Should organ donors be paid?
March 11, 2020 7:34 AM Subscribe
Should organ donors be paid? The heavy toll of US kidney shortage (BBC): Most people in the US who need a kidney transplant will die while on the waiting list. Some countries have experimented with an "opt out" model, which automatically places people on a national register of donors unless they choose not to be, with little change (BBC) in the number of transplants. The surest way to substantially alleviate the shortage of kidneys is through an increase in living donors. But there is fierce disagreement on how to achieve this.
The Kindest (Tax) Cut: A Federal Tax Credit for Organ Donations (Tax Notes PDF):
National Kidney Foundation Position on Increasing Organ Donation and Transplantation
Paid organ donation: the case against (Annals Royal College of Surgeons of England)
Financial compensation for organ donors (Organ Transplant journal)
The Kindest (Tax) Cut: A Federal Tax Credit for Organ Donations (Tax Notes PDF):
We do not propose any change to the ban on buying and selling organs in private exchanges between donors and recipients but we believe that the lack of financial compensation for donors is almost surely responsible for tens of thousands of needless deaths. We therefore propose a $50,000 federal tax credit for individuals who are willing to save the life of a stranger by donating a kidney and a $5,000 federal tax credit for deceased donors of kidneys, intestines, pancreases, livers, and lungs. The availability of the credit would be conditioned on stringent safeguards and would not (at least initially) apply to directed donations to specific individuals.Should Organ Donors Be Paid? (leapsmag):
While some contend it's exploitative to entice organ donors and their families with compensation, others maintain they should be rewarded for extending their generosity while risking complications and recovering from donation surgery. But many agree on one point: The focus should be less on paying donors and more on removing financial barriers that may discourage interested prospects from doing a good deed. [...] From a financial standpoint, estimates have found it costs a kidney donor in the United States an average of $3,000 to navigate the entire transplant process, which may include time off from work, travel to and from the hospital, accommodations, food and child care expenses.Compensation for organ donors: A primer (Washington Post):
[In 2015], a group of researchers published in the American Journal of Transplantation a cost-benefit analysis for a government-funded program that would offer $45,000 to living kidney donors. They calculated that such an approach would not only fulfill the entire waiting list, but save a whopping $46 billion a year — an amount that has attracted the attention of a handful of economists.A kidney for $10,000? Paying donors actually pays off, new study finds (NBC News):
They determined that paying living kidney donors $10,000 apiece would save about $340 per patient, compared with the ongoing costs of dialysis, and would also provide a modest boost of .11 in quality-adjusted life years, or QALY scores, a measure of the quality and length of life. (The money would come from an independent third-party entity, like the Canadian Blood Services or perhaps through OPTN in the U.S., Manns said.)
Those figures are based on what Manns called a “very conservative” assumption that financial incentives would boost kidney donations by 5 percent. If donations actually rose by 10 percent or 20 percent, the cost savings would jump to $1,640 and $4,030 per patient, respectively. [...]
The new research follows a recent survey of 3,000 Canadians by Manns and his colleagues. It found that about 70 percent of members of the general public thought that some form of compensation for organ donation would be OK, but that only 25 percent of transplant doctors agreed.
The same survey found that about half of people who said they wouldn't be likely to donate an organ changed their minds if the deal included a $10,000 payment.
National Kidney Foundation Position on Increasing Organ Donation and Transplantation
Paid organ donation: the case against (Annals Royal College of Surgeons of England)
Financial compensation for organ donors (Organ Transplant journal)
While some contend it's exploitative to entice organ donors and their families with compensation, others maintain they should be rewarded for extending their generosity while risking complications and recovering from donation surgery. But many agree on one point: The focus should be less on paying donors and more on removing financial barriers that may discourage interested prospects from doing a good deed. [...] From a financial standpoint, estimates have found it costs a kidney donor in the United States an average of $3,000 to navigate the entire transplant process, which may include time off from work, travel to and from the hospital, accommodations, food and child care expenses.
Universal healthcare would also go a really long way. Why would I put my body at a disadvantage when I have no guarantee of ever being able to see a doctor again; I have a great job and I'm still 2 paychecks away from being homeless no matter what I do. A one-time cash payment doesn't really address the inability to predict if I'll be able to access healthcare in the future. Anything can change in an instant. God bless you if you're willing to do this but I'm not.
posted by bleep at 7:53 AM on March 11, 2020 [25 favorites]
Universal healthcare would also go a really long way.
