I don't think this is a good comparison. almost all of those examples are things that naturally regrow on their own, so selling or donating them is entirely temporary. eggs do not replenish, but...
Exemplary
The National Organ Transplant Act prohibits compensating kidney donors, which is strange in that in American society, it’s common to pay for plasma, bone marrow, hair, sperm, eggs and even surrogate pregnancies.
I don't think this is a good comparison. almost all of those examples are things that naturally regrow on their own, so selling or donating them is entirely temporary.
eggs do not replenish, but at puberty there are hundreds of thousands of them and about 1000 of them per month are lost naturally, so the argument in favor of selling eggs is that it's a negligible loss compared to what is occurring anyway.
surrogate pregnancy is the only thing on that list that is even somewhat permanent. the majority of the health effects are confined to the 9 months of surrogacy, but pregnancy does cause permanent changes to the body.
and there are already ethical debates over paid surrogacy, to a much greater extent than there are with the other examples they give.
since selling or donating a kidney is an even more permanent life change than pregnancy, I would have liked to see the authors address this, rather than hand-waving over it by mentioning surrogate pregnancies in the same sentence as they talk about selling hair.
Another way to think about this, as one bioethicist points out: “Every person in the chain of living organ donation, except one, profits.” The hospital gets paid, the doctors and nurses and staff get paid, the pharmaceutical industry gets paid and the recipient is the main beneficiary. Everyone benefits except the donors, who get reimbursed only for their expenses.
when I look at the American healthcare system, "what we need is more profit-seeking" is...uhh...not the first thought that comes to mind.
The ethical concerns regarding compensation are straightforward. Nobody wants to coerce or compel those in desperate financial straits to do something they would not have done otherwise.
they give this "nobody wants to..." disclaimer, but it rings hollow. isn't that exactly what they're proposing?
their argument is that the payment will increase the numbers of "donated" kidneys. how would this happen, if it were not for people who were compelled by the payment to do what they wouldn't have done otherwise?
After much review, we come down strongly in support of indirect payment, specifically, a $100,000 refundable federal tax credit. The tax credit would be uniformly applied over a period of 10 years, in the amount of $10,000 a year for those who qualify and then become donors.
so basically, a form of universal basic income for 10 years, but only for people who sell a kidney?
This kind of compensation is certainly not a quick-cash scheme that would incentivize an act of desperation.
hoo boy this is stunningly out of touch with reality.
just out of random curiosity, what are these authors' current incomes and net worth? have they, at any point in their adult lives, lived below the federal poverty line?
they're trying to argue two contradictory things simultaneously - that the payment for selling a kidney will be large enough to incentivize people to do it, but that it's small enough that it wouldn't incentivize poor people to do it out of financial desperation. it's half Goldilocks, half Schrodinger - just right, because it's both too big and too small?
I would respect this argument so much more if they were just honest about it. "we think poor people with healthy kidneys should be able to sell them, and rich people with kidney disease should be able to buy them". ditch the sugar-coating. ditch the hollow concern about people in poverty selling kidneys out of financial desperation. ditch the neoliberal "make it a refundable tax credit" shit.
instead, they should just argue "look how well it's worked in other countries, the US should do the same":
the authors fail to mention any of these other countries, which is another indication to me that this is not a serious argument.
if there was a single country they could point to as an organ-selling success story, they'd be shouting it from the rooftops. instead, experiences around the world seem to be uniformly negative, and in the exact way the authors claim wouldn't happen in the US. so they sweep that under the rug and don't grapple with it at all in this piece.
That magical amount of money doesn't exist. Any amount of money that's enough to incentive even a small amount of people will be enough money that some will sell their kidneys out of desperation....
they're trying to argue two contradictory things simultaneously - that the payment for selling a kidney will be large enough to incentivize people to do it, but that it's small enough that it wouldn't incentivize poor people to do it out of financial desperation.
That magical amount of money doesn't exist. Any amount of money that's enough to incentive even a small amount of people will be enough money that some will sell their kidneys out of desperation. I'd bet there are tens of thousands who would sell their kidney for less than $1,000. I would absolutely sell mine for $100,000. That's a good portion of a house where I live!
