Kidneys'R Us

[boooeee]

Because not every thread can be about Iraq, Israel, or Bush.

I read an editorial in The Economist the other day advocating for a free market solution to kidney transplant waiting lists. Unfortunately, most of the Economist's online content is now locked off, so I'll try to summarize:

About 4,000 people a year die in the US while waiting for a kidney transplant. As I understand it, the way the transplant system works now is that a donor is either a) recently deceased or b) a freind or family member who has agreed to donate their kidney to their loved one. Apparently, it is currently against the law to pay compensation to the person donating their kidney.

The Economist argued that lifting this ban would dramatically increase the number of available kidneys and eliminate the waiting list. Currently, Iran (that hotbed of free market thinking) is the only country that allows people to sell one of their kidneys and they have no waiting list for transplants.

It is not too surprising that The Economist is advocating a free market solution to a problem. I am inclined to agree with their proposed solution, but I was wondering what other people thought about the issue.

[Darth Rotor]

Because not every thread can be about Iraq, Israel, or Bush.

I read an editorial in The Economist the other day advocating for a free market solution to kidney transplant waiting lists. Unfortunately, most of the Economist's online content is now locked off, so I'll try to summarize:

About 4,000 people a year die in the US while waiting for a kidney transplant. As I understand it, the way the transplant system works now is that a donor is either a) recently deceased or b) a freind or family member who has agreed to donate their kidney to their loved one. Apparently, it is currently against the law to pay compensation to the person donating their kidney.

The Economist argued that lifting this ban would dramatically increase the number of available kidneys and eliminate the waiting list. Currently, Iran (that hotbed of free market thinking) is the only country that allows people to sell one of their kidneys and they have no waiting list for transplants.

It is not too surprising that The Economist is advocating a free market solution to a problem. I am inclined to agree with their proposed solution, but I was wondering what other people thought about the issue.
Organ harvesting off of death row, and speedier executions might help. Likewise, let's step up organ harvesting on the streets of Baghdad, to correct this imbalance in supply and demand. It's all about the Benjamins, of course.

DR

[boooeee]

Organ harvesting off of death row, and speedier executions might help. Likewise, let's step up organ harvesting on the streets of Baghdad, to correct this imbalance in supply and demand. It's all about the Benjamins, of course.

DRA modest proposal?

Sarcasm tags duly noted, but I want to be clear that the decision to become a donor would be voluntary. As I understand it, you can live quite healthily with only one functioning kidney. Although, if anybody has evidence to the contrary, I would like to hear about it.

[Almo]

I don't like the idea of monetary compensation for organs for the same reason I don't like state lotteries. It offloads a societal cost onto the poor.

It's like legalizing child labor so that poor families have better access to capital.

[drkitten]

Sarcasm tags duly noted, but I want to be clear that the decision to become a donor would be voluntary.

So, in theory, was enrollment in social security. (Look up Hoover's "Volunteerism.")

I see no reason to believe that the decision to become a kidney donor would remain voluntary for long enough for the ink to dry on the paper.

[Darth Rotor]

So, in theory, was enrollment in social security. (Look up Hoover's "Volunteerism.")

I see no reason to believe that the decision to become a kidney donor would remain voluntary for long enough for the ink to dry on the paper.
FWIW, my DL lists me as an organ donor, has for over 25 years. If someone comes for my organs before I'm done with them, there may be some friction. :cool:

I am not sure the Economist's writer considered the long term effects, or the laws of unintended outcomes, in his advocacy of "letting the market dictate" blah blah blah. I'll offer the harvesting of rare animals in Africa, to fill another market niche, for an example.

DR

[boooeee]

So, in theory, was enrollment in social security. (Look up Hoover's "Volunteerism.")

I see no reason to believe that the decision to become a kidney donor would remain voluntary for long enough for the ink to dry on the paper.What do you mean, exactly? The US government would start picking citizens at random and force them to give up one of their kidneys?

First, do you really think that's a possibility?

Secondly, what makes you think demand won't be met under a voluntary system? As mentioned, Iran has no waiting list.

[boooeee]

I don't like the idea of monetary compensation for organs for the same reason I don't like state lotteries. It offloads a societal cost onto the poor.

It's like legalizing child labor so that poor families have better access to capital.I'm not against state lotteries, although I can understand the reasons people oppose them. However, with state lotteries, there are other viable methods of revenue generation (taxes, bond measures, etc.). I know of no other solution that would eliminate the need for a transplant waiting list.

[luchog]

Organ harvesting off of death row, and speedier executions might help. Likewise, let's step up organ harvesting on the streets of Baghdad, to correct this imbalance in supply and demand. It's all about the Benjamins, of course. R

It's working fine for China.

[luchog]

Secondly, what makes you think demand won't be met under a voluntary system? As mentioned, Iran has no waiting list.

And I'm willing to be that, despite their propaganda, donation isn't always entirely voluntary.

[Loss Leader]

.The Economist argued that lifting this ban would dramatically increase the number of available kidneys and eliminate the waiting list. Currently, Iran (that hotbed of free market thinking) is the only country that allows people to sell one of their kidneys and they have no waiting list for transplants.

I don't think I've ever encountered a stupider application of free market thinking.

First of all, would the price of a kidney be capped? Or would those in need have to enter a bidding war against each other wherein the wealthy will always get kidneys and the poor will always get screwed?