According to this 2019 study, almost every country with universal healthcare has lower living kidney donation rates than the United States.
posted by NotMyselfRightNow at 8:22 AM on March 11, 2020 [10 favorites]
According to this 2019 study, almost every country with universal healthcare has lower living kidney donation rates than the United States.
posted by NotMyselfRightNow at 8:22 AM on March 11, 2020 [10 favorites]
Still though I'm not sure how you can wonder why people aren't donating more when we make it incredibly expensive to stay alive and incredibly difficult to earn enough to pay to stay alive.
posted by bleep at 8:26 AM on March 11, 2020 [13 favorites]
posted by bleep at 8:26 AM on March 11, 2020 [13 favorites]
We need to start growing kidneys from stem cells.
posted by grumpybear69 at 8:41 AM on March 11, 2020 [7 favorites]
posted by grumpybear69 at 8:41 AM on March 11, 2020 [7 favorites]
Still though I'm not sure how you can wonder why people aren't donating more when we make it incredibly expensive to stay alive and incredibly difficult to earn enough to pay to stay alive.
The United States has one of the highest living kidney donation rates in the world. Assuming the "we" in that statement is the US, and you're comparing us to countries with universal healthcare and other social safety nets that we lack, then I'd say that the data actually tells us we need to look elsewhere for the answer of how to raise living donation rates.
posted by NotMyselfRightNow at 8:51 AM on March 11, 2020 [3 favorites]
The United States has one of the highest living kidney donation rates in the world. Assuming the "we" in that statement is the US, and you're comparing us to countries with universal healthcare and other social safety nets that we lack, then I'd say that the data actually tells us we need to look elsewhere for the answer of how to raise living donation rates.
posted by NotMyselfRightNow at 8:51 AM on March 11, 2020 [3 favorites]
I looked into living kidney donation earlier this year. The materials indicated that under the current laws of the US and my state, insurance companies are allowed to treat voluntary kidney donation as a pre-existing condition for the rest of the donor's life. The people running the donation program assured me that it had never been a problem except for one time, and that time, one call from the donation program got the insurance company to change its mind. That's a hard pill to swallow -- do a good turn for a total stranger, and then possibly get screwed for it years down the road unless the insurance companies decide to be nice.
posted by Etrigan at 9:04 AM on March 11, 2020 [35 favorites]
posted by Etrigan at 9:04 AM on March 11, 2020 [35 favorites]
I just find it hard to believe that it's really a one-time cash payment that would change someone's mind and not the idea that they're cutting something they don't have in half and giving it away. The fact that a lot of people do that now anyway is just a testament to how much better we deserve as a people.
posted by bleep at 9:23 AM on March 11, 2020
posted by bleep at 9:23 AM on March 11, 2020
You can get insurance, lost wage coverage, travel and lodging, probably more if you donate through the National Kidney Registry, which has the added benefit of organizing giant donation chains so that a single act of donation can lead to multiple transplants. I will try to return later when I have more time to elaborate. I personally think payment for donation is a bad idea.
posted by Missense Mutation at 9:48 AM on March 11, 2020 [2 favorites]
posted by Missense Mutation at 9:48 AM on March 11, 2020 [2 favorites]
I do think that donors should get insurance and future medical care, but I am real fucking reluctant to see actual cash change hands, because of the shit capitalism gets up to. Look at post-mortem donations as ab example. Also, I fundamentally don't think people should be donating their organs because of financial desperation, and if 10K changes your mind, it is very likely financial need. It seems exploitative.
posted by tavella at 9:59 AM on March 11, 2020 [6 favorites]
posted by tavella at 9:59 AM on March 11, 2020 [6 favorites]
On one hand, I feel like people should be free to make this kind of decision with their own bodies. But on the other hand, everything capitalism touches turns to Soylent Green so I'm suuuper leery of this.
posted by Horkus at 10:24 AM on March 11, 2020 [2 favorites]
posted by Horkus at 10:24 AM on March 11, 2020 [2 favorites]
According to this 2019 study, almost every country with universal healthcare has lower living kidney donation rates than the United States.
That's because the financial part isn't the highest part of the cost of donating a kidney, by far.
I came real close to donating a kidney to my mother (unfortunately, her health never recovered enough to make it feasible), and "how much would it cost?" never entered into my mind. And I don't mean because it was my mother and money was no object etc. etc. I mean because it would have been life changing enough to me that that the numbers really didn't make a difference either way.
It's been 15 years, but I remember being told I'd be in the hospital for a week later than my mother (they don't cut up the recipient to put the kidney in the same place as it would naturally go). I was looking at weeks of recovery from the surgery. I had to live a far healthier lifestyle (not a bad thing, to be honest). I had to give up for the rest of my life any sort of "contact" sports such as football, mountain biking, surfing, etc. And while as a donator I'd go to the top of any list assuming i needed a transplant myself, I was likely shorting my life because old age brings decreased kidney function, and at 23 years old I was cutting my potential function in half.