It does suck that the donor gets nothing and I think there's a way to help them, but not by money. Instead donors should get priority for kidney's in the future. They've already given the choice...
It does suck that the donor gets nothing and I think there's a way to help them, but not by money. Instead donors should get priority for kidney's in the future. They've already given the choice to help someone else so I think it's only fair they get first pick of kidney's should they need one. Could also sweeten the pot by making the procedure free. It's only fair as they put themselves in a much higher danger of needing a kidney by donating.
The reality is that we aren't going to fix organ shortages by making it easier to cut them out of people. Only a medical miracle of artificial organs can really solve it.
In the US, they do. I just received a kidney transplant and my sister-in-law was the donor. If she ever needs a transplant in the future, she'll be right at the top of the list. This is also the...
Instead donors should get priority for kidney's in the future.
In the US, they do. I just received a kidney transplant and my sister-in-law was the donor. If she ever needs a transplant in the future, she'll be right at the top of the list.
Could also sweeten the pot by making the procedure free.
This is also the case. My insurance paid for all of her testing, exams, the procedure, and the follow up visits. Her only costs were travel-related which my insurance could also reimburse, but she chose not to pursue it.
Out of curiosity, will her long-term health consequences be covered? For example, if she experiences a health problem 50 years in the future due to having only one kidney or due to complications...
Out of curiosity, will her long-term health consequences be covered? For example, if she experiences a health problem 50 years in the future due to having only one kidney or due to complications from the surgery, will your insurance still cover that? Will she have any copays or have to shop around for a doctor who's in the network? What happens if your insurance company goes out of business before then; will another insurance company take on that responsibility?
I am a citizen of both the US and Australia. Since getting Australian citizenship, I am far more willing to donate a kidney now than I was with only US citizenship (i.e., there is a far larger pool of people I'd be willing to donate a kidney to now than there was before). I'm so much less scared of falling between the cracks here.
They didn’t spell it out, but I think the reasoning might be that the first payment wouldn’t be until next year, so that wouldn’t be useful for someone who needs to raise money quickly. There...
They didn’t spell it out, but I think the reasoning might be that the first payment wouldn’t be until next year, so that wouldn’t be useful for someone who needs to raise money quickly. There would be compensation, but it wouldn’t be something someone would do on impulse or out of desperation.
I’d guess the stories from other countries might be good reasons to be reluctant to give people immediate cash?
It’s a short op-ed article and I can understand not being entirely convinced, but I don’t get the contempt.
You can already get a loan on your tax return, or if you have an annual disbursement you can sell it to get cash up front. This will absolutely create that industry around kidney sale tax credits....
You can already get a loan on your tax return, or if you have an annual disbursement you can sell it to get cash up front. This will absolutely create that industry around kidney sale tax credits.
I'm not the previous poster but I share the distaste for the veneer of rationality covering over the "poor people with healthy kidneys should be encouraged to sell them to rich people with kidney disease."
Yes, it might be possible to get loans based on these things, or alternatively, entirely unsecured loans are available. Someone could run up their credit cards based on income they expect to have....
Yes, it might be possible to get loans based on these things, or alternatively, entirely unsecured loans are available. Someone could run up their credit cards based on income they expect to have.
But I expect that the worst decisions are made people who aren’t thinking like this? And there could be other hoops. An op-ed isn’t a complete policy proposal.
I guess there’s little point in arguing about distaste, but I do find it odd that having a few hoops to discourage making impulse decisions is more distasteful than making no attempt at all.
Great, so instead of them getting safe money, now they get locked into horrible interest ridden debt. Thereby only increasing their issues. You say it's not something someone with good financial...
Great, so instead of them getting safe money, now they get locked into horrible interest ridden debt. Thereby only increasing their issues.
You say it's not something someone with good financial sense would do, but those willing to sell their lives are not making good choices already. I'm sure they'd continue making bad choices after the sale.
Hoops are not what is distasteful. Selling organs is. And pretending this is a logical solution and not still the same one with hoops to distract you (and to reinforce the idea that poor people...
Hoops are not what is distasteful. Selling organs is. And pretending this is a logical solution and not still the same one with hoops to distract you (and to reinforce the idea that poor people make bad financial decisions rather than just being in bad situations) is very distasteful
Provide UBI and universal healthcare to everyone - and I suspect living organ donations would in face rise. Because people have a safety net and a societal culture of community care.
