Markets in Everything, ctd.
Megan McArdle has a challenge for those opposed to the sale of bodily organs:
Justify driving organ sales to the black market, where the brokers get rich, the sellers get a pittance, and only the rich can afford them, rather than taking the money we currently spend on dialysis to compensate those who are willing to help provide the gift of a dialysis-free life to others. Bonus question: explain why we should prevent people from voluntarily donating a kidney when living kidney donors do not appear to have an elevated risk of kidney failure without resorting to any of the following
- Huffy declarations that anyone who disagrees with you must be amoral
- Appeals to the fact that many other people are also against organ donation
- Invoking the infamous "ick" factor involved in selling a body part
Extra credit: do all of the above, to someone on longterm dialysis who is legally prevented from buying an organ, or having the government buy one for her.
I am similarly inclined, though as a reader pointed out no less an authority – for some of us, anyway – than the Pope himself has suggested a line of argument that seems to meet Megan’s criteria:
As regards the practice of organ transplants, it means that someone can give only if he/she is not placing his/her own health and identity in serious danger, and only for a morally valid and proportional reason. The possibility of organ sales, as well as the adoption of discriminatory and utilitarian criteria, would greatly clash with the underlying meaning of the gift that would place it out of consideration, qualifying it as a morally illicit act.
The central concern that Benedict is articulating here has to do with the need to prevent our understanding of the human person from being captured or corrupted by what he calls “the logic of the market”; the body must not be “considered a mere object”, and the potential for self-commodification that could attend the sale of body parts is something that any advocate for open markets in human organs should take very seriously. (Except the libertarians, who are in favor of the commodification of everything.*) If I were of the sort to offer arguments for the blanket illegalization of material compensation for living organ donors, these are the lines those arguments would follow.
But at least two further points need to be made.
The first is that it is not at all clear that compensating organ donors would essentially “clash with the underlying meaning of the gift” in the ways in question. To take a few admittedly strained examples, think of opera halls and campus buildings that have been named after donors, or – better – stained glass windows in churches that bear the names of the people who paid for them. Having such a window installed simply for the sake of putting one’s name up there for all to see is clearly an exercise of vanity, but we don’t decide that the real possibility of feeding into such sinful tendencies is a reason to do away with that form of acknowledgment altogether; rather, we see that the potential for societal recognition can incentivize giving without compromising its nobility. So why can’t it similarly be that, as the University of Minnesota’s Arthur Matas puts it to Virginia Postrel, the promise of compensation for organ donors could help to “push them over the edge”, and send the message that “We can compensate you but never repay you”? Can it really be that any sort of material compensation turns a gift into a sale, thereby making it morally illicit?
Secondly and relatedly, it is important to see that there is a large gap between allowing donors to receive tens of thousands of dollars in exchange for their organs and prohibiting them from receiving any compensation whatsoever beyond travel costs and a bit of disability pay. AEI’s Sally Satel made this point quite effectively in Sunday’s Wall Street Journal:
States could offer health and life insurance to living donors, or funeral benefits to families of posthumous donors. Donors could also be offered a tax credit or perhaps a very generous contribution to a charity of their choice.
The rewards could come from state governments or approved charities, not from individuals, and the organs would be distributed according to formulas already in place. That means organs will not be available only to the wealthy.
In fact this strikes me as even more caution than would be necessary, but the key point is that not all compensation must take the form of money that can be immediately spent – and instituting limits of these sorts would clearly be a way to work against the potential for “clash with the underlying meaning of the gift” that Benedict reasonably worries about. Given the pain currently endured by tens of thousands of dialysis patients waiting years on end for a transplant, it seems appropriate to hope that space can be opened to try to find such a middle ground, ideally on a state-by-state basis.
This is, as I said many times in the comments to my earlier post, not at all an issue about which I’ve made up my mind; and I do think that the concerns about self-commodification are very, very legitimate. But it seems clear to me that the question of which political arrangements will best serve the public good in this domain should be regarded as open, rather than as closed.
* Actually, that’s not true. But it is fun to say.