Anyway, my main point is that even with American health care costs, no one is doing this for the money. So it makes sense that having lower costs doesn't translate into more kidneys getting transplanted.
posted by sideshow at 10:30 AM on March 11, 2020 [10 favorites]
That's because the financial part isn't the highest part of the cost of donating a kidney, by far.
I came real close to donating a kidney to my mother (unfortunately, her health never recovered enough to make it feasible), and "how much would it cost?" never entered into my mind. And I don't mean because it was my mother and money was no object etc. etc. I mean because it would have been life changing enough to me that that the numbers really didn't make a difference either way.
It's been 15 years, but I remember being told I'd be in the hospital for a week later than my mother (they don't cut up the recipient to put the kidney in the same place as it would naturally go). I was looking at weeks of recovery from the surgery. I had to live a far healthier lifestyle (not a bad thing, to be honest). I had to give up for the rest of my life any sort of "contact" sports such as football, mountain biking, surfing, etc. And while as a donator I'd go to the top of any list assuming i needed a transplant myself, I was likely shorting my life because old age brings decreased kidney function, and at 23 years old I was cutting my potential function in half.
Anyway, my main point is that even with American health care costs, no one is doing this for the money. So it makes sense that having lower costs doesn't translate into more kidneys getting transplanted.
posted by sideshow at 10:30 AM on March 11, 2020 [10 favorites]
According to the National Kidney Foundation, "The Affordable Care Act has made it illegal for health insurance companies to refuse to cover you or charge you more because you have a pre-existing condition."
posted by Mr.Know-it-some at 10:36 AM on March 11, 2020 [1 favorite]
posted by Mr.Know-it-some at 10:36 AM on March 11, 2020 [1 favorite]
however the ACA could disappear if the GOP has its way and then you're screwed
posted by kokaku at 10:40 AM on March 11, 2020 [3 favorites]
posted by kokaku at 10:40 AM on March 11, 2020 [3 favorites]
government-funded program that would offer $45,000 to living kidney donors. They calculated that such an approach would not only fulfill the entire waiting list, but save a whopping $46 billion a year
I really, REALLY don't want to see cash payments for organ donations happen, because we have way too many people who have someone else making medical decisions for them.
How many people with cognitive disabilities will find themselves donating organs so their caregivers can get rich? Especially the ones living in managed-care facilities rather than being cared for by family members.
Nope. Hard nope. I get that it may be worth offering incentives, tax rewards, some kind of encouragement, but it needs to start with "absolutely cannot involve people who are legally unable to make medical decisions for themselves."
(And re: pre-existing conditions - Yes, the ACA doesn't allow blocking or charging more for that. And if the ACA were a constitutional amendment, instead of a law the current administration is actively trying to remove, that would be reassuring.)
posted by ErisLordFreedom at 10:41 AM on March 11, 2020 [8 favorites]
I really, REALLY don't want to see cash payments for organ donations happen, because we have way too many people who have someone else making medical decisions for them.
How many people with cognitive disabilities will find themselves donating organs so their caregivers can get rich? Especially the ones living in managed-care facilities rather than being cared for by family members.
Nope. Hard nope. I get that it may be worth offering incentives, tax rewards, some kind of encouragement, but it needs to start with "absolutely cannot involve people who are legally unable to make medical decisions for themselves."
(And re: pre-existing conditions - Yes, the ACA doesn't allow blocking or charging more for that. And if the ACA were a constitutional amendment, instead of a law the current administration is actively trying to remove, that would be reassuring.)
posted by ErisLordFreedom at 10:41 AM on March 11, 2020 [8 favorites]
What if instead of a cash payment or tax benefit, you get instant and perpetual access to Medicare? That seems like something lots of people could get on board with.
posted by Maecenas at 11:05 AM on March 11, 2020 [2 favorites]
posted by Maecenas at 11:05 AM on March 11, 2020 [2 favorites]
I think it's important to note that for-profit healthcare systems in the U.S. are already selling organs. The actual organ cost is broken down on your bill if you receive a transplant, completely independent of professional charges for transportation/handling or facilities cost or any of the regular fees. There is a straight up dollar amount assigned to organs that goes toward profits.
The organ donor is expected to give out of the goodness of their heart, but then the hospital complex gets to make money from it. I'm not sure transactional payment for organs is a good idea, but I'm also not on board with any sort of solution that socializes the incentive to donate while allowing the profit to remain private.
posted by FakeFreyja at 11:18 AM on March 11, 2020 [13 favorites]
The organ donor is expected to give out of the goodness of their heart, but then the hospital complex gets to make money from it. I'm not sure transactional payment for organs is a good idea, but I'm also not on board with any sort of solution that socializes the incentive to donate while allowing the profit to remain private.
posted by FakeFreyja at 11:18 AM on March 11, 2020 [13 favorites]
How many people with cognitive disabilities will find themselves donating organs so their caregivers can get rich? Especially the ones living in managed-care facilities rather than being cared for by family members.
