NationStates Jolt Archive

In the UK the gap between the number of successful donations of solid organs (kidneys, liver, etc) and the number of patients on the transplant waiting list has widened over the past years. At present organs are obtained as a result of brain death, cardiac death, or living donors but it is illegal to accept payment for donation, as in the vast majority of countries.

What would your views be on a system in which it was legal for donors to sell their organs in order to increase the number available for transplant?

What would your views be on a system in which it was legal for donors to sell their organs in order to increase the number available for transplant?For one, poor people would be pressured into doing it, much like poor communities are pressured into allowing their land to be turned into landfills. Secondly, illegal organ harvesting would probably rise, as there is no legal hindrance of selling organs anymore.

While I'm not a libertarian, I see nothing wrong in selling organs. It should be legal.

What would your views be on a system in which it was legal for donors to sell their organs in order to increase the number available for transplant?
It would need to be incredibly well regulated, with major safeguards.

Something I don't think any British government or NHS trust could handle.

What would your views be on a system in which it was legal for donors to sell their organs in order to increase the number available for transplant?
The problem is that if it were possible for people to get paid for donating their organs, then very few people would donate them for free.

Think about it this way: you could either choose to donate your organs for free, or you can choose to donate the organs AND have money paid to your loved ones. Given that a huge proportion of families in my country are struggling economically, I can't really blame anybody for wanting to leave some extra money to their family if something should happen.

The organizations that currently procure donated organs simply cannot afford to pay every donor. So, perversely, paying donors might create an incentive for more people to donate, but it would actually LOWER the availability of organs for people who need them.

For one, poor people would be pressured into doing it, much like poor communities are pressured into allowing their land to be turned into landfills. Secondly, illegal organ harvesting would probably rise, as there is no legal hindrance of selling organs anymore.

Why would illegal organ harvesting have to rise in a properly regulated system where the benefit would be for the donors to approach the legal organisations?

There was a proposal in Israel that, were such changes made, that organ sale should only be legal if it was directly to a central agency regulated by the government itself. This way the middle man organ broker is removed from the equation and the donor recieves all of the payment. At present there are reports that donors are paid in the region of $1,000-$2,000 on the black market while patients can pay anywhere from $18,000-$145,000.

In a government run system you could adequetely compensate the donors

You can also have a system where the donations go into a central pool and are allocated by the medical authorities to those in most need rather than those most able to pay

I actually recently watched a documentary on the Iranian body parts market. Any time you are offering people money, you will get desperate people that will do just about anything to get ahold of some cash. The thing that struck me as sad in the documentary was that just about all of the people selling their kidneys were desperate for money and looking for immediate relief. I think a system like this has the potential to breed much greed and scandal. I worry too about how hard something like this would be to regulate. Eventually in my opinion it would not amount to much more than another reason for big business to take advantage of people that need money. Its also very easy to picture people without the money to pay a donor dying while the wealthy get whatever they need for the right price.:(

The organizations that currently procure donated organs simply cannot afford to pay every donor. So, perversely, paying donors might create an incentive for more people to donate, but it would actually LOWER the availability of organs for people who need them.

However it would be more cost effective for the government as a transplantation costs less than long term dialysis

Or instead they could just turn it into an opt-out system instead of an opt-in one.

Although there is debate that it isn't the system itself that improves donation rates but rather every family is approached by a transplant co-ordinator

It's also interesting to note that UK Transplant is actually against opt-out

Or instead they could just turn it into an opt-out system instead of an opt-in one.

If organ donors are paid then who exactly is going to pay them? The hospitals? The would-be receivers of the organs? Would you have to pay to get on the transplant list? And how much do you pay for which organs anyway? Who gets the money if the donor is deceased?

If organ donors are paid then who exactly is going to pay them? The hospitals? The would-be receivers of the organs? Would you have to pay to get on the transplant list? And how much do you pay for which organs anyway? Who gets the money if the donor is deceased?