But that would require something of the rich, not just the poor
I don't understand your accusation about not having read the article. The first commenter in this chain quoted huge chunks of it. I absolutely read the article and I still feel this practice would...
I don't understand your accusation about not having read the article. The first commenter in this chain quoted huge chunks of it. I absolutely read the article and I still feel this practice would be coercive. The only relevant part that the first commenter didn't quote was the author's extremely thin rebuttal:
But would it be exploitative? Not at all.
No explanation as to how or why it wouldn't be exploitative. It just won't! The most charitable interpretation is that if you don't get your benefits quickly, it's not exploitation. That's extremely unconvincing to me.
Because rich folks are statistically more likely to get organ donations. Because they're more likely to have health insurance or be able to pay additional costs out of pocket. (The tax credit...
Because rich folks are statistically more likely to get organ donations. Because they're more likely to have health insurance or be able to pay additional costs out of pocket. (The tax credit covers the donator, the recipient is still on the hook for medical costs)
They're more likely to have the resources to address the disqualifying factors for receiving an organ. And there's no guarantee of healthcare for the donor who now is statistically more likely to need additional medical treatment.
If you don't find coercion to be a valid argument I'd still encourage looking at the articles shared that discuss the outcomes of organ sales in other countries. I, like @GenuinelyCrooked am unconvinced that it wouldn't be about as exploitative as handing people the cash. (and they'd be handed the cash by tax credit advance people)
the government tax credit is only used as an incentive to encourage more kidney donors/sellers. there is still the cost of the kidney transplant surgery itself. this estimates the out-of-pocket...
Why do you say "rich people with kidney disease"? The rich aren't paying in this model, it's a government tax credit.
the government tax credit is only used as an incentive to encourage more kidney donors/sellers. there is still the cost of the kidney transplant surgery itself. this estimates the out-of-pocket cost, without insurance, as $442,500.
despite the Affordable Care Act trying to make coverage universal, there are still 27 million people in the US without health insurance. those people almost certainly don't have half a million dollars sitting in a savings account for a rainy day. so there's 27 million people, 8.3% of the US population, who are not rich and are not going to get a kidney transplant, regardless of any of the changes proposed in this op-ed.
if the transplant patient does have health insurance, plans in the US are ranked based on their actuarial value - an average of what percentage of overall costs the insured person ends up paying out-of-pocket.
plans range from a Platinum plan, where the insured can expect to pay 10% of the costs, to Bronze, where they pay 40%.
so obviously this is full of "it depends on the exact insurance company and their policies" caveats, but that gives us an estimate that someone with a Platinum plan would still end up paying ~$44k for a kidney transplant, while someone with a Bronze plan would have to pay ~$175k.
rich people can definitely afford kidney transplants. middle-class people might be able to, it seems likely they'd have to go into a significant amount of debt, and/or cash in some of their retirement savings (assuming they have some). lots of poor people will be unable afford them at all, even if the proposal in this op-ed was implemented and worked the way the authors hope.
that just means they didn't actually read the article.
Tildes tries to operate on the principle of charity. please assume the best about people you disagree with, including that they're not lazy and that they read the same article you did, just reached different conclusions.
say I'm an elderly billionaire with kidney failure. I (realistically, I'd probably have my butler do it) go up to a homeless man and offer him $100,000 for one of his kidneys, if we're a match....
It isn't coercion, and there is no duress/compulsion.
say I'm an elderly billionaire with kidney failure. I (realistically, I'd probably have my butler do it) go up to a homeless man and offer him $100,000 for one of his kidneys, if we're a match. not the $10k/year tax credit this op-ed suggests, but a cashier's check for $100k when he wakes up from the surgery.
isn't what you said equally true in that case? there's no coercion, duress, or compulsion. both the homeless man and I are fully-informed, consenting adults. why shouldn't this be allowed?
laws in the US, as they stand now, wouldn't permit doctors to do that transplant surgery. no problem, I have a private jet, I'll have it fly us both to a country with looser regulations. or, since this op-ed is discussing changing US laws, why shouldn't we go all the way and allow unrestricted buying & selling of organs?