Hmm. I want to push back against this because as I understand it, barring a written instruction, a health care proxy or decision-maker must act in the best interest of the patient. Forcibly taking an organ from a cognitively impaired patient is not going to pass muster here. I think that this line of thinking is a little bit like saying 'If you allow a barber to cut your hair, next thing you know he'll take your nose too!'.
I think there are a lot of reasons that offering lump-sum payments to organ donors is perhaps not the best direction to move in (and the greedy taking advantage of the desperate is definitely one of them) but presuming that we're going to start seeing care homes stealing organs is, in my opinion, a pretty big jump to make. I know there's a lot of predatory/not great care homes out there but this is the kind of thing that is already illegal. Paying or not paying for the organ doesn't change the legality.
posted by DSime at 11:27 AM on March 11, 2020 [5 favorites]
Hmm. I want to push back against this because as I understand it, barring a written instruction, a health care proxy or decision-maker must act in the best interest of the patient. Forcibly taking an organ from a cognitively impaired patient is not going to pass muster here. I think that this line of thinking is a little bit like saying 'If you allow a barber to cut your hair, next thing you know he'll take your nose too!'.
I think there are a lot of reasons that offering lump-sum payments to organ donors is perhaps not the best direction to move in (and the greedy taking advantage of the desperate is definitely one of them) but presuming that we're going to start seeing care homes stealing organs is, in my opinion, a pretty big jump to make. I know there's a lot of predatory/not great care homes out there but this is the kind of thing that is already illegal. Paying or not paying for the organ doesn't change the legality.
posted by DSime at 11:27 AM on March 11, 2020 [5 favorites]
Forcibly taking an organ from a cognitively impaired patient is not going to pass muster here.
I feel like right now today in 2020 saying "but that would be illegal!!" as though that has any meaning at all whatsoever anymore when it comes to the financially motivated abuse of minorities is a little naive.
posted by poffin boffin at 11:37 AM on March 11, 2020 [15 favorites]
I feel like right now today in 2020 saying "but that would be illegal!!" as though that has any meaning at all whatsoever anymore when it comes to the financially motivated abuse of minorities is a little naive.
posted by poffin boffin at 11:37 AM on March 11, 2020 [15 favorites]
Also as the country with the largest population of disenfranchised captive minorities on earth I feel like that's also something to consider when proposing financial compensation for the donation of human organs.
posted by poffin boffin at 11:38 AM on March 11, 2020 [18 favorites]
posted by poffin boffin at 11:38 AM on March 11, 2020 [18 favorites]
Forcibly taking an organ from a cognitively impaired patient is not going to pass muster here.
Like sterilizing them? Or forcing abortions on them?
I have no trouble imagining a facility manager saying, "This person will lose a kidney, but gain $$$ that will be used to improve quality of life for several years; it's in their best interests." And I know how much oversight there is of long-term care facilities, especially those operated by public funding.
I mean. Even without direct organ-stealing, there's the option of the caregiver pressuring the person to sign the waivers and agree to give up a kidney, part of their liver, donate blood, whatever. Once you allow for donations/sales from people who aren't in control of their own lives, there are swarms of opportunities for manipulation and abuse.
If this were implemented, how long before prisoners got "encouraged" to sign up for the donation lists?
posted by ErisLordFreedom at 12:14 PM on March 11, 2020 [5 favorites]
Like sterilizing them? Or forcing abortions on them?
I have no trouble imagining a facility manager saying, "This person will lose a kidney, but gain $$$ that will be used to improve quality of life for several years; it's in their best interests." And I know how much oversight there is of long-term care facilities, especially those operated by public funding.
I mean. Even without direct organ-stealing, there's the option of the caregiver pressuring the person to sign the waivers and agree to give up a kidney, part of their liver, donate blood, whatever. Once you allow for donations/sales from people who aren't in control of their own lives, there are swarms of opportunities for manipulation and abuse.
If this were implemented, how long before prisoners got "encouraged" to sign up for the donation lists?
posted by ErisLordFreedom at 12:14 PM on March 11, 2020 [5 favorites]
I feel like right now today in 2020 saying "but that would be illegal!!" as though that has any meaning at all whatsoever anymore when it comes to the financially motivated abuse of minorities is a little naive.