With a true free market, those kidney donors with exceedingly rare blood types could literally hold the dying for ransom. If an O+ donor didn't like a bid, there's another O+ donor right behind him. But if an AB- donor didn't like a bid, he could sit quietly and just watch the numbers go up. Hell, AB- blood donors are, I think, the only blood type that still gets paid. They could hold out for literally millions.

But the real problem with this very dumb idea is that it creates a society that I, at least, do not want to live in. Prostitution is illegal in part because no little girl grows up thinking "I want to be a prostitute someday." Kidney donation for profit should be illegal for the same reason. The only people who will ever do it are those who have to because their minds, their efforts, and their creativity have no value. Let's spend money making everyone valuable, not cutting off pieces of the ones who aren't.

[a_unique_person]

It is not too surprising that The Economist is advocating a free market solution to a problem. I am inclined to agree with their proposed solution, but I was wondering what other people thought about the issue.

It's the standard solution when there is a shortage, just make the poor go without.

[TragicMonkey]

I hope technology and medicine progresses, soon, to a point where this will not be considered because we'll have better options. Such as growing a new kidney from the patient's own stem cells. How neat would that be, being able to regrow damaged or missing organs! Blind? New eyes! Accident messed up your liver? Grow a new one! Not only would that dodge all the ethical concerns, but it would end the risk of getting diseases from infected donors, and transplant rejection. That would be very sweet.

[casebro]

But if an AB- donor didn't like a bid, he could sit quietly and just watch the numbers go up. Hell, AB- blood donors are, I think, the only blood type that still gets paid. .

I'm AB, and I'm positive I'm negative- I think. My understanding is that AB is a universal receptor- I can use any blood type. The blood bank stopped calling me, yet kept after my B father.

But I think transplant matchs go for much deeper data than just blood type. Remember the difficulty with trying to find matchs for bone marrow? And the testing costs? So, while perfect matchs are few, the closer the better. Blood type would become inconsequential, any random donor might be the more valuable asset.

Then, back to the market. What effect would sales have on the post-mortem donors? Million of organs go to waste now, but if the heirs could sell Pop's parts that he isn't using anymore... That segment alone ought to flood the market, and keep the prices down.

[Darth Rotor]

I hope technology and medicine progresses, soon, to a point where this will not be considered because we'll have better options. Such as growing a new kidney from the patient's own stem cells. How neat would that be, being able to regrow damaged or missing organs! Blind? New eyes! Accident messed up your liver? Grow a new one! Not only would that dodge all the ethical concerns, but it would end the risk of getting diseases from infected donors, and transplant rejection. That would be very sweet.
OK, besides saving the poster boys for liver or kidney problems (like a Walter Payton), or one of thousands of children whose kidneys fail, this capability will extend more and more lives a decade or so longer for those who can affort the "grow me a new kidney/liver/prostate/heart" process.

Pseudo immortality.

Then what?

DR

[Francesca R]

I don't like the idea of monetary compensation for organs for the same reason I don't like state lotteries.According to the article, organs from deceased people are already legitimately traded and companies generate revenue from it. It's only individuals who are denied any participation. Why is this state of affairs better?

I see no reason to believe that the decision to become a kidney donor would remain voluntary for long enough for the ink to dry on the paper.But does the problem of enforcing against non voluntary kidney donations mean that compensation for donating them must be outlawed?

I don't think I've ever encountered a stupider application of free market thinking.

First of all, would the price of a kidney be capped? Or would those in need have to enter a bidding war against each other wherein the wealthy will always get kidneys and the poor will always get screwed?The poor "get screwed" whenever they can't afford something that rich people can. Why does that mean that the market should not exist? And sure the price could be capped (although that would simply remove the market from existing above the cap and stop some donations from happening), and aid could be available for the poor.


With a true free market, those kidney donors with exceedingly rare blood types could literally hold the dying for ransom. If an O+ donor didn't like a bid, there's another O+ donor right behind him. But if an AB- donor didn't like a bid, he could sit quietly and just watch the numbers go up. Hell, AB- blood donors are, I think, the only blood type that still gets paid. They could hold out for literally millions.Yes. What's the alternative? He is not allowed any compensation and so decides not to donate at all. Is the person who would have paid better off? From where does their substitute kidney come then?


But the real problem with this very dumb idea is that it creates a society that I, at least, do not want to live in. Prostitution is illegal in part because no little girl grows up thinking "I want to be a prostitute someday." Kidney donation for profit should be illegal for the same reason. The only people who will ever do it are those who have to because their minds, their efforts, and their creativity have no value. Let's spend money making everyone valuable, not cutting off pieces of the ones who aren't.This is not correct. People will donate if the value of so doing is greater than the cost in their view. At the moment the only value can be an altruistic one. What is wrong with allowing monetary value?

It's the standard solution when there is a shortage, just make the poor go without.Is exacerbating the shortage so that more people go without better?

[Loss Leader]

This is not correct.

Yes, it is.

[boooeee]

Yes, it is.
Are you against paying people for blood donation?

[Ziggurat]

I am not sure the Economist's writer considered the long term effects, or the laws of unintended outcomes, in his advocacy of "letting the market dictate" blah blah blah. I'll offer the harvesting of rare animals in Africa, to fill another market niche, for an example.