like I said, I respect this version of the argument more than the sugar-coated version the authors of this op-ed present. I still disagree with it, but I respect its honesty.
for example, why is the price of a kidney fixed at $100k in this op-ed's proposal? isn't that inefficient, top-down, central planning by the federal government? shouldn't the invisible hand of the free market determine the price of a kidney?
maybe that homeless man is in his 40s, and he's a frequent alcohol drinker. his kidneys might work better than my failing ones, sure, but they're still in bad shape. market price of one of those kidneys is $25k, maybe $30k tops.
but I'm willing to pay top-dollar for a high-quality kidney.
the best strategy for that, I think, would be to find a bunch of young poor people, and convince as many of them as I can to go through the testing process, to increase the odds that I find a match.
maybe I'd go to a community college somewhere with deep poverty like West Virginia, and offer $100 to anyone who'll go through the process of getting blood drawn and tested.
say I find a 20-year-old in good health, with pristine kidneys. hell, maybe they're a Mormon, which would mean those kidneys have never been subjected to alcohol or even coffee. (now that I think of it, Utah or southern Idaho might be an even better spot to look for kidneys than West Virginia - Mormons in poverty is the perfect demographic)
maybe that kid isn't willing to give up their kidney if the payment is only $100k. maybe they won't budge for less than $5 million. that's fine, my private jet cost more than that. I get a new kidney, that kid gets set up for life. isn't that win-win? why should that be illegal?
It would save lives and I (already an organ donor, not money seeker) think that's great if it would get more people to join their states' registries and save more lives.
my proposal, to allow a completely free market in kidney sales, would also save lives. what do you think of it?
To be fair, a $10,000 tax credit will not benefit anyone who doesn’t pay at least $10,000/year in taxes. So those with 20k/yr incomes do not have an incentive in this scenario. Ball parking here,...
To be fair, a $10,000 tax credit will not benefit anyone who doesn’t pay at least $10,000/year in taxes. So those with 20k/yr incomes do not have an incentive in this scenario. Ball parking here, but a single individual with no 401k contributions or other tax complexities would need to make roughly 80k before their tax burden is 10k/yr
Quickly skimming through Google, it looks like most cases of renal failure are caused by high blood pressure or diabetes. Given that both of those are extremely preventable, maybe let’s manage...
Quickly skimming through Google, it looks like most cases of renal failure are caused by high blood pressure or diabetes. Given that both of those are extremely preventable, maybe let’s manage that better (eg free meds, free meal planning or assistance, free psych care, etc.) first before considering buying organs from poor people? Even if, as that bioethicist pointed out, all the middlemen in the healthcare industry would profit from doing so.
There are certainly cases where blood pressure and/or diabetes cause renal failure, but it's fairly common for the opposite to be true. I (39M) was recently diagnosed with renal failure after...
There are certainly cases where blood pressure and/or diabetes cause renal failure, but it's fairly common for the opposite to be true. I (39M) was recently diagnosed with renal failure after going to the hospital with migraines caused by high blood pressure. An autoimmune issue with my kidneys was to blame, and they failed to adequately get rid of excess water, causing the high blood pressure. The docs were on high alert for diabetes as well, constantly checking my blood sugar, which was consistently normal. The doctors told me that "the big three" as they called them often come as a set and any can cause any of the others. They also warned that some people who receive transplants end up getting diagnosed with type 1 diabetes later in life.
Since getting a transplant, my blood pressure has returned to normal and the migraines have stopped completely.
That was me. Lost a kidney to cancer, ended up with diabetes and (for a time) high blood pressure. And, seeing as I have rather a personal stake in the question at hand, I would say to the...