I agree. And as I said, I think there are many reasons to shy away from offering payment for organs. But there's already a black market for organs, and there are already incentives in place for gross scumbags to harvest organs under questionable or full-on illegal circumstances. And, while it does happen, it doesn't happen that much. It's clear that the illegality and follow-on difficulty in getting the organs to market does somewhat discourage potential organ brokers. Any changes to the law allowing payments to organ donors would be pretty unlikely to also add a 'plus it's chill to grab these organs from anyone under your care!' clause. So while I would be against changing laws to allow payments, I don't think that it makes sense to extrapolate that it will suddenly become legal and common to steal organs from prisoners and people in care homes.
posted by DSime at 12:16 PM on March 11, 2020
I agree. And as I said, I think there are many reasons to shy away from offering payment for organs. But there's already a black market for organs, and there are already incentives in place for gross scumbags to harvest organs under questionable or full-on illegal circumstances. And, while it does happen, it doesn't happen that much. It's clear that the illegality and follow-on difficulty in getting the organs to market does somewhat discourage potential organ brokers. Any changes to the law allowing payments to organ donors would be pretty unlikely to also add a 'plus it's chill to grab these organs from anyone under your care!' clause. So while I would be against changing laws to allow payments, I don't think that it makes sense to extrapolate that it will suddenly become legal and common to steal organs from prisoners and people in care homes.
posted by DSime at 12:16 PM on March 11, 2020
Once you allow for donations/sales from people who aren't in control of their own lives, there are swarms of opportunities for manipulation and abuse.
That's what I'm saying - I don't think allowing payments does allow for donations/sales from people who aren't in control of their own lives. Most of the people who are out there donating today unpaid are not cognitively impaired patients being taken advantage of, and the discussed change would not begin allowing that. It's to offer payment to the same group who are already doing it for free - people who are in charge of their own medical decisions and of sound mind.
I still don't think it's a good idea, I'm just saying that the issue of caretakers/medical proxies taking advantage of their charges is a different issue than offering payments. It might incentivize caretakers to find illegal ways to take advantage of their charges, and this is, yes, a good reason to be against payments, which I am. But saying that offering payments will make it suddenly legal to harvest organs from people in your care is not correct.
posted by DSime at 12:24 PM on March 11, 2020
That's what I'm saying - I don't think allowing payments does allow for donations/sales from people who aren't in control of their own lives. Most of the people who are out there donating today unpaid are not cognitively impaired patients being taken advantage of, and the discussed change would not begin allowing that. It's to offer payment to the same group who are already doing it for free - people who are in charge of their own medical decisions and of sound mind.
I still don't think it's a good idea, I'm just saying that the issue of caretakers/medical proxies taking advantage of their charges is a different issue than offering payments. It might incentivize caretakers to find illegal ways to take advantage of their charges, and this is, yes, a good reason to be against payments, which I am. But saying that offering payments will make it suddenly legal to harvest organs from people in your care is not correct.
posted by DSime at 12:24 PM on March 11, 2020
i mean right now today there are indigenous children being sold to evangelical christian families once again with open government complicity and assistance despite laws like the ICWA and international conventions against genocide so like. whether or not something is legal has absolutely no bearing on whether or not it could happen, regularly, with the approval of the current US administration.
posted by poffin boffin at 12:29 PM on March 11, 2020 [11 favorites]
posted by poffin boffin at 12:29 PM on March 11, 2020 [11 favorites]
Wealth tax. Anyone worth over $10 million ponies up a kidney.
posted by GenjiandProust at 12:32 PM on March 11, 2020 [15 favorites]
posted by GenjiandProust at 12:32 PM on March 11, 2020 [15 favorites]
But saying that offering payments will make it suddenly legal to harvest organs from people in your care is not correct.
AFAIK, it's legal now - there's just no incentive to do it. It costs money, hassle, and creates potential future health problems that the caregiver will have to deal with. A caregiver, who may or may not be family, might sign off on a disabled person donating a kidney to their own brother; they're not likely to put up with the risk, hassle, and cost to do so for a stranger.
That changes if there's substantial money involved.
posted by ErisLordFreedom at 12:51 PM on March 11, 2020
AFAIK, it's legal now - there's just no incentive to do it. It costs money, hassle, and creates potential future health problems that the caregiver will have to deal with. A caregiver, who may or may not be family, might sign off on a disabled person donating a kidney to their own brother; they're not likely to put up with the risk, hassle, and cost to do so for a stranger.
That changes if there's substantial money involved.
posted by ErisLordFreedom at 12:51 PM on March 11, 2020
This is an issue close to my heart. I wrote this comment on a should-we-pay-organ-donors thread 11 years ago (11 years!!!). (My dad and his donee are both still alive and healthy! I think it has been 17 years.)
+++++++++++++++++
My dad donated a kidney to a family friend several years ago. It was crazy to see how many disincentives there were to his act of charity.