In defense of the market, though, that is also a tragedy of the commons problem. Though I'd agree that a little trepidation concerning the creation of markets for human body parts seems pretty reasonable to me.

[Ziggurat]

Are you against paying people for blood donation?

Where I am currently living, it is legal to pay for blood plasma, and I've seen advertisements. In California, it had previously been legal to pay for blood plasma, but it is not anymore. The reason for the change was not because of moral qualms, it was because they were getting too many HIV-positive donors when they were paying for plasma.

That said, paying for blood or plasma isn't the same as paying for a kidney. You regenerate your blood, you don't regenerate a kidney. And while most people can live fine with only one, it IS a permanent loss, and it could have negative consequences for some people (for example: traumatic car accident which damages the remaining kidney). I'm not yet sure how I feel about the idea - it would likely increase the number of donations, and that's a good thing, but I do worry about possible subtle, unintended consequences.

[boooeee]

But the real problem with this very dumb idea is that it creates a society that I, at least, do not want to live in. Prostitution is illegal in part because no little girl grows up thinking "I want to be a prostitute someday." Kidney donation for profit should be illegal for the same reason. The only people who will ever do it are those who have to because their minds, their efforts, and their creativity have no value. Let's spend money making everyone valuable, not cutting off pieces of the ones who aren't.
Fair point. I think this is probably the crux of the issue. I understand how people would me made uncomfortable by this. It's definitely a checkmark in the "Con" column.

However, in the "Pro" column, we have the 3,886 people who died in 2004 while on the kidney transplant waiting list. If we can dramatically increase the supply of available organs, we have a direct, concrete benefit in lives saved. I'm not convinced that allowing paid organ donation is going to have any long term negative societal impact.

Also, I should clarify that I am not advocating a true free market solution in which both buyers and sellers compete on price. Let's keep the current system of prioritizing organ recipients based on need and prognosis. The proposed approach would affect the supply side only by increasing the number of available kidneys. Also, I see nothing wrong with implementing a price cap (or maybe just a flat rate), as long as the cap isn't set too low that it doesn't increase organ donation.

[Francesca R]

Yes, it is.That doesn't advance your argument.

It's not correct that "The only people who will ever [sell a kidney on an organs market] are those who have to because their minds, their efforts, and their creativity have no value". It's no more correct than saying that: "the only people who will risk their life in the armed services for money are those who have to because their minds, their efforts, and their creativity have no value". Is that what you think about soldiers?

[TragicMonkey]

OK, besides saving the poster boys for liver or kidney problems (like a Walter Payton), or one of thousands of children whose kidneys fail, this capability will extend more and more lives a decade or so longer for those who can affort the "grow me a new kidney/liver/prostate/heart" process.

Pseudo immortality.

Then what?

DR

We live longer. Is that a bad thing?

[Loss Leader]

Also, I should clarify that I am not advocating a true free market solution in which both buyers and sellers compete on price. Let's keep the current system of prioritizing organ recipients based on need and prognosis. The proposed approach would affect the supply side only by increasing the number of available kidneys.

With those caveats in place, it would appear that the cost of the kidney would be borne by the insurance companies, the donors to remain secret from the recipients. In that case, this entire argument is something of a sophistry because the insurance companies will never pay.

[boooeee]

With those caveats in place, it would appear that the cost of the kidney would be borne by the insurance companies, the donors to remain secret from the recipients. In that case, this entire argument is something of a sophistry because the insurance companies will never pay.Then we mandate that an insurance company cover those costs. There are literally hundreds if not thousands of coverages that insurance companies are required to pay. Why not make this one of them?

Or, what if a charitable donation agreed to put forth the money? For example, if you agree to donate your kidney, the National Kidney Foundation pays you $20,000 and your kidney goes to the person next in queue on the prioritized list. Currently, a charity is prohibited from doing this.

I don't think it is sophistry. Is there any reason one of the above solutions wouldn't work?

[Darth Rotor]

We live longer. Is that a bad thing?
Who is "we?"

We all die.

I am trying to look at the knock on effects of a population, and its social and economic impact, made up of increasingly older people.

If, for example, 60% of the population of a country is over 60 years old, what does that do to a society? Over 40% over 80 years old?

Does it tend to calcify?

Logan's Run for fifty, Alex? :eek:

On the micro level, yes, not dying from a bad kidney is good, particularly if it is you, your nephew, your brother, etc. As the ability to regrow organs that you suggest becomes more commonplace, what impact does that have at the macro level? Initially, it becomes a luxury for the rich. (See how car phones and then cell phones were phased into the market for an idea of what I am getting at.) Then, for many. Then, widely available.

Then what?

What does the continued extension of longevity do? Like cloning, this appears to raise the thorny problem of "can you?" versus "should you?"

DR

[boooeee]

Where I am currently living, it is legal to pay for blood plasma, and I've seen advertisements. In California, it had previously been legal to pay for blood plasma, but it is not anymore. The reason for the change was not because of moral qualms, it was because they were getting too many HIV-positive donors when they were paying for plasma.

That said, paying for blood or plasma isn't the same as paying for a kidney. You regenerate your blood, you don't regenerate a kidney. And while most people can live fine with only one, it IS a permanent loss, and it could have negative consequences for some people (for example: traumatic car accident which damages the remaining kidney). I'm not yet sure how I feel about the idea - it would likely increase the number of donations, and that's a good thing, but I do worry about possible subtle, unintended consequences.True enough. I asked the blood question because I was trying to distinguish between two positions:

Position 1 : Against paid organ donation because of the potential negative health effects to the donor.