That was me. Lost a kidney to cancer, ended up with diabetes and (for a time) high blood pressure. And, seeing as I have rather a personal stake in the question at hand, I would say to the original article - absolutely not. Because I've also lived paycheck to paycheck, and worked with many people who are in that situation or worse, and I've witnessed the ways in which people living in poverty often don't have the luxury of choice. I think GenuinelyCrooked passed it very succinctly: poverty is duress. Erase poverty and you may have an argument for financial incentives, but as it stands, all the arguing doesn't convince me that this 'solution' won't be most deleterious to those living in poverty - people who may genuinely feel they cannot afford to say no, but also will not be able to afford the lifelong additional healthcare and medication that may result down the road. But that right there is the catch with poverty. Often the only choice they do get is 'bad' or 'different bad'. I would argue that the authors should be arguing for universal basic income and universal healthcare. More people with kidney problems under control because they can afford treatments and have the bandwidth for better self care, more people living healthy, secure enough lives to have the bandwidth (and healthy kidneys) to consider the benefits to others than themselves should they donate... exactly what they want, without the exploitation that cannot just be erased by claiming 'good intentions'. Additionally, it will benefit a lotof other people with other health problems.
Although there’s often more people could do to improve their health, opposing medical treatment because you blame them is both ignorant and heartless. You need to learn more about diabetes. Maybe...
Although there’s often more people could do to improve their health, opposing medical treatment because you blame them is both ignorant and heartless. You need to learn more about diabetes. Maybe start with the difference between type 1 and type 2.
Sorry — if my response seemed harsh, it’s because I’m tired of moralistic opinion pieces that try to reframe problems into false binaries that inevitably disadvantage the already disadvantaged...
Exemplary
Sorry — if my response seemed harsh, it’s because I’m tired of moralistic opinion pieces that try to reframe problems into false binaries that inevitably disadvantage the already disadvantaged while barely addressing the problem. I’d imagine that you posted this because someone you care about has been affected by CKD, and I’m very sorry to have started an argument in a thread about saving the life of one of your loved ones.
I wouldn’t blame you if you don’t, but if you would permit me a second shot, here is a longer argument (partially) in bullet form. My conclusion isn’t any different, but maybe the context will help see why I disagree extremely strongly with the author’s take but not the problem itself:
(article’s statement) there are 100000 people on the kidney transplant list and several orders of magnitude too few donors,
(article’s statement) there are ~800000 people with end stage renal disease.
(inference) ~700000 people do not qualify for organ donation (eg too old, health is poor overall, not rich enough to travel for medical care, etc.) but will soon die of renal failure.
(my statement, based on points 3, 4, 5) ~700000 people are going to die with no chance at getting a transplant to save their life, and the majority of those deaths are entirely preventable.
(my statement, citationless) organ transplants cause lifelong hardship for the recipient and the donor, and without addressing the underlying issue which caused it, will require another transplant later.
(my statement, citationless) the article does not explain the context of why these people need organ transplants. It claims the following:
Increasing transplants is the solution to save lives.
This is a citationless and poorly argued claim. Here is another: the solution to saving lives is preventing most of 800000 people from acquiring an extremely preventable disease. Here is a quote from an article that is not an LA Times opinion piece about chronic kidney disease globally, not just in the USA:
Importantly, early detection and treatment of diabetes, hypertension, and CKD is possible using readily available, often inexpensive, treatments. These interventions can improve renal and cardiovascular outcomes and slow or prevent progression to ESKD.22, 23, 24
Conclusion: Organ transplants are not bad. Encouraging more people to be organ donors, and helping prevent deaths is not bad. Statistically, there will always be a need for organ transplantation as many illnesses are not preventable, and arguing for a sufficient organ supply to meet that is not bad. Finding some way to help all 800000 people is not bad, and in the extremely short term that could make paid organ donation the most ethical option.
Reframing a medical reality so that the only path towards saving lives is exploiting people who would trade their left kidney for a few bucks is more than horrific. The author is either extremely uninformed or intentionally trying to manipulate readers.
It is better for the patient to never get a preventable disease. It is better for the donor to keep their organs inside them. And, contrary to the article’s position, it is better for the economy to focus on solving actual problems (such as genetic treatments for type 1 diabetes, xenobiotic organ transplants, or another sci fi tech that would be accomplishable if not for this BS) than to try to solve a natural outcome of systemic poverty and discrimination resulting in preventable illness by slapping some kidneys onto the symptom.
To say that I am sick and tired of these types of opinion pieces is an understatement. This can go burn with the “by your own bootstraps”, “it’s a natural cycle”, and “it’s a choice, not biologically determined” arguments in whatever rhetorically appropriate afterlife may be invoked in polite internet conversation.