His time off of work was only begrudgingly given, and he was not permitted (other than the medical bills themselves) to recover any of his personal expenses associated with the surgery and recovery time. The donee's family wanted to cover lost wages, but was told unequivocally by the hospital that they could not because it is illegal for someone to receive money in exchange for organ donation. He wasn't expecting to make a dime, of course, but he shouldn't have been required to lose money to give away a body part and save someone else's life.
The concept of organ markets is offputting, but thousands of people dying each year waiting on transplant lists is heartbreaking. With just about everyone else along the chain profiting from trade in body parts, it seems screwy that the body itself can't.
posted by AgentRocket at 12:59 PM on March 11, 2020 [20 favorites]
+++++++++++++++++
My dad donated a kidney to a family friend several years ago. It was crazy to see how many disincentives there were to his act of charity.
His time off of work was only begrudgingly given, and he was not permitted (other than the medical bills themselves) to recover any of his personal expenses associated with the surgery and recovery time. The donee's family wanted to cover lost wages, but was told unequivocally by the hospital that they could not because it is illegal for someone to receive money in exchange for organ donation. He wasn't expecting to make a dime, of course, but he shouldn't have been required to lose money to give away a body part and save someone else's life.
The concept of organ markets is offputting, but thousands of people dying each year waiting on transplant lists is heartbreaking. With just about everyone else along the chain profiting from trade in body parts, it seems screwy that the body itself can't.
posted by AgentRocket at 12:59 PM on March 11, 2020 [20 favorites]
You can not sell a kidney to bring your family out of poverty, but you can work in a third-world sweathouse environment that will kill your organs and bring an early death and keep your family in poverty.
posted by dances_with_sneetches at 2:21 PM on March 11, 2020 [3 favorites]
posted by dances_with_sneetches at 2:21 PM on March 11, 2020 [3 favorites]
Is there anyone here, in this conversation, whose profession involves caring for the donor or the recipient around the time of the event?
posted by Baeria at 2:23 PM on March 11, 2020
posted by Baeria at 2:23 PM on March 11, 2020
No, but I am actively considering being a living kidney donor, and have been reading every single first-hand account I can find, if you have a specific question.
posted by NotMyselfRightNow at 2:47 PM on March 11, 2020 [2 favorites]
posted by NotMyselfRightNow at 2:47 PM on March 11, 2020 [2 favorites]
Every anti-choice activist who wants me to use my body to support another living body needs to pony up one of their kidneys to prove their bonafides.
posted by jfwlucy at 3:47 PM on March 11, 2020 [7 favorites]
posted by jfwlucy at 3:47 PM on March 11, 2020 [7 favorites]
When is it going to be ok to die from abusing your organs?
What is this incessant need to prolong the quantity life and not the quality?
When is death going to be as sacred as life?
posted by Mesaverdian at 3:58 PM on March 11, 2020
What is this incessant need to prolong the quantity life and not the quality?
When is death going to be as sacred as life?
posted by Mesaverdian at 3:58 PM on March 11, 2020
I feel like the first two comments from the poster above are somehow contradictory. In any case, I feel obligated to note that needing a kidney transplant does not necessarily mean that you have “abused your organs.” Also, kidney transplants are about improving the quality of a person’s life and not just the quantity.
Based on a recent stint at my dad’s death bed, I have to say that neither life nor death are especially sacred in various times and at various places. Or even in most times and at most places. I think it’s a tragedy that people are dying with usable kidneys, which means that other people are dying because they can’t get the transplants they need. I don’t think there’s anything sacred about dying because you need an organ transplant.
posted by Bella Donna at 4:42 PM on March 11, 2020 [6 favorites]
Based on a recent stint at my dad’s death bed, I have to say that neither life nor death are especially sacred in various times and at various places. Or even in most times and at most places. I think it’s a tragedy that people are dying with usable kidneys, which means that other people are dying because they can’t get the transplants they need. I don’t think there’s anything sacred about dying because you need an organ transplant.
posted by Bella Donna at 4:42 PM on March 11, 2020 [6 favorites]
My opposition to paying a lump sum to organ donors is largely because being paid a lump sum is very likely to ruin your life. Look at what happens to people who win the lottery. It's bad.
--
In a lot of ways, legalizing organ donation seems like legalizing sex work. I have deep concerns about coercion, it's unsettling because the risk of unintended consequences is high, I dread inevitable innovations in capitalist exploitation, and I have personal aesthetic qualms.
Buuuuut, we already permit much worse things, don't we? Like, okay, keep paid organ donation banned. But now it's kind of a moral imperative to consider all those people willing to risk their health, endure pain, and shorten their lives for a few years pay in compensation -- well, probably a few years pay for *them*. The transplant surgeon is maybe making $50k in a month, depending. Anyway, yeah, all the people willing to suffer and maybe die for $50k are probably already suffering and maybe dying.