Filed under: morality
Thank you for the thoughtful post. I have to note that if a tiny, tiny percentage of the country’s practicing Christians would donate kidneys we wouldn’t even be having this discussion.
As the death toll from the organ shortage mounts, public opinion will eventually support an organ market. Changes in public policy will then follow.
In the mean time, there is an already-legal way to 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. UNOS, which manages the national organ allocation system, has the power to make this simple policy change. No legislative action 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 http://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. Non-donors should go to the back of the waiting list as long as there is a shortage of organs.
the body must not be “considered a mere object”, and the potential for self-commodification that could attend the sale of body parts is something that any advocate for open markets in human organs should take very seriously
This point transcends open markets in human organs, though. Why don’t we compensate foster families? Why don’t we pay women, who otherwise would seek an abortion, to carry a fetus to term? (note: we of course do allow payments to surrogate mothers, so there’s definitely precedent there)
As Benedict writes: “it means that someon can give…only for a morally valid and proportional reason.” In essence he is discussing the logic of charity. How would the introduction of compensation affect the institutions of adoption or child-rearing (or charity – specific to one’s own physical sacrifice – as a whole)? Positively or negatively? The cautious answer to this question is we don’t know, and because these institutions are so vital to our society, it’s best that we leave them be.
I understand the libertarian/utilitarian argument for markets in
everythingorgan donation. Simple logic really: create a market for kidneys and we’ll have more kidneys to donate. When combined with the health economics of dialysis, the utilitarian position for a kidney market is hard to reject. The existence of a human organ black market seems to be the last piece of evidence one needs to accept the rationale for legalization of human tissue and organ sales. In fact, I agree with this position. However, at the same time, I have deep concerns about how compensation for organ donation alters our perceptions of physical sacrifice, how this will affect similar charitable institutions, and where we place limits for what can and cannot be marketed nowadays.Yes, but part of my point is that not everything that is done partly in response to an external incentive is one in which the promise of that incentive constitutes the reason why that thing is done. And of course we already do incentivize parenthood, through the structure of the tax code – obviously this isn’t, and shouldn’t be, a case in which the compensation exceeds the market value of the sacrifice, but they seem to be cases in which incentives can play a role without destroying the “underlying logic” of what iis at stake.
part of my point is that not everything that is done partly in response to an external incentive is one in which the promise of that incentive constitutes the reason why that thing is done
This is of course true, and why the libertarian position for markets in organ donation is hard to refute. We will never truly know the reasons for why certain decisions are made, only that they are made, and that the utility of said decisions can be measured. However…
but they seem to be cases in which incentives can play a role without destroying the “underlying logic” of what iis at stake
For every child tax credit, I can raise you one child welfare subsidy (which were reformed, but bear with me) which can cause immeasurable damage to a vulnerable community. I think the conservative approach to markets in organ donation must be a system where compensation and market transactions are defined by the primay consumer and supplier (receiver-donor), not third parties (e.g. gov’t). Third parties then can play a role in regulation and security. This is the only way in which both the markets and the Church’s goals can be met – for if we all adopt a morally valid and proportionally reasoned approach to decision making, our markets would work both more fluidly and ethically. Inject government/politics into the fray, and all bets are off.
Indeed. I take the point, and should have acknowledged it explicitly myself. But we don’t think, do we, that the reality of such abuses is a reason to do away with the corresponding incentives altogether?
Mr. Undis’ fear-based scheme to increase organ donation will never happen. He would like to create two waiting lists: those who have registered as organ donors, and those who have not. Available organs would first go to those who have registered as donors. The theory is that more people will register to be donors if they think they might miss out on the opportunity to receive a lifesaving transplant in the future.
Lifesharers promises preferred access to the organs of other Lifesharers who die. The only way a Lifesharer will receive the organs of a fellow member is for them to meet the existing criteria used by the national organ allocation system.
Mr. Undis has been trying to enlist members for his “organ club” for more than six years. He has signed up a little more than 12,000 members in that time. Those of us legimitately engaged in this lifesaving work every day have registered more than 82 million Americans.
If Mr. Undis was serious about increasing organ donation, he would encourage Americans, as we do, to go to http://www.donatelife.net and find out how to become a registered donor in their own state.