Thanks for explaining. I still see it differently, though. Many newspapers have pretty strict word limits for op-ed articles and sometimes they don’t allow citations either. Although it seems like...
Thanks for explaining. I still see it differently, though.
Many newspapers have pretty strict word limits for op-ed articles and sometimes they don’t allow citations either. Although it seems like an obsolete tradition to me, I’m generally willing to give their authors a pass on a lack of detail, because I assume the format is rather limited.
Maybe I should have looked for a more in-depth article. Their policy website is Coalition to Modify NOTA but like a lot of political websites, it’s not very good. It’s disappointing that they don’t seem to have published a longer essay somewhere else. (There are videos but I didn’t watch them.)
It seems like your contempt is at least partly because you’re reacting to what others have said on the Internet about different subjects? Is “not biologically determined” referring to anti-gay rhetoric? It doesn’t seem much related to people who need a kidney.
The authors of this article didn’t write those things and I don’t see anything in the opinion piece that opposes research, prevention, or funding for alternative treatments. You claim they argue that it’s the “only path forward” but I think they’re just very focused on making the case for removing this particular restriction.
I did see a link to this piece on Marginal Revolution and it was posted by Alex Tabarrok, whose writing style I somewhat dislike based on vibes. But I think it would unfair to judge the opinion piece by who linked to it.
My rebuttal of that article's claims is based entirely on the content of the article itself. If you don't feel that the author is pushing a narrative (ie. give me your kidneys; CKD happens),...
It seems like your contempt is at least partly because you’re reacting to what others have said on the Internet about different subjects? Is “not biologically determined” referring to anti-gay rhetoric? It doesn’t seem much related to people who need a kidney.
My rebuttal of that article's claims is based entirely on the content of the article itself. If you don't feel that the author is pushing a narrative (ie. give me your kidneys; CKD happens), that's fine, I do and have written a TED Talk about it apparently. Coincidentally, so has Ned Brooks (the man actually pushing this, who operates a kidney donor charity that raked in ~$800000 last year and spent more than half of it on salaries -- nice), and given another 15 minutes he still couldn't find the time to explain how many, many more lives could be saved by prioritizing giving people adequate medical care before resorting to second hand kidneys. But I digress.
Separately -- since I was called heartless (and poorly read?) in an earlier draft of a parent comment -- I alluded to other topics which attract similarly well written op-eds to provide the emotional context for my snide post. I wanted to show how I am only a little heartless, but I am a lot angry at platforms that publish simplistic takes to complex problems. Feel free to pick nits at my emotional reaction to this (my amygdala isn't as big as Ned Brooks', so I can't handle feelings this large), but my argument was that the article is reductive, poorly motivated, and has flaws so massive you could drive a fully loaded ambulance packed with welfare kidneys through them.
I'm not willing to give professional writers on a copy edited platform the benefit of the doubt the same way I'd grant it to a tildeser.
(edit)
Thanks for explaining. I still see it differently, though.
No worries! I think it's healthy for people to disagree; we're all on the same page that the medical system should try to reduce all the suffering and death that it can, at least. Surprisingly that can be a point of contention, so I'm glad to have spent ... two hours refining my perspective on kidney transplants! Hopefully this whole thread hasn't been too draining for you; it seems like there've been several other dissenting discussions going on.
I don't think this conversation was fun for anyone, so I guess I'll chalk it up as another failure. It's disheartening to post what I thought was a not-bad idea argued reasonably well and see not...
I don't think this conversation was fun for anyone, so I guess I'll chalk it up as another failure.
It's disheartening to post what I thought was a not-bad idea argued reasonably well and see not only the idea condemned, but its authors as well. They're strangers we never heard of before. We never heard of their charity before either. It seems like a quick rush to judgement to assume that the charity does bad work? I don't even know what they do, but I can imagine salaries being paid for good or bad reasons.
But I won't investigate or defend it further. This has become another "contempt trial" where people condemn something and I try to say "hey, maybe it shouldn't be held in contempt? These arguments for summary dismissal are terrible." But I'm not really all that invested in this subject, it's just out of the perceived unfairness of it all that I take the other side.
What was I expecting? I don't expect a short op-ed about a controversial idea to convince anyone, but I guess I hoped that, even if people disagreed, it was worth debating rather than condemning.