But solving the underlying poverty requires taxing the surgeon (and other wealthy folks). The burdens of the status quo fall on patients who can't get organs, and the poor who can't get nuthin'.
Opposing legalizing organ compensation isn't a complete political position, is what I'm saying. Like, if you're that concerned about capitalist exploitation and the desperation of the poor that you're willing to let people die of organ failure, you need to show the depth of that conviction more generally.
posted by Richard Daly at 8:29 PM on March 11, 2020 [3 favorites]
--
In a lot of ways, legalizing organ donation seems like legalizing sex work. I have deep concerns about coercion, it's unsettling because the risk of unintended consequences is high, I dread inevitable innovations in capitalist exploitation, and I have personal aesthetic qualms.
Buuuuut, we already permit much worse things, don't we? Like, okay, keep paid organ donation banned. But now it's kind of a moral imperative to consider all those people willing to risk their health, endure pain, and shorten their lives for a few years pay in compensation -- well, probably a few years pay for *them*. The transplant surgeon is maybe making $50k in a month, depending. Anyway, yeah, all the people willing to suffer and maybe die for $50k are probably already suffering and maybe dying.
But solving the underlying poverty requires taxing the surgeon (and other wealthy folks). The burdens of the status quo fall on patients who can't get organs, and the poor who can't get nuthin'.
Opposing legalizing organ compensation isn't a complete political position, is what I'm saying. Like, if you're that concerned about capitalist exploitation and the desperation of the poor that you're willing to let people die of organ failure, you need to show the depth of that conviction more generally.
posted by Richard Daly at 8:29 PM on March 11, 2020 [3 favorites]
Medical/student loan forgiveness in exchange for a kidney seems fair to me.
posted by wenestvedt at 6:31 AM on March 12, 2020 [2 favorites]
posted by wenestvedt at 6:31 AM on March 12, 2020 [2 favorites]
When is it going to be ok to die from abusing your organs?
What is this incessant need to prolong the quantity life and not the quality?
When is death going to be as sacred as life?
I.... am struggling to understand this. Are you saying that people with kidney failure have 'abused their organs'? Are you unaware that kidney transplantation offers huge, huge quality of life improvements over dialysis (and also over dying of kidney failure) - I provide technical support to transplantation research and I have heard so, so many stories of patients noticing within the first week or two that they feel really well for the first time in years. The anti-rejection drugs are rough and taking care of the new organ isn't simple, but at its best transplantation is truly life changing. It allows us to use one person's un-needed organs to turn a profoundly malfunctioning body into one that can function almost as well as a healthy one, and I don't think there is anything more sacred than that.
posted by Acheman at 7:21 AM on March 12, 2020 [4 favorites]
What is this incessant need to prolong the quantity life and not the quality?
When is death going to be as sacred as life?
I.... am struggling to understand this. Are you saying that people with kidney failure have 'abused their organs'? Are you unaware that kidney transplantation offers huge, huge quality of life improvements over dialysis (and also over dying of kidney failure) - I provide technical support to transplantation research and I have heard so, so many stories of patients noticing within the first week or two that they feel really well for the first time in years. The anti-rejection drugs are rough and taking care of the new organ isn't simple, but at its best transplantation is truly life changing. It allows us to use one person's un-needed organs to turn a profoundly malfunctioning body into one that can function almost as well as a healthy one, and I don't think there is anything more sacred than that.
posted by Acheman at 7:21 AM on March 12, 2020 [4 favorites]
This idea (of paying organ donors) is the absolute worst idea in an entire ocean of bad ideas. From the second-to-last link (Paid organ donation: the case against):
Look, I get it. There's a serious crisis in terms of organ availability. People die every day because there aren't enough kidneys. And on a spreadsheet, it's definitely cost-effective to pay $50K to donors instead of the $75K/year for dialysis (taking into effect as well the cost of surgery vs. dialysis). But the cost to our souls for harvesting organs from the poor has no upper limit.
There are lots of good ideas in the comments above about how we can make things easier for altruistic donors, and I support all of those. Free medical insurance for life, or medicare for life, or even just compensation for travel and childcare and lost wages. That would truly be a wonderful recognition of the real costs and inconveniences faced by living donors.
I speak from experience earned in blood and flesh. My wife came down with kidney disease three years ago. She went on dialysis soon after. The next year I gave her my kidney (see my history for details). Had I not been a match, we would have been on the waiting list, maybe for years. And maybe my wife would have died on the waiting list, as so many people do. And I was desperate, so very desperate, and if I had to, I would have burned down the world to give my wife another year of life, and if there was an open market you bet your sweet soul that I would have taken a second mortgage on the house, raided the kids college fund, and paid cash on the table for someone's kidney. Hell, I would have carved it out of them myself, consequences be dammed.
