Yeah! I also think it’s tacky for doctors to demand payment from their patients. It’s a hospital, not a boardroom! Go earn money at your day job, Doctor, so that your heart can be pure when you’re operating for free on my heart.
Frankly, Karl Marx must have been a classy guy. I’m beginning to think it’s tacky that I have to pay for anything at all…
I suppose it’s also tacky for firefighters to demand payment before putting out a fire. Or for police officers to demand payment before investigating a burglary.
Yes, we would still have a shortage. You can’t take organs from just anyone who just died. Damaged or diseased organs are useless for transplant. Even if we harvested every viable organ for transplant there would still not be enough organs for everyone who needed one to live. Making donation mandatory won’t fix the underlying problem of organ shortage.
I’m not arguing against UHC. Whether it is the government or individual citizens paying the firefighters, the firefighters still get paid. If you want to outlaw non-volunteer fire departments and police, that would be a more analogous situation. Do you really think society would be better off if police and firefighters were forbidden from making money, or even recouping their costs? Do you think we would have enough emergency personnel if it was against the law for paramedics and doctors to charge for their services?
That is absolutely not true. Not every single person will need to have every single organ replaced during his lifetime; this means that we don’t need to harvest all that many organs to fully meet demand.
As an example, let’s look at heart transplants. During any given year, approximately 3,000 people in the US are waiting for a heart transplant:
Each year, more than 2,000,000 people die in the US:
Obviously, you do not need to harvest the heart of each and every deceased person in order to take care of the heart transplant waiting list. In fact, you don’t even need to harvest 1% of the available hearts to meet the need.
OK, the problem is NOT the supply of dead people. Clearly, the annual production of dead people vastly outnumbers the people who need organ transplants.
The problem is that you can’t simply use organs from any old dead guy. Grandpa slips in the bathroom, dies of a head injury, and is found a week later? Sorry - no usable organs. Person dies of cancer? Sorry, can’t use their organs - you’d likely be transplanting cancer cells along with it, into a person with a suppressed immune system. That would not end well. People with hepatitis, HIV, rabies, and bunch of other diseases? You’d be transmitting the disease as well (and yes, the US had a donor with rabies slip through the net, resulting in the deaths of all recipients of his organs). 100 year old dude? Probably not a suitable donor. And so on.
In order to get a viable donor organ (outside of live donations) you need a donor who is dead, but not too dead. Brain dead, specifically, but maintained without interruption on life support so their organs are kept alive and in good condition. The problem here?
Very few people die in that manner.
Mostly, it’s young people dead of brain injuries caused by an accident - and they would have to be still breathing up until at least the time the emergency personnel got to them, and kept oxygenated until it’s finally determined that they aren’t going to get better, their brain really is toast. If, for example, someone dies of a head injury in an accident and stops breathing long enough it doesn’t matter if you get their heart going again - it’s not just the brain that is affected by oxygen deprivation, just that the brain is affected first and worst. If someone has a traumatic injury and dies in the ICU later they may not be suitable due to organ damage sustained as their condition deteriorates, or due to infection, or whatever killed them other than the horrible accident they suffered. You might think burn patients who later expire in the hospital might be good donors, but the body’s reactions to large burns can cause all sorts of organ damage so no, they’re not good donors, either. You really need someone who dies of a brain injuries, and fairly quickly after the damage is induced, but not too quickly.
So the problem isn’t the number of dead, it’s the number of dead who die in a manner that allows for organ harvest. There aren’t enough of them. On top of that, if you’re a donor with weird immune characteristics you may still be screwed because not just any ol’ body part will do, you need a match and if you’re an outlier you might just not have a match die in the “proper” manner before you check out.
The percentage of people who die in a “proper” manner so as to leave them potential organ donors minus all of those unsuitable for other reasons isn’t a very big number.
So, while mandatory donation would increase available organs there still won’t be enough to go around to all who need them.
I think a good policy would be requirement that people have to be in the organ pool to get an organ. Basically, if you have not agreed to be an organ donor (before you need an organ), you cannot get an organ (or at least go to the bottom of the list).
Reinterating “Caught in the Organ Draft” by Sliverberg
Broomstick - I’m pretty sure that mandatory donation would eliminate organ shortfalls. As I said previously, we don’t need that many organs in the first place. For example, the link a posted earlier states that 3,000 hearts are needed in the US each year, and 2,000 are provided. That’s 2,000 hearts without mandatory harvesting. I’m confident that mandatory harvesting would get a 50% increase in heart supply, at the very least - and that’s all we need. Enough young people die in hospitals to give us the measly amount of organs required per annum.
