Soliciting Organ Donation
There’s a really controversial NEJM opinion article from Dr. Douglas Hanto on organ donor solicitation. He shows up to defend his position and convince skeptics on Paul Levy’s blog (the CEO of Beth Israel Deaconess Medical Center in Boston; isn’t the internet wonderful?). NextGen (shameless plug) offers free online access to the NEJM article.
Dr. Hanto advocates forbidding direct organ solicitation from patients to potential organ donors, arguing that it circumvents the fair distribution of organs based on medical need. I infer, though I’m not entirely clear on this, that he also advocates forbidding organ donation except to the central repository or list system that hospitals use to triage out the organs to patients. I will assume he advocates this position, since from the article, he seems to say this.
I really must respectfully disagree with Dr. Hanto. He states that organ donation must occur in this centrally managed way, because allowing organ donors to choose to whom they would like to donate would violate the “rights” of patients on the list. I’m not really sure which right he means, but he says, “Donor autonomy is not absolute and must consider the fair rights of others.” I’m not really sure this is a valid thing to say. What “rights” to other people have on organs or property of another? Is it just to say that the poor have a “right” to the private money donations of a wealthy individual? I think not. It is a private donation, and one freely given by one individual to another.
To put it another way, is it “fair” that Michael Jordan has so much money? People pay him tons of money to play basketball (well, they did in the past). Is it really good for society and fair for all that someone who plays basketball is making tons more money than, say, a hot-shot surgeon who saves people’s lives every day? Should we make it illegal for them to just give him money, and instead have the government pay each person what they “have a right to”? That’s pretty much complete communism, and I’m quite against that. People can do with their property what they will, wasteful or not. I assume that people have a right to do with their bodies as they will, wasteful or not. There’s no magical “fairness” right that gives other people rights to someone’s private property. That’s what makes it private. People’s bodies are part of their private property.
Dr. Hanto argues that there isn’t such a thing as complete donor autonomy, because organ transplantation surgery does require a significant commitment of resources and time that is not funded by the donor. That’s true, but it is true of any donation process, money, organs, blood, anything. The hospital is perfectly allowed to refuse to operate unless the donor donates to the central hospital list, but if a surgery team and hospital is willing, then it shouldn’t be illegal. Alternatively, some other donor or the patient or even the organ donor could cover the cost of doing the surgery, in compensation for taking up the hospital’s time and resources. If the patient is willing to pay the hospital to do this, the hospital is willing to take the money in compensation for their time, and the donor is willing to give the organ in this circumstance, there is nothing wrong with allowing the surgery to proceed.
Don’t get me wrong; it would probably be more kind for people to donate to the central bank, but I’m not giving out karma points or heaven points or whatever. These people have the right to do what they want. We are a society based on individual rights. We shouldn’t turn into a society where the government controls everything that people do.
Update: On the other hand, the US Government is doing nothing to help with the organ shortages. Here’s a good Freakonomics blog article on the (lack of an) organ market. And another one with links.
One particularly interesting and tragic side effect of preventing organ donation between specific groups of strangers would be that it would derail a whole slough of programs that are set to encourage people to donate organs, from LifeSharers, a group dedicated to donating organs but also who preferentially donates organs to those who vow to donate, and the New England Program for Kidney Exchange, which matches donor-recipient pairs, where (for example) one family member is willing to donate to another, but can’t due to blood-type incompatibility. They would be matched with another biologically complementary donor-acceptor pair in order to ensure that both patients get their organs.
A blog on this topic is the Organomics blog. One good entry is on arguments against the “coercion of the poor” objection to organ markets. I don’t always agree with the tone of the blog, or some of the ad hominem attacks it makes on critics of its ideas, but the ideas it has are (mostly) good one.