Position 2 : Against paid organ donation because of a general opposition to allowing the sales of body parts for profit.

I could agree with Position 1 if the adverse consequences were significant enough. From what I've read, the risk seems pretty small. At this point, I don't think I agree with Position 2.

[Loss Leader]

I don't think it is sophistry. Is there any reason one of the above solutions wouldn't work?

Yes. It's called politics. The insurance lobby won't let it happen.

[boooeee]

Yes. It's called politics. The insurance lobby won't let it happen.Really? Even though the all-powerful insurance lobby has let hundreds of other mandates pass? Is there a reason they would fight particularly hard for this one?

Also, that doesn't address the second possibility. Allowing charities to pay money to organ donors. Would you object to this? How would the insurance companies prevent this? You'll have to be more specific than "politics".

[casebro]

So how much effect would paying $5,000 for the kidney have? Times 4,000 needed, $20 million total. Everybody's premium would go up 7 cents per year?

BUT, since the cost of the operation must run $200,000, then times 4,000, thats $800 million. However, most kidney transplants are paid for by Medicare, so it would only be a growth sector in our economy. What's an extra billion to the whole population- $3 per? Think of the trickle down effect!

[Darth Rotor]

So how much effect would paying $5,000 for the kidney have? Times 4,000 needed, $20 million total. Everybody's premium would go up 7 cents per year?

BUT, since the cost of the operation must run $200,000, then times 4,000, thats $800 million. However, most kidney transplants are paid for by Medicare, so it would only be a growth sector in our economy. What's an extra billion to the whole population- $3 per? Think of the trickle down effect!
I was under the impression that trickle was part of the problem with kidney failure. :p

ba dump, tsch!

I'll be here til Thursday, please tip your waitress. :D

DR

[TragicMonkey]

Who is "we?"

We all die.

I am trying to look at the knock on effects of a population, and its social and economic impact, made up of increasingly older people.

If, for example, 60% of the population of a country is over 60 years old, what does that do to a society? Over 40% over 80 years old?

Does it tend to calcify?

Logan's Run for fifty, Alex? :eek:

On the micro level, yes, not dying from a bad kidney is good, particularly if it is you, your nephew, your brother, etc. As the ability to regrow organs that you suggest becomes more commonplace, what impact does that have at the macro level? Initially, it becomes a luxury for the rich. (See how car phones and then cell phones were phased into the market for an idea of what I am getting at.) Then, for many. Then, widely available.

Then what?

What does the continued extension of longevity do? Like cloning, this appears to raise the thorny problem of "can you?" versus "should you?"

DR

Were the same arguments raised about vaccination? Perhaps we should stop doing that, to thin our numbers and let the resources go to fewer people.

The thing is, we're not in a state of nature. We're better than nature. We can put ourselves, in many aspects, outside and above it. We don't die because we can't bring down prey anymore. We don't die because we have an abcessed tooth. We developed workarounds.

Yes, living longer could mean a larger population. But it could mean fewer offspring. Look at Europe. Aren't countries in Europe experiencing a slower, and in some places, actually negative population growth, while their citizens get older? Since technology is helping us live longer but not stay young longer, it's not like people are still popping out babies during the extended lifespan (although they can have children at an age unheard of by our ancestors). As for resources, yes, there will be more consumers...but their will also be more producers. Maybe people won't retire at 65. They'll go on working, with increased experience and skill. The economy will get a boost, too, as people will invest for longer and longer hauls.

I can't see that medical advances that prolong life, especially if they improve the quality of that life, are anything other than good. Yes, you can find negatives in it. You can find negative aspects to anything. And positive aspects to dropping dead earlier. But then, the Black Plague killed a crapload of people, and some historians think it was that sudden depopulation that inspired the beginnings of the Renaissance. WWII killed a lot of people, but it pulled the US out of a depression. Does that mean we should wish for plagues and wars, because they help society in some ways?

As for "macro" and "micro", it's my opinion that "society" is just an idea. It's made up of real people. What's good for the people is good for society, because that's what society really is. Choosing to benefit the abstract collective idea at the expense of the real individuals who comprise it is nonsensical to me. Living longer and healthier is a good thing for people, in the individual or the group. Will problems arise? Yes. Luckily there will be more people around, alive and healthy, to solve those problems.

[Francesca R]

What does the continued extension of longevity do? Like cloning, this appears to raise the thorny problem of "can you?" versus "should you?"You're asking someone to make the case for increasing longevity?

[skeptifem]

people sell their blood/plasma all the time. what is the difference?


eta-I know you dont generate kidneys like blood cells, but i dont really see how that is an argument against it. I could own two cars and sell one, and have the remaining one break down- does that mean owning a single car should be illegal? you should have to buy two?

Not to mention having kidneys be sellable would make it much easier to find one if your remaining one did go to crap- is there any actual indication that the person who donated a kidney and had the remaining one fail would only have one diseased kidney if they had kept both? If not it would basically amount to one kidney saving a life instead of two getting diseased and failing inside of one person.

[Darth Rotor]

You're asking someone to make the case for increasing longevity?
Now that you put it that way, yes, I am, because the increase is not holistic, but a patchwork of putting in spare parts while the frame is rusting. The general aging mechanism isn't undone by replacing defective parts now and again.