Which organs are removable without causing death in the donor? It’s just one kidney, one lung and part of your liver, and bone marrow, right? Or is there other stuff?
I don’t think this would help. You want to provide incentives to people to become organ donors without destroying the charity motivation, and making it so that donors only help donors is contrary to that goal.
Our position is that it doesn’t matter if this would eliminate the organ shortfalls, because it’s immoral to harvest organs without the consent of the donor. I’m pretty sure that offering a financial incentive to go on the donor list would also eliminate organ shortfalls, without turning ourselves into a bunch of grave robbers. Just market it as helping take care of the families of those that help other people, and it should work fine.
You could also conceivably harvest one or both corneas.
A colleague of mine argues that postmortem donation is the moral minimum. I’m pretty sure that he’s right.
As far as paying people for post-mortem donation goes:
Since the number of people who die in such a way as to have donatable organs seems to be relatively small, it seems to me that there wouldn’t be any market incentive to pay people for post-mortem donations until they die and have the organs available. Which means the payment would have to go to the donor’s estate. I suppose that would provide some incentive to put yourself on the organ donor list, but my personal experience is that the people you most want on the list (young people) are the people least likely to think about estate planning. So, we would probably see some increase in the post-mortem donor pool, but I’m not sure it would be that much. I don’t really have a problem with the concept though.
Although… if I think about this further, I could imagine very poor people in 3rd world countries or even in 1st world countries taking the idea of a post-mortem payment very seriously. And since you need good health-care facilities to extract organs post-mortem, such a payment system might very well incentivize the market into providing excellent emergency/critical health-care facilities to poor people. That might be a benefit of post-mortem payments.
I’ll have to think about this further.
I thought about it a bit more. Say someone is borderline and it would cost a lot of money to save him. By creating a post-mortem payment situation, you’ve created a perverse financial incentive on the part of his heirs and perhaps medical care givers to end treatment and take his organs… treating him costs you money but harvesting organs makes you money. So, you would need a very strict regulatory regime to make sure that people would be seriously punished for harvesting organs in that situation. Of course, we sort of have those same perverse incentives today, particularly with poor patients who can’t afford treatment, so it’s not an insurmountable barrier. It’s just something you would need to watch for and regulate accordingly.
Why are you paying the hospital extra just to do their jobs? It’s the donor we’re trying to encourage.
In the US, the cost of emergency treatment is partly paid for by the individual (or his family), and partly paid for by the hospital, unless the individual has adequate health insurance to cover the majority of the costs. So, there are financial incentives on both the part of the hospital and the individual’s next of kin to skip on treatment. Note that I’m not saying that hospitals or next-of-kin would necessarily do this, just that the financial incentive exists to do it.
So, take this example: a guy shows up in the ER in critical condition. He doesn’t have adequate insurance and he doesn’t have adequate savings, and he’s unconscious so he can’t make decisions. In that case, both the hospital and the next of kin have a financial incentive to not treat him. If you pay for post-mortem donation of organs, then you’ve furthered skewed the incentive towards not treating.
In some countries (such as the US), you get around the perverse incentive problem by legally requiring all treatment necessary to stabilize the patient and save his life. But some countries don’t have adequate safeguards in this area, so you’d have to watch for that, if you wanted to import organs from other countries (is that technically feasible to import organs?).
As I said, it’s not an unsolvable issue, it’s just an issue that needs to be watched for and regulated appropriately.
We’re talking about money as an incentive to donate, not an incentive to remove organs in the first place. The incentives don’t change in your scenario. It still costs money to save this guy’s life, and organs are still valuable. That he can be paid to donate the organs doesn’t make the doctor want his organs more, it is supposed to make the patient want to donate more. Whether the patient gets paid for his organs or not, the incentives in the ER scenario don’t change.
“He” is not getting paid anything, since he will be dead after the donation. His heirs are the ones who are going to get paid for the donation. Paying them for the donation changes their incentives. I’ve explained the perverse incentive problem pretty clearly here. Other people besides the donor benefit from the donation, so that incentivices them to not have the donor’s best interests at heart. And anytime you introduce new payment scenarios, incentives change. That’s Econ 101.
I find the idea disgusting, a clear example of the wealthy preying upon the poor. Desperate hopeless people accepting money and condemning themselves to a likely shorter lifespan so that the wealthy can live longer while exploiting the people they are getting organs from.
And if their remaining organs fail, I guarantee they won’t get a replacement organ for the one they gave up however many years ago. Just malign neglect and perhaps some speeches about how the fact that they are poor shows that they are scum who don’t deserve sympathy.
If your heirs want you dead to get a few thousand dollars, they probably want you dead right now.
Der Trihs, please try to read the thread before going off on wild tirades.