Thank God there was not an open market. I pray to God there never will be.
posted by fuzzy.little.sock at 9:11 AM on March 12, 2020 [8 favorites]
Donors are poor, with most living below the poverty line. Most are illiterate and in low-paid manual jobs, their sole reason for donating not borne of altruism but to pay off debt. In Pakistan many individuals donate kidneys to release themselves from bonded slavery but have insufficient capital to make a new life and often return to debt... We find it difficult to relate to concepts such as the entrapment represented by bonded slavery but how would our society view individuals in our own country driven to donate a kidney to pay off credit card debt, college fees or to satisfy a drug problem?I shudder at the thought of an organ open market where we fly in poor people from third-world countries, harvest their organs, and then dump them back in their home villages with a brief period of prosperity but no follow-up medical care. Or sometimes the promised money never comes through, like in this story.
Sadly for the majority of donors, selling a kidney does not result in the significant economic benefit of which they dreamed. Often it is associated with a decline in general health. Many fall back into debt, often compounded by the inability to work following donation due to ill health. Supporters of paid donation argue that a person should have the basic right to choose the fate of his or her organs. In the setting of paid donation, informed consent is often of dubious quality, with the risks of surgery often not being properly explained or understood. Furthermore, many individuals are pressured to donate by family members, with the outcome of any ‘balanced discussions’ about wishing to proceed with organ donation predetermined
Look, I get it. There's a serious crisis in terms of organ availability. People die every day because there aren't enough kidneys. And on a spreadsheet, it's definitely cost-effective to pay $50K to donors instead of the $75K/year for dialysis (taking into effect as well the cost of surgery vs. dialysis). But the cost to our souls for harvesting organs from the poor has no upper limit.
There are lots of good ideas in the comments above about how we can make things easier for altruistic donors, and I support all of those. Free medical insurance for life, or medicare for life, or even just compensation for travel and childcare and lost wages. That would truly be a wonderful recognition of the real costs and inconveniences faced by living donors.
I speak from experience earned in blood and flesh. My wife came down with kidney disease three years ago. She went on dialysis soon after. The next year I gave her my kidney (see my history for details). Had I not been a match, we would have been on the waiting list, maybe for years. And maybe my wife would have died on the waiting list, as so many people do. And I was desperate, so very desperate, and if I had to, I would have burned down the world to give my wife another year of life, and if there was an open market you bet your sweet soul that I would have taken a second mortgage on the house, raided the kids college fund, and paid cash on the table for someone's kidney. Hell, I would have carved it out of them myself, consequences be dammed.
Thank God there was not an open market. I pray to God there never will be.
posted by fuzzy.little.sock at 9:11 AM on March 12, 2020 [8 favorites]
It's a really all-or-nothing approach to compare the current system with an outright high-dollar cash payment. You could do a huge amount with the combination of:
1) switch to deceased-donor opt-out instead of opt-in
2) mandated 3 months of sick leave/short term disability for donors (with protection of their position and subsidy to cover costs of leave)
posted by mercredi at 2:17 PM on March 12, 2020 [2 favorites]
1) switch to deceased-donor opt-out instead of opt-in
2) mandated 3 months of sick leave/short term disability for donors (with protection of their position and subsidy to cover costs of leave)
posted by mercredi at 2:17 PM on March 12, 2020 [2 favorites]
According to this 2019 study, almost every country with universal healthcare has lower living kidney donation rates than the United States.
So is that measuring the generosity of family and friends, or the inefficiency of the system for distributing cadaver kidneys?
posted by Idcoytco at 12:14 PM on March 14, 2020
So is that measuring the generosity of family and friends, or the inefficiency of the system for distributing cadaver kidneys?
posted by Idcoytco at 12:14 PM on March 14, 2020
« The surest way to substantially alleviate the shortage of kidneys is through an increase in living donors. »
Is it really the surest, though? What about medical research into lab-grown kidneys, or into better prevention or treatment of kidney conditions?
(Realistically, all of these at once...)
posted by Belostomatidae at 4:50 PM on March 14, 2020 [1 favorite]
Is it really the surest, though? What about medical research into lab-grown kidneys, or into better prevention or treatment of kidney conditions?
(Realistically, all of these at once...)
posted by Belostomatidae at 4:50 PM on March 14, 2020 [1 favorite]
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Avoiding a lump sum payment and adding a significant delay between donation and payment could do a lot to reduce perverse incentives and donations born of desperation. Plus donors who encounter health problems down the road would have a continuous, if small, source of additional income.
* Roughly $50,000 divided by the average length of retirement in the US, which is 18 years, rounding up to (crudely) account for the time value of money.
posted by jedicus at 7:51 AM on March 11, 2020 [7 favorites]