TM's comment about how "we are above nature" is at least partly true.

DR

[boooeee]

Now that you put it that way, yes, I am, because the increase is not holistic, but a patchwork of putting in spare parts while the frame is rusting. The general aging mechanism isn't undone by replacing defective parts now and again.

TM's comment about how "we are above nature" is at least partly true.

DRFrom this link http://news-service.stanford.edu/news/2005/september28/med-scandling-092805.html

The average life expectancy of a kidney from a deceased donor is only 10 years or so. The average life expectancy of a kidney from a living donor is longer, about 18 years. One of the greatest challenges in transplantation today is to improve long-term outcome.

Kidney transplant doesn't confer immortality, but 18 additional years is nothing to sneeze at. Who cares if it's holistic or patchwork?

[Darth Rotor]

From this link http://news-service.stanford.edu/news/2005/september28/med-scandling-092805.html



Kidney transplant doesn't confer immortality, but 18 additional years is nothing to sneeze at. Who cares if it's holistic or patchwork?
I was not referring to transplants, sort of a zero sum game when we go beyond kidneys to hearts, livers, spleens, stomachs, etc. I was referring to TM's point on the ability (future?) to grow replacement organs for one's self from stem cells. The transplant matter is relevant, your point on mean time between failures a nice addition :), but not the focus of my concern.

DR

[Francesca R]

Now that you put it that way, yes, I am, because the increase is not holistic, but a patchwork of putting in spare parts while the frame is rusting. The general aging mechanism isn't undone by replacing defective parts now and again. Are you actually opposed to organ transplants because they are not "holistic"? (which a transplant cannot be by definition). Or are you simply pointing out that an ethical dilemma exists according to some?

[ponderingturtle]

What do you mean, exactly? The US government would start picking citizens at random and force them to give up one of their kidneys?

First, do you really think that's a possibility?

Secondly, what makes you think demand won't be met under a voluntary system? As mentioned, Iran has no waiting list.

It was legal in india to sell your kidney for a while, look at the effects there.

[ponderingturtle]

But the real problem with this very dumb idea is that it creates a society that I, at least, do not want to live in. Prostitution is illegal in part because no little girl grows up thinking "I want to be a prostitute someday."

How many people grow up thinking "I want to be a sewer worker, or janitor"?

[ponderingturtle]

Are you against paying people for blood donation?

And what are the long term health effects of blood donation compared to the long term effects of donating a kidney?

[Darth Rotor]

Are you actually opposed to organ transplants because they are not "holistic"? (which a transplant cannot be by definition). Or are you simply pointing out that an ethical dilemma exists according to some?
No, not opposed to organ transplants due to their nature. It is IMO more than an ethical dilemma, it is a quality of life issue.

I don't have an answer, but I see a profound influence on social forces if the population spread biases heavily toward the aged. I don't know if that would be a beneficial, detrimental, or neutral effect overall.

DR

[boooeee]

And what are the long term health effects of blood donation compared to the long term effects of donating a kidney?
From the same Standford link:

http://news-service.stanford.edu/news/2005/september28/med-scandling-092805.html

A lot of loved ones now realize that the waiting list for a deceased- donor transplant is so long that they're coming forward and offering to donate one of their own.

That goes hand-in-hand with improvements in the method for taking a kidney from a live donor. Laparoscopic or minimally invasive kidney donor surgery results in a more rapid return to daily life activities. While that was first reported about 10 years ago, it really took off in the late 1990s with technical advances in the procedure.

Now more than half of live kidney donations are obtained laparoscopically. Live-kidney donors return quickly to full, active lives without restriction on diet or physical activity. Police, fire and military personnel can all return to active duty after donation. Women may have children after donation. Life expectancy is not affected by donation.
I am sure the operation is not risk-free and it is obviously more invasive than blood transfusion, but it seems to be a fairly standard procedure with no long lasting effects.

The only downside I can see is Ziggurat's earlier point concerning not having a "spare" kidney in case of some traumatic accident.

[ponderingturtle]

From the same Standford link:

http://news-service.stanford.edu/news/2005/september28/med-scandling-092805.html


I am sure the operation is not risk-free and it is obviously more invasive than blood transfusion, but it seems to be a fairly standard procedure with no long lasting effects.

The only downside I can see is Ziggurat's earlier point concerning not having a "spare" kidney in case of some traumatic accident.

Jama article (http://jama.ama-assn.org/cgi/content/abstract/288/13/1589)

THere many people report a degredation in health after donating a kidney and 97% would not recomend to others about selling kidneys

[luchog]

First of all, would the price of a kidney be capped? Or would those in need have to enter a bidding war against each other wherein the wealthy will always get kidneys and the poor will always get screwed?

This is different from today, how?

With a true free market, those kidney donors with exceedingly rare blood types could literally hold the dying for ransom. If an O+ donor didn't like a bid, there's another O+ donor right behind him. But if an AB- donor didn't like a bid, he could sit quietly and just watch the numbers go up. Hell, AB- blood donors are, I think, the only blood type that still gets paid. They could hold out for literally millions.

And this is different from today, how? Oh yeah, rare tissue types simply aren't available, period, and many people die waiting for one. Guess encouraging people to donate with rare tissue types could cause the downfall of civilization, just like those with rare blood types have done. All those evil AB- donors who sit around demanding more money or they won't help save lives by donating their blood. Oh wait....