(And I do get snippy about immediate dismissals, and made hasty judgements of my own. Not one of my better moments.)
With a lot of opinion pieces (and also science fiction that are true social commentaries and attempts at solutions) I feel it's important to take a step back from the idea and the solution(s) it...
With a lot of opinion pieces (and also science fiction that are true social commentaries and attempts at solutions) I feel it's important to take a step back from the idea and the solution(s) it proposes and first decide if there is a way for society to avoid getting to the point where that solution is necessary or practical. Because if you take every Cool New Idea at face value a lot of them sound good -- they may be well-reasoned, they may be emotionally gripping, they may pay into personal or cultural biases or play against them, heck they might just be downright fascinating -- and then you're invested in a potential solution that maybe never should be needed because there are Other mechanisms, ideas, religions, whatever, that propose a way of doing things that, if we continue on that Other route, we'd never get to a point where we need that Cool New Idea.
Discussions of bringing back species that humans made extinct are a good example of this. We more or less have the technology, so could talk about how, why, at what scale, and who should pay for bringing back extinct species. But first we should ask ourselves "Shouldn't we solve the socio-political, environmental, and other problems that cause extinctions in the first place? Should we pay money into one industry to bring back a species that we're paying money into other industries to make extinct?"
This is getting awfully abstract, but sure, one more post. There are always alternatives worth considering. In the abstract, it's fair to argue for doing something else instead. However, I think...
This is getting awfully abstract, but sure, one more post.
There are always alternatives worth considering. In the abstract, it's fair to argue for doing something else instead.
However, I think it can be taken too far. An alternative to spending money is anything else you could spend the money on. Does an idea have to defended against every other idea? That doesn't seem fair. Arguing that something is a good idea doesn't mean you necessarily think it's the best possible use of funds, or that you've considered every other possible use of funds. Even limiting that to medical spending for the same health issue, it's a very broad comparison to ask people to make.
But even that assumes some kind of rough equivalence between choices. When it's not a real choice we're making, it's easy to suggest alternatives that we don't even know how to do. "A way for society to avoid getting to the point where that solution is necessary or practical," if you mean avoiding kidney transplants for people who need them now, sounds more like one of those ideas.
Sometimes being able to imagine an alternative, however costly, unlikely, vaguely sketched out, or utopian, is treated as a convincing argument against an idea, if it avoids something more immediate and practical that's distasteful. That can be pretty frustrating.
Of course with politics, everything is difficult, and it's not really up to us, and this isn't really my issue, so I should just let it go. I leaned that an unpopular idea is unpopular.
It's perhaps clumsily worded, but free healthcare that looks at the full range of bio-psycho-social factors that people with T1 or T2 diabetes struggle with would be good for those people, and...
It's perhaps clumsily worded, but free healthcare that looks at the full range of bio-psycho-social factors that people with T1 or T2 diabetes struggle with would be good for those people, and would reduce the number of people with diabetes who need kidney transplants.
As you probably know it would not eliminate the need, because i: people are complicated and ii: T1 diabetes is often accompanied with autoimmune conditions too.
But still, asking for better care for people doesn't seem heartless.
Preventative care wouldn’t help the people who already need a kidney transplant. What other medical procedures do people oppose using this sort of reasoning?
Preventative care wouldn’t help the people who already need a kidney transplant. What other medical procedures do people oppose using this sort of reasoning?
To answer your question not my personal beliefs but as a case manager and hearing unsolicited opinions about work ive helped coordinate. I would say bariatric surgery and addiction treatment...
To answer your question not my personal beliefs but as a case manager and hearing unsolicited opinions about work ive helped coordinate. I would say bariatric surgery and addiction treatment especially suboxone get high scrutiny.
Current events wise abortion which is a medical procedure.
I'd also argue liver transplants get significant pushback from a public viewpoint.
I don't understand the question - most healthcare focuses on prevention if possible, and treatment if needed. I am not saying "don't give these people kidneys". I'm saying there are better ways to...
What other medical procedures do people oppose using this sort of reasoning?
I don't understand the question - most healthcare focuses on prevention if possible, and treatment if needed. I am not saying "don't give these people kidneys". I'm saying there are better ways to get kidneys - opt out donor