I'm looking at this from an NHS viewpoint mostly in which the NHS would be pay the donors in just the same way as they currently pay for long term dialysis, etc

There wouldn't be a need for the patients to pay

Indeed.

Allowing the sale of organs leads to exploitation of the poor, more unhealthy organs in the system (someone who really needs the money will lie about their health background), and the issue of illegal organ harvesting.

Every nation with an opt-out system has far more organs in the system, largely because of apathy. Most people don't care enough about the subject to fill out any paperwork for it - either to opt in or to opt out. In an opt-out system, all of those people who couldn't care less default as organ donors.

Link (http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/17/ndonor117.xml)

That is being debated though

He cited the example of Spain where a switch to an opt-out system has led to a rise in organ donation. However there is a row over whether there are other reasons for this such an increase in the number of families approached by transplant co-ordinators.

Why would illegal organ harvesting have to rise in a properly regulated system where the benefit would be for the donors to approach the legal organisations?Because there is a likelihood that others will seek to profit from this without selling their own organs, duping others to give them their organs (or stealing them outright).

There was a proposal in Israel that, were such changes made, that organ sale should only be legal if it was directly to a central agency regulated by the government itself. This way the middle man organ broker is removed from the equation and the donor recieves all of the payment. At present there are reports that donors are paid in the region of $1,000-$2,000 on the black market while patients can pay anywhere from $18,000-$145,000.There's still the possibility that people will sell other people's organs.

In a government run system you could [B]adequetely compensate[B] the donorsHow do you compensate someone adequately for taking their organs?

You can also have a system where the donations go into a central pool and are allocated by the medical authorities to those in most need rather than those most able to payThat's not the point. Where they go to is less of an issue, it's where they come from that's important in this case. What I'm afraid of is that this will lead to sales from illicit sources.

Also, I believe that the pressure to sell organs simply to make ends meet is deplorable enough on its own to oppose organs being sold. Likewise, I support the German Red Cross' decision not to pay people for donating blood, because organs (including blood) should not become a commodity to be bartered or sold.

Or instead they could just turn it into an opt-out system instead of an opt-in one.

Indeed.

Allowing the sale of organs leads to exploitation of the poor, more unhealthy organs in the system (someone who really needs the money will lie about their health background), and the issue of illegal organ harvesting.

Every nation with an opt-out system has far more organs in the system, largely because of apathy. Most people don't care enough about the subject to fill out any paperwork for it - either to opt in or to opt out. In an opt-out system, all of those people who couldn't care less default as organ donors.

Because there is a likelihood that others will seek to profit from this without selling their own organs, duping others to give them their organs (or stealing them outright).

Which is happening already


How do you compensate someone adequately for taking their organs?

Under the current Criminal Injury Compensation guidelines the loss of a kidney is compensated by £22,000. I'd consider this much better than the $1,000 - $2,000 currently being paid on the black market although it isn't my personal view of what it is worth

Not to mention that the donor mortality rate at present is 0.03% and there is no difference between donors and their siblings (in terms of measuring possible renal disease) at 20 year follow up

(Lancet 1992;340:807-9)

That's not the point. Where they go to is less of an issue, it's where they come from that's important in this case. What I'm afraid of is that this will lead to sales from illicit sources.

Which is happening anyway.

Also, I believe that the pressure to sell organs simply to make ends meet is deplorable enough on its own to oppose organs being sold. Likewise, I support the German Red Cross' decision not to pay people for donating blood, because organs (including blood) should not become a commodity to be bartered or sold.

How about the payment of medical research volunteers?

How about the payment of medical research volunteers?
I've done research with human subjects, so I'd like to answer this from the perspective of somebody who has paid research volunteers.

We paid our volunteers as compensation for their time, since they were traveling to our lab and spending an afternoon with us. Our experiments were purely cognitive (no drugs or medical treatments were administered to the subjects), so our research subjects were basically doing a job for us. Now, granted, their "job" was simply to behave normally as we exposed them to a range of stimuli and measured the results, but still. It felt reasonable to pay them for their time.