You're also assuming that people who would donate voluntarily, as a few do now, will instantly be overcome with greed; and that all organ donation programs will be instantly terminated.

But the real problem with this very dumb idea is that it creates a society that I, at least, do not want to live in. Prostitution is illegal in part because no little girl grows up thinking "I want to be a prostitute someday."

That's patently ludicrious. How many little kids think "I want to be a low-paid manual labourour doing mind-numbingly dull and potentially hazardous work?" Guess we should prohibit garbage collection.

Prostitution is illegal in some areas due to puritanical attitudes toward sex. But there are a number of places in the world where it's legal. Yes, even in advanced, developed nations like the United States and Holland.

I am entirely for anything that would increase the availability of potentially life-saving items like kidneys, without compelling people to donate.

Kidney donation for profit should be illegal for the same reason. The only people who will ever do it are those who have to because their minds, their efforts, and their creativity have no value. Let's spend money making everyone valuable, not cutting off pieces of the ones who aren't.
Or those who need money to advance their own life, like for secondary education, purchasing a house, etc. Hell, if I knew I could get even US$50,000 for selling one of my kidneys, I'd do it in a New York minute. That would get me the education to get out of this **** job and into a better paying slot in about a tenth the time and effort I would normally need.

[drkitten]

Or those who need money to advance their own life, like for secondary education, purchasing a house, etc. Hell, if I knew I could get even US$50,000 for selling one of my kidneys, I'd do it in a New York minute. That would get me the education to get out of this **** job and into a better paying slot in about a tenth the time and effort I would normally need.


That's part of the problem right there.

If you knew that you could get $50,000 for your kidney to buy a house, you'd do it. This means that the next time a house goes on sale, you would be able to afford to bid $50,000 higher than someone who didn't sell a kidney.

Pretty soon, the market has this factored in. With the sudden influx of money, house prices are now $50,000 higher than they used to be. GIving up a kidney is now a more or less mandatory part of home buying, unless you're extremely lucky or wealthy.

We've already seen this effect in college prices; fifty years ago, working your way through college was considered a practical option. In most cases now, it's not. Thirty years ago, it was possible for parents to send their children to college without dipping into their home equity. Today, that's more or less no longer possible. Thirty years from now, will college prices have risen to the point that students need to sell organs to make tuitioni payments? If not, what will stop them?

Which would you rather see -- your daughter, kidney-less at Harvard, or your daughter, at Enormous State University but with two kidneys?

I'd rather see her not get faced with that dilemma at all....

[Darth Rotor]

That's part of the problem right there.

If you knew that you could get $50,000 for your kidney to buy a house, you'd do it. This means that the next time a house goes on sale, you would be able to afford to bid $50,000 higher than someone who didn't sell a kidney.

Pretty soon, the market has this factored in. With the sudden influx of money, house prices are now $50,000 higher than they used to be. GIving up a kidney is now a more or less mandatory part of home buying, unless you're extremely lucky or wealthy.

We've already seen this effect in college prices; fifty years ago, working your way through college was considered a practical option. In most cases now, it's not. Thirty years ago, it was possible for parents to send their children to college without dipping into their home equity. Today, that's more or less no longer possible. Thirty years from now, will college prices have risen to the point that students need to sell organs to make tuitioni payments? If not, what will stop them?

Which would you rather see -- your daughter, kidney-less at Harvard, or your daughter, at Enormous State University but with two kidneys?

drkitten, I think your slippery slope may have ignored the differences in orders of magnitude. What about the daughter being at Enormous State U and 15,000 stashed away for grad school? For the wedding? :cool:

How many new students in college each year?

How many kidney replacements each year?

Orders of magnitude.

Not seeing where you get that the effect is big enough to materially change the market.

How many houses sold each year?

And another point. The 50,000 may put luchog into a market, as an entrant, where there was one less market participant previously. This adds nominally, at best, to a few bids being a few thousand different for a house, rather than your postulated entire sum overreaching another's bid.

DR

[Francesca R]

I don't have an answer, but I see a profound influence on social forces if the population spread biases heavily toward the aged. I don't know if that would be a beneficial, detrimental, or neutral effect overall. But you seem to be saying "Hold on, lets not do this yet". How are you going to determine if it's good or bad? Why not just let it happen?

[Darth Rotor]

But you seem to be saying "Hold on, lets not do this yet". How are you going to determine if it's good or bad? Why not just let it happen?
Why not just use asbestos in all buildings?

I see where you are coming from: "let's deal with that when we get to it." Not an invalid position, but not one to evoke much thought or planning.

DR

[Francesca R]

How much planning went into advancing life expectancy by medical research? How much planning went into whether electricity should be made available to the public? How much planning went into whether or not to develop the H-bomb? As far as I know, there is not much planning involved in technological or societal progress.

I can see an argument in favour. I just don't think it happens

[Darth Rotor]

How much . . .

I can see an argument in favour. I just don't think it happens
Agreed.

Acid Rain for fifty, Alex. :D

DR

[drkitten]

drkitten, I think your slippery slope may have ignored the differences in orders of magnitude.

You evidently aren't familiar with college tuition recently. There are colleges today where $50,000 won't buy a year's education.


How many new students in college each year?