Phil Van Stavern
LifeShare of Oklahoma
(21-year kidney recipient)
Of course we already have markets in human tissue – sperm and ovum. And I think an honest look at that market will tell you your fears are overblown. The commodification of sperm and ovum has in no way lessened the joy and happiness that couples or single mothers get from bearing children. I know first hand since I was conceived from donor insemination. There are certainly some issues regarding anonymity of donors that still need to be worked out but all in all we have more stable happy families because of it.
Yes, well there are some other reasons why Catholics are opposed to markets in sperm and ova.
Of course we already have markets in human tissue – sperm and ovum. And I think an honest look at that market will tell you your fears are overblown.
To conflate sex cell donation with organ donation, specifically kidney donation, is massively disingenuous. You have billions of sperm, and are constantly making billions more every week. You have 2 kidneys, and after you donate one you better hope the other one never gets hurt.
part of my point is that not everything that is done partly in response to an external incentive is one in which the promise of that incentive constitutes the reason why that thing is done
Perhaps. But it’s hard to shake the notion that if: (a) a free market in kidneys were permitted; and if (b) tons of poor people started donating kidneys to strangers; then (c) the only conclusion would be that, for most of the donators, the incentive is precisely the reason for the donation.
Don’t you think?
Yes, I do – and that’s a large part of why I don’t think allowing a wholly free market is the right approach.
Ignore the nasty comments from the morally impaired. Your right to say no is just as valuable and right as my right to say yes. We all suffer when our rights are impaired, no matter how righteous the alleged cause.
Organs are free because state and federal laws say they are free.
What most people don’t know is that organ procurement organizations and tissue banks can make up to $2 million off a donated whole body. This is a $20 billion a year business in the United States. If we were talking about copper and Bolivia, the issues would be crystal clear. The current system is unjust and immoral.
If you live in a state that has adopted the 2006 Uniform Anatomical Gift Act, it is presumed that you are an organ donor until they can find evidence of a contrary position. This includes hooking you up to life support systems even if you have an Advanced Healthcare Directive that says otherwise. They can keep your body alive until they can talk to your family to find out what your true intentions were.
Under this new Act, you have the right to refuse to participate in an organ harvesting procedure, but you must register your desire with a known organ registry. There is only one organ registry in operation that allows you to record your preferences, including allowing for the contingency that just compensation might become legal at some future date.
Check out http://www.DoNotTransplant.com to learn more about your rights under the law
You mean all those concerned with the plight of the tens of thousands of people coping with the painful indignity of dialysis? Yes, please do ignore them. What an outrage.
P.S. The issue of presumed consent has not been a part of this discussion at all, from what I can tell.
Mark, like Dave Undis, has a form letter he posts everywhere this subject comes up.
In that spirit, let me post the most important paragraph from my Atlantic Unbound article on how to end the waiting list (it’s not just about financial compensation):
To end the list, we first have to give up the idea that “organ donor” means someone dead. Deceased donors are, of course, essential for hearts. But not for kidneys. And not enough people die in exactly the right way to meet the need for kidneys. The best estimate is that there are between 10,500 and 13,800 brain-dead potential organ donors each year. More than half already become donors, and not all their kidneys can be used. If every single person who died the right way became an organ donor, an optimistic estimate would be that 7,000 more kidneys a year would be available for transplant. Since the list is now increasing by 6,000 a year, that would be enough to end it—in 80 years.
http://www.theatlantic.com/doc/200907u/kidney-donation
I agree that the Iranian theocracy is not where I normally go to get my dose of moral instruction but could we please have a little more knowledge of the one country that has a paid kidney transplant market and, amazingly not by coincidence, no shortage of kidneys?
I’ve also noted with immense enjoyment that elsewhere there are all sorts of people leaping on Benny XVI’s comments as presented above. A vast number of those doing so (present company excepted of course) actively reject his thoughts and teachings on many a subject.
Quite why we should listen to anyone who happily, nay avidly, rejects his views on divorce, contraception, IVF, buggery, abortion and all the rest but adopts a repectful reverence when he says that markets are bad, M’Kay is a little beyond me.