In that respect, they were being paid for a service. We weren't purchasing any item or items from them. I don't know how big a difference this distinction makes here, but it does seem like a relevant one.

Link (http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/07/17/ndonor117.xml)

That is being debated though

It is standard practice in the US for a transplant coordinator to approach the family of any person who could possibly be an organ donor. It hasn't helped. In fact, waiting until that moment - when the family is upset - might actually lower the rates of organ donation.

Meanwhile, I really have to question anyone who claims that there is no evidence that an opt-out system would increase the number of donors. By its very nature, it does just that. It gets around the problem of apathy - which would no lead to donations, rather than a lack of donations.

I've done research with human subjects, so I'd like to answer this from the perspective of somebody who has paid research volunteers.

We paid our volunteers as compensation for their time, since they were traveling to our lab and spending an afternoon with us. Our experiments were purely cognitive (no drugs or medical treatments were administered to the subjects), so our research subjects were basically doing a job for us. Now, granted, their "job" was simply to behave normally as we exposed them to a range of stimuli and measured the results, but still. It felt reasonable to pay them for their time.

In that respect, they were being paid for a service. We weren't purchasing any item or items from them. I don't know how big a difference this distinction makes here, but it does seem like a relevant one.

I apologise. I had meant research volunteers paid for research involving drugs or medical treatments

The local contract research organisation pays their volunteers by a wage payment model based on the minimum wage. It takes into account the number of days they take part, the number of visits they have to make to the centre itself, and a 'procedure factor' (based on the invasiveness or possible risks of the tests)

Which is happening alreadyNo need to increase it. More below.

Under the current Criminal Injury Compensation guidelines the loss of a kidney is compensated by £22,000. I'd consider this much better than the $1,000 - $2,000 currently being paid on the black market although it isn't my personal view of what it is worth

Not to mention that the donor mortality rate at present is 0.03% and there is no difference between donors and their siblings (in terms of measuring possible renal disease) at 20 year follow up

(Lancet 1992;340:807-9) You've given a price that others deem adequate. Now show me why it is adequate.

Which is happening anyway.Again, no need to increase it. You've given the example that illegal organ harvesting often happens when people are willing to pay large sums of money instead of waiting for their place on the list. That's not going away even if you legalize organ sales. The initial reason for the black market sale of organs remains largely untouched unless you manage to drastically increase the amount of organs supplied.

How about the payment of medical research volunteers?Depends on the type of research. Some are deplorable and some are not.

It is standard practice in the US for a transplant coordinator to approach the family of any person who could possibly be an organ donor. It hasn't helped. In fact, waiting until that moment - when the family is upset - might actually lower the rates of organ donation.

Meanwhile, I really have to question anyone who claims that there is no evidence that an opt-out system would increase the number of donors. By its very nature, it does just that. It gets around the problem of apathy - which would no lead to donations, rather than a lack of donations.

This (http://www.uktransplant.org.uk/ukt/newsroom/statements_and_stances/statements/opt_in_or_out.jsp) is the position UK Transplant takes on opt-out :

One problem with presumed consent is the risk of causing major distress to a close relative or partner and creating ill-will which would outweigh any advantages in the longer term. If organs were removed and relatives subsequently came forward with objections, the cause of transplantation could suffer adverse publicity, and this could have a major impact on their trust and respect for the medical profession.

There could also be medical risks involved with the removal of organs without discussion with relatives. Families are a valuable source of information about their loved one's previous health and relatives are questioned as part of the screening process.

If an individual does not register an objection, this silence may indicate a lack of understanding rather than an agreement with the policy

I apologise. I had meant research volunteers paid for research involving drugs or medical treatments

See, now this is where it gets a little confusing.

I guess you could perceive it as paying for the service, just like in the cognitive field, since the person's "job" is to take the medication or treatment or whatever. But it still does kind of feel like they are "selling" their bodily systems (or at least renting them out) if they're allowing you to chemically or physically alter their body. In a lot of experiments there will be physical samples collected (hair, skin, blood, etc), which again seems like the individual is getting paid for the sale of their body parts.