How many kidney replacements each year?

Orders of magnitude.

Actually, all this means is that the current $50,000 price tag is unsustainably high, and that if hordes of desperate college students become able to sell kidneys, the market will be flooded and the price will drop. Meaning your daughter will be at Enormous State with about $1,000 tucked away.

In general, making something saleable that was not saleable before will simply have the effect of pumping more money into the market as people sell it. The net effect is simply to inflate the overall prices.

You're contradicting yourself. If the effects of selling a kidney are to give a lot of money to the seller, then the market for highly competitive goods will simply rise to the present cost plus a kidney. If the effects of selling a kidney are not to give a log of money to the seller, then not as many people will sell kidneys, and a lot of people will undergo unnecessary surgery for very little benefit. The actual effect will probably be somewhere in between.

Either way, the overall effect is negative.

[Darth Rotor]

You evidently aren't familiar with college tuition recently. There are colleges today where $50,000 won't buy a year's education.
Sez you. My daughter is a senior in HS. :p Those "colleges" have priced themselves out of my debt tolerance.
Actually, all this means is that the current $50,000 price tag is unsustainably high, and that if hordes of desperate college students become able to sell kidneys, the market will be flooded and the price will drop.
That I'll buy, but that wasn't your original scenario. I was going to add a bit about prices dropping, but didn't. Haha, you beat me to it.

In general, making something saleable that was not saleable before will simply have the effect of pumping more money into the market as people sell it. The net effect is simply to inflate the overall prices.
Only if in significant volume, and value is beyond marginally influential.

Seen the price of a PC lately, compared to 1987?

You're contradicting yourself. If the effects of selling a kidney are to give a lot of money to the seller, then the market for highly competitive goods will simply rise to the present cost plus a kidney.
Again, only if the market has a significant supply and demand for kidneys, which is where your original problem of orders of magnitude comes in. The presence of Porsches being sold by the VW dealer doesn't materially influence the price of my Saturn sedan.
Either way, the overall effect is negative.
Either way, 5,000 kidneys versus 5 milliion college tuitions is a pimple on the Professor's Economic ass.

DR

[Almo]

I'm not against state lotteries, although I can understand the reasons people oppose them. However, with state lotteries, there are other viable methods of revenue generation (taxes, bond measures, etc.). I know of no other solution that would eliminate the need for a transplant waiting list.

But I fail to see eliminating the transplant waiting list as necessary. Organ transplants are a life-saving luxury.

[skeptifem]

From the same Standford link:

http://news-service.stanford.edu/news/2005/september28/med-scandling-092805.html


I am sure the operation is not risk-free and it is obviously more invasive than blood transfusion, but it seems to be a fairly standard procedure with no long lasting effects.

The only downside I can see is Ziggurat's earlier point concerning not having a "spare" kidney in case of some traumatic accident.

Giving blood isnt risk free either. People having a seizure while giving blood is not that uncommon, often locking up their arms and lodging the needle deep into the arm.

Our phlebotomy teacher told us a horror story of this 250 lb biker dude having a seizure during a blood drive while he was eating candy, our teacher was a pretty tiny lady, she was climbing on this dude trying to pull his arms down to find the needle and realizing he was going to choke, so she gets the sucker out of his mouth and is able to pull down his arm and the needle is completely lost in his bicept,

You can have your forearm or hand crippled during a blood transfusion or suffer tendon/nerve damage, and there is a chance of hitting an arterie which can really hurt someone.

[WildCat]

OK, besides saving the poster boys for liver or kidney problems (like a Walter Payton),
Payton was not a candidate for a transplant, was not on a waiting list.

[WildCat]

That's part of the problem right there.

If you knew that you could get $50,000 for your kidney to buy a house, you'd do it. This means that the next time a house goes on sale, you would be able to afford to bid $50,000 higher than someone who didn't sell a kidney.

Pretty soon, the market has this factored in. With the sudden influx of money, house prices are now $50,000 higher than they used to be. GIving up a kidney is now a more or less mandatory part of home buying, unless you're extremely lucky or wealthy.
Wow! You're either greatly overestimating the nimber of kidneys needed each year, or underestimating the number of houses sold each year. Also you're assuming that every dollar received from a kidney goes into housing.

The reality is the relatively few kidneys sold would have a negligible effect on any market you pick, excepting of course the kidney market.

[Francesca R]

In general, making something saleable that was not saleable before will simply have the effect of pumping more money into the market as people sell it. The net effect is simply to inflate the overall prices.Incorrect. Totally. It is not inflationary to un-restrict a market. Quite the opposite. You can sell stuff on e-Bay today that no liquid market existed for previously. Has that pushed up general prices? Or has it kept them down?

You're contradicting yourself. If the effects of selling a kidney are to give a lot of money to the seller, then the market for highly competitive goods will simply rise to the present cost plus a kidney.Please show this using rudimentary economics. The person who has bought the kidney has less cash to spend on the same goods. No money has been added to the system. How do prices rise?

If the effects of selling a kidney are not to give a log of money to the seller, then not as many people will sell kidneys, and a lot of people will undergo unnecessary surgery for very little benefit. The actual effect will probably be somewhere in between.Contradictory.

[skeptifem]

i couldnt edit my post- just a quick appology for the spelling/grammar errors. ugh, i really need to watch that!

