Monday, July 27, 2009

Kidneys for sale - is it immoral?


Wall Street Journal

Even by New Jersey standards, Thursday's roundup of three mayors, five rabbis and 36 others on charges of money laundering and public corruption was big. But what put this FBI dragnet head and shoulders above the rest are the charges of trafficking in human body parts.

According to a federal criminal complaint filed in district court in New Jersey, Levy Izhak Rosenbaum of Brooklyn conspired to broker the sale of a human kidney for a transplant. The cost was $160,000 to the recipient of the transplant, of which the donor got $10,000. According to the complaint, Mr. Rosenbaum said he had brokered such sales many times over the past 10 years.

"That it could happen in this country is so shocking," said Dr. Bernadine Healy, former head of the Red Cross.

No, it isn't. When I needed a kidney several years ago and had no donor in sight, I would have considered doing business with someone like Mr. Rosenbaum. The current law—the National Organ Transplant Act of 1984—gave me little choice. I would be a felon if I compensated a donor who was willing to spare me years of life-draining dialysis and premature death.

The early responses to the New Jersey scandal leave me dismayed, though not surprised. "We really have to crack down," the co-director of the Joint Council of Europe/United Nations Study on Trafficking in Organs and Body Parts told MSNBC. That strategy is doomed, of course. It ignores the time-tested fact that efforts to stamp out underground markets either drive corruption further underground or causes it to flourish elsewhere.

The illicit organ trade is booming across the globe. It will only recede when the critical shortage of organs for transplants disappears. The best way to make that happen is to give legitimate incentives to people who might be willing to donate. Instead, I fear that Congress will merely raise the penalties for underground organ sales without simultaneously establishing a legal mechanism to incentivize donors.

Al Gore, then a Tennessee congressman who spearheaded the National Organ Transplant Act, spoke of using "a voucher system or a tax credit to a donor's estate" if "efforts to improve voluntary donation are unsuccessful." After 25 years, it is clear they have been unsuccessful.

More than 80,000 Americans now wait for a kidney, according the United Network for Organ Sharing. Thirteen of them die daily; the rest languish for years on dialysis. The number of donors last year was lower than in 2005, despite decades of work to encourage people to sign donor cards and donate to loved ones. [...]

12 comments :

  1. There is a simple means of making more organs available:

    Switch to a system where no explicit consent is necessary: everyone is a donor, unless he explicitely states otherwise. With this system, you get donor rates over 90% of the population. When you have to give explicit consent, donor rates rarely go over 30%.

    So if you want to provide your 80'000 americans with kidneys, here is the solution.

    But don't wait for poor Indians or Moldovians or Ukrainians to sell them...

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  2. Actually, what he's being accused of is FAR FAR worse...

    From FOX News: Nancy Scheper-Hughes, an anthropology professor at the University of California at Berkeley and the author of an upcoming book on human organ trafficking, ... said she was told Rosenbaum carried a gun, and when a potential organ seller would get cold feet, Rosenbaum would use his finger to simulate firing a gun at the person's head.

    -micha

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  3. The organ trafficking issue is part of a general irrational hang-up in the Western world that something legal or even, in some cases, praiseworthy, becomes a crime if money changes hands.

    Thus, donating a kidney is perfectly acceptable and considered an act of kindness, but it is illegal to do so for money.

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  4. Just looking over the article by FOX News quoted by Micha. The arguments against organ "trafficking" are essentially circular:

    "There is a black market, almost exclusively in kidneys," Caplan said. "All international medical groups and governments ought to condemn any marketing in body parts. It's simply too exploitative of the poor and vulnerable. The quality of the organs is questionable. People lie to get the money. The middle men are irresponsible and often criminals. They don't care about the people who sell."

    These characteristics are true for all black markets precisely because they are illegal. Legalization provides protection for all the parties involved. A legalized market would almost certainly increase the profit for the donor while reducing the cost for recipient, while allowing proper medical oversight. It would also save thousands of lives.

    Of course, none of this is relevant to the current criminal charges, especially if the accusation that this fellow actually used threats of physical harm. (I am, however, dubious on the reliability of this testimony.)

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  5. 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 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.

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  6. modern chassidishJuly 27, 2009 at 11:37 PM

    Its basic supply and demand. It really is no different from any other transaction. Illegal transactions include illicit drugs, unregistered firearms, prostitution, organs.
    Let's see. Drugs kill people. Firearms can kill people too. Prostitution can result in STDs.
    And organ transfers save lives!

    Wait a second something is not right here.

    Public policy is to protect the masses from harm.

    I am not sure why providing a financial incentive or a reward for organ donations are illegal.

    I think this has more to do with the far reaching issue of exploitation of foreigners and third world labor. If organ donations were compensate able, their on outrage against all the other exploitative legal policies.

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  7. The other commentors touch on this, but I think it's worthwhile to explicitly point out that people are discussing two separable issues here: 1) whether or not a licit market for human organs should exist, and 2) whether or not, in the absence of a licit market for human organs, one should participate in an illicit market for human organs. I'm sure everyone will agree that it's possible for a reasonable person to simultaneously say 'yes' on issue 1 and 'no' on issue 2.

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  8. If a person needs a kidney to survive, and he can get one by paying money to someone to sell it to him, then, according to halacha, a strong case can be made that he is obligated to do so. Dina d'malchusa certainly doesn't override pikuach nefesh.

    That being said, it could easily be argued further that it would be obligatory or proper for others to help him. It would appear to be straightforward hatzolas nefashos.

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  9. and it is also possible for one to say that 1) yes on that, 2) no on this 3) but still if it is a clear cut case of pikuach nefesh (and he is not making a profit, but participating in something that perhaps legal law says no, but a certain life will be forfeited, that pikuach nefesh docheh dina demalchussa dina!

    and is is also possible and important to discuss them together: for many here and outside argue that 2) is the CAUSE TO ONE! and that is the height of immorality when other consderations (even valid ones which needs to be addressed separately) override PKIUACH NEFESH and 80,000 people die yearly!

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  10. i meant 3: when he is not making a profit; not coercing others to do something they do not want with their full heart. It is obvious that this is what i mean.

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  11. Roni,

    Even though it may be obvious, you need to state it.

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  12. And I'll state it again: i am NOT talking about coercing or harassing an individual to gvive up his kidney. (in fact, another point of discussion might be: Is offering a nice for a donor a form of monetary coercion or is it fair way to cause the person to agree to this); i am also NOT talking about exploting the situation to make money from the mitzvah of pikuach nefesh; since it is clearly forbidden as in truth al pi halacha doctors should not *essentially* get money, just like essentially a person should not get paid for teaching torah (only schar batalah), so usurping the situation of pikuach nefesh to make a buck is immoral and unethical and aginst halacha.

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