chances with an auctioneer than a death panel!”)

    Locke, what about them?

    Retired, the ability to raise money says nothing about fiscal responsibility. It says a lot about the ability to raise money, and nothing else.

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  11. @Mr. V: Okay, you have me, markets are auctions. -But they are generally not as immediately reactive as a “normal” auction. I think the price of a kidney would fluctuate by an order of magnitude on a monthly basis. I think putting a dollar amount on living or dying would divide the country more than any political issue since 1861.

    Can I invest in organs strictly for resale? If so, can I refuse to sell to people over age 50, or Hispanics, or alcoholics? Can I sell a kidney to Jennifer Aniston for $10, when John Rockefeller is offering me $20?

    [Retired], I am a capitalist. I agree those with money should be able to spend it in whatever legal way they desire. I do believe when the dying, cute, blonde 8 year old girl’s working-class parents are outbid for a kidney by an ugly, evil petroleum CEO (or perhaps a corrupt Senator, or an Internet porno-website owner) there will be a huge public outcry against the system, and eventually a violent reaction. Don’t for a second think the system will sucessfully allow anonymity.

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  12. V&T: In regards to “I think putting a dollar amount on living or dying would divide the country more than any political issue since 1861,” YOU and everyone else put a dollar amount on living. You may not realize you do so, but you do. For example, I could spend millions of dollars getting tests every month to ensure my health; however, I decide that’s TOO expensive. It’s not worth it. Why do people die in car accidents? Surly we could turn every car into a tank with 400m thick sides, and slow the vehicles down to a max speed of 15mph. Then nobody driving would die…BUT, the costs are too great. People say, I would rather pay less and drive a more dangerous vehicle. This type of reasoning extends to home safety, general precautions (look both ways before crossing the street), and other preventive decisions you choose or don’t choose to make. Therefore, you inadvertently put a dollar value on your life all the time. But to vocalize this is deemed morally reprehensible…We like to think we’re better than that…but we’re not.

    In regards to how you can sell your organs or the organs you purchased: Sure, you own them, do whatever you want with them. If it brings you more satisfaction to sell to Jennifer and not John, by all means…but I’d take the extra cash personally. And guess what, by INVESTING in the kidney market, you will raise prices and encourage MORE kidneys to be sold and made available. So I would solute you for your humanitarian ways!

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  13. You’re talking about the cost of indirectly prolonging your life versus the direct cost of not dying. I don’t believe it to be a good analogy.

    Not driving a tank does not mean you will definitely die.
    Not purchasing a kidney does mean you definitely will die.

    Not looking both ways when crossing a street does not mean you will die.
    Not purchasing a kidney does mean you definitely will die.

    FWIW, I’m actually a heartless jerk, so it won’t bother me if poor people can’t afford to pay for life-saving treatments. It will bother me when there are riots in the streets because only rich white people are getting kidney transplants.
    The inevitable conclusion our government will come to is THEY buy all the kidneys, and then sell them to people based on their income. Anyone who makes less than $30,000 per year will be paid to take the kidney they need.

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  14. And don’t forget, there will always be those little fundraisers to help a sickly child. Also, a kidney might count against your deductable (please correct the spelling error), and because insurance is now paid for by tax payers anyway, thus the government would control the kidney auction AND the means to get said kidney, it would result once again to a form of death panel, and higher taxes, with more government spending. The future looks bleak.

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  15. Locke, “for or against them” is a bit broad, hence the request for clarification. I don’t oppose gay marriage. If repealing “Don’t Ask, Don’t Tell” makes our military more effective (or if it doesn’t hurt the military), then I’m all for it– but there is no right to serve in the military, so I never bought the argument that it was an equal protection issue, or any other sort of constitutional issue.

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  16. WHAT’S UP, I’m late. I’ve been neglecting my blog-stalking responsibilities. Apologies, job and what not.

    I actually completely agree with V&T. The idea in theory of legalizing the selling and buying of organs solves a problem of supply and reduces the cost of investigating and prosecuting such exchanges, that is true. But eventually it will turn into a situation where only the rich and powerful have access to that exchange. Reagan (And my GOD the irony that that is your alias), unfortunately those “fundraisers for sickly children” are not nearly widespread enough to make a real impact in the organ-needing community. It will be affluent individuals purchasing kidneys at wildly inflated prices to ensure their own survival and the people who (although perhaps once fiscally comfortable) are now too bogged down by medical bills and other related expenses that will have to wait and die on an organ list that will have shrunk (or even ceased to exist) because everyone has sold their donatable organs for cash already.

    A simple solution is to promote organ-donation awareness, a positive connotation of the process, and dispell beliefs that giving up ones organs once dead is in some way immoral or dirty – and to get more people to become donors.

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  17. I also think its worthwhile to note my absolute hypocrisy as a person who supports the legalization of both marijuana and prostitution, and the continued legalization of abortions (for the exact health and risk reasons you presented as reason to legalize the organ market).

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  18. Blonde:

    “But eventually it will turn into a situation where only the rich and powerful have access to that exchange. […] It will be affluent individuals purchasing kidneys at wildly inflated prices to ensure their own survival and the people who (although perhaps once fiscally comfortable) are now too bogged down by medical bills and other related expenses that will have to wait and die on an organ list that will have shrunk (or even ceased to exist) because everyone has sold their donatable organs for cash already.”

    1. History is replete with examples of goods that became more plentiful as markets were allowed to function properly (i.e., producers and consumers were free to come to terms of sale). Can you give an example of any good that became less available upon legalization of its sale? If so, can you explain the mechanism by which this happened?

    2. If you can convince people to donate more organs out of the kindness of their hearts in a donation-awareness initiative, more power to you. That’s very noble. Want to know what would work faster and more efficiently?

    3. Here’s a loaded hypothetical:

    Situation A. Imagine that five people need kidneys, that organ sales are illegal, and that there is only one kidney available. The poorest of the five gets on the waiting list first and gets the kidney. The other four die.

    Situation B. Imagine that five people need kidneys, that organ sales are illegal, and that there is only one kidney available. The richest of the five gets on the waiting list first and gets the kidney. The other four die.

    Situation C. Imagine that five people need kidneys, that organ sales are legal, and that there are two kidneys available. The two richest people buy the two kidneys. The other three die.

    Again, it’s a loaded hypothetical, but which of these three situations bothers you the most? Heck, you can even throw one out and tell me which of the two leftovers bothers you most.

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  19. For those interested (and I highly recommend it) here is a link to a podcast by EconTalk talking about Exchange, Exploitation and Euvoluntary Transactions regarding organ transactions.
    http://www.econtalk.org/archives/2011/06/munger_on_excha.html

    Mike Munger is a very enjoyable interviewee and I would recommend any of his interviews. With that said, if you want an excellent EconTalk on price gouging, here is another link:
    http://www.econtalk.org/archives/2007/01/munger_on_price_1.html

    Hope everyone enjoys it!

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