[Darth Rotor]

Payton was not a candidate for a transplant, was not on a waiting list.
I recall there having been a discussion on his "place in line" for a transplant, I guess I didn't read all of the news stories after that. Thanks for the update.

DR

[Marmaduke]

I just wanted to share my experiences on this subject.

When I was eight I was diagnosed with kidney disease. At age 13 I went into renal failure and spent the next 22 months on peritoneal dialysis. It wasn’t fun. I was alive, but not feeling great. I missed out on a lot as I had to be tied up to that machine for 10 – 12 hours a day.

When I was 15 my father donated his left kidney to me. My quality of life shot way up, up to where everyone else’s was my age. In total, I have three kidneys, my original two, plus his. Rarely do the original kidneys get removed. They only get removed if there’s a possibility that the original disease that attacked the first two can attack the new one.

As of September, I’ve lived longer with my father’s kidney in me, than I did with my original two kidneys + dialysis. My kidney functions are excellent and probably better than most peoples.

As with any surgery there can be risks. Roughly twelve hours after my father left the operating room, he was wheeled back in for emergency surgery because one of his arteries hadn’t been tied up properly.

As for my father’s health, other than the artery flub, it has never suffered. Sure he had a few weeks of discomfort from the surgery, but that was to be expected.

I’ve never met a donor who had any regrets whatsoever – and I’ve met a lot of donors. I also can’t recall ever meeting a donor whose health suffered long term, I’m not saying it can’t happen, but they make sure you’re in pretty good shape before they let you donate.

[boooeee]

But I fail to see eliminating the transplant waiting list as necessary. Organ transplants are a life-saving luxury.Is it me, or does "life-saving luxury" sound like an oxymoron?

I am not trying to emotionalize this debate, but it seems odd that you would casually dismiss a life saving operation as a "luxury" and not "necessary".

[boooeee]

Jama article (http://jama.ama-assn.org/cgi/content/abstract/288/13/1589)

THere many people report a degredation in health after donating a kidney and 97% would not recomend to others about selling kidneysThanks for the link. The full text of the study requires a login, so I will have to base my comments on the abstract:

1) It is unclear if this study is based on transplants done prior to the 1995 ban India implemented, or subsequent to it. If it occurred subsequent to the ban, then these transplants would have been done on the black market, and it would not surprise me if these operations had a poor safety record.

2) It is also unclear how the health of the donors was evaluated. From the text of the abstract, it says "About 86% of participants reported a deterioration in their health status after nephrectomy". If this was a just a yes or no question posed to the donors, then I would say this is a serious flaw in the study. I would be more swayed if there was actual clinical evidence to back this up. It's possible there is, but the abstract is unclear.

3) The most important point is that this is a study of the safety of tranplants done in India. If it is true that kidney donation is unsafe in India, then I would say that that is a valid reason for continuing the ban on paid organ donation in India. However, I have yet to see a study claiming that kidney donation performed in the United States has adverse health consequences.

I also think it is important to consider the degree to which health status is affected by organ donation. There are plenty of examples in today's society where people take upon risk of bodily harm in exchange for monetary compensation. Mine workers, deep sea fishermen, and truck drivers come to mind. The armed forces has been brought up already.

And, if you want an example that is closely analagous to organ donation, there is surrogate motherhood. I don't have the source readily available, so feel free to discount the following, but I remember reading that the risk of death was six times greater for a surrogate mother than for a kidney donor.

[boooeee]

Either way, the overall effect is negative.

There's a lot to tackle in this post (I didn't quote the whole thing), and some of it is probably for another thread, but I would like to point out that you are missing a term in your equation: The 4,000 deaths per year that could be prevented if there were enough kidneys available for transplant. I'm still not convinced that without this term, your equation sums to a negative, but with it, it seems to be a positive to me.

Also, as it has already been pointed out, the market for kidneys is not unlimited. From the Stanford link I posted earlier, there are currently 60,000 people on the waiting list. I think Darth Rotor's "pimple" comment is appropriate.

[boooeee]

I just wanted to share my experiences on this subject.

When I was eight I was diagnosed with kidney disease. At age 13 I went into renal failure and spent the next 22 months on peritoneal dialysis. It wasn’t fun. I was alive, but not feeling great. I missed out on a lot as I had to be tied up to that machine for 10 – 12 hours a day.

When I was 15 my father donated his left kidney to me. My quality of life shot way up, up to where everyone else’s was my age. In total, I have three kidneys, my original two, plus his. Rarely do the original kidneys get removed. They only get removed if there’s a possibility that the original disease that attacked the first two can attack the new one.

As of September, I’ve lived longer with my father’s kidney in me, than I did with my original two kidneys + dialysis. My kidney functions are excellent and probably better than most peoples.

As with any surgery there can be risks. Roughly twelve hours after my father left the operating room, he was wheeled back in for emergency surgery because one of his arteries hadn’t been tied up properly.

As for my father’s health, other than the artery flub, it has never suffered. Sure he had a few weeks of discomfort from the surgery, but that was to be expected.

I’ve never met a donor who had any regrets whatsoever – and I’ve met a lot of donors. I also can’t recall ever meeting a donor whose health suffered long term, I’m not saying it can’t happen, but they make sure you’re in pretty good shape before they let you donate.

Thanks Marmaduke for sharing your experience. I was not aware that kidney transplant recipients usually kept their original kidney.