I suppose one key difference is that research subjects will (hopefully!) be alive after the study ends. Organ donors won't be.


The local contract research organisation pays their volunteers by a wage payment model based on the minimum wage. It takes into account the number of days they take part, the number of visits they have to make to the centre itself, and a 'procedure factor' (based on the invasiveness or possible risks of the tests)
Yeah, that's pretty standard.

This all is a very interesting point you bring up.

For myself, I don't have a problem with paying people for their organs in and of itself. The reason I object to the practice is primarily because I believe it will cause problems for people who need organs, and also will open up a lot of potentially icky avenues of abuse and exploitation. Which is not to say that such abuses don't already happen, but it's a lot easier to prosecute them and to shut them down right now.

You've given a price that others deem adequate. Now show me why it is adequate.

You're right. Perhaps I should have said 'improved' instead.

Again, no need to increase it. You've given the example that illegal organ harvesting often happens when people are willing to pay large sums of money instead of waiting for their place on the list. That's not going away even if you legalize organ sales. The initial reason for the black market sale of organs remains largely untouched unless you manage to drastically increase the amount of organs supplied.

I'd say this point depends on whether the majority of black market supply comes from paid donors or from forced donors. If the resources dry up then the market would be decreased in such a case. My understanding was that it comes from paid donors although it is something I would need to research. The bolded is what I would consider the aim of a system of legal organ sale

Organ donors won't be.

Why not? The risk of morbidity of a kidney donor is 0.03% with no difference on 20 year follow up. Don't get me wrong i'm not talking about stripping them of both kidneys or all of their liver or lungs, etc


Yeah, that's pretty standard.

This all is a very interesting point you bring up.

I hadn't thought a course called 'Transplantation ethics' would be all that interesting. Turns out I was wrong and NSG makes a good sounding board before I go off writing papers

For myself, I don't have a problem with paying people for their organs in and of itself. The reason I object to the practice is primarily because I believe it will cause problems for people who need organs, and also will open up a lot of potentially icky avenues of abuse and exploitation. Which is not to say that such abuses don't already happen, but it's a lot easier to prosecute them and to shut them down right now.

Why is it easier to prosecute them now rather than in the alternative?

This (http://www.uktransplant.org.uk/ukt/newsroom/statements_and_stances/statements/opt_in_or_out.jsp) is the position UK Transplant takes on opt-out :

The opt-out system doesn't keep the transplant coordinators from taking a medical history of the donor or from talking to the family (assuming they are available).

The opt-out system doesn't keep the transplant coordinators from taking a medical history of the donor or from talking to the family (assuming they are available).

True

Why not? The risk of morbidity of a kidney donor is 0.03% with no difference on 20 year follow up. Don't get me wrong i'm not talking about stripping them of both kidneys or all of their liver or lungs, etc

Being an organ donor of the sort we're discussing is only about what happens to your body after you die.

If I'm in a car crash, I'm unconscious but stable when brought to the hospital, and they see on my license that I'm an organ donor, they don't get to take my kidney while I'm unconscious and then thank me for it when I wake up. That would be pretty fucked up, and I certainly wouldn't be a donor if that were the case.

Being an organ donor of the sort we're discussing is only about what happens to your body after you die.

If I'm in a car crash, I'm unconscious but stable when brought to the hospital, and they see on my license that I'm an organ donor, they don't get to take my kidney while I'm unconscious and then thank me for it when I wake up. That would be pretty fucked up, and I certainly wouldn't be a donor if that were the case.

I apologise i'm a bit confused by this post (most likely I need sleep)

Which sort of organ donor are we discussing? I had intended this to be about living persons approaching an NHS type organisation with the intention of selling their organs, while still in good health (as opposed to the next time they are brought in to hospital), to a central bank of organs from which medical authorities could allocate to those most in need rather than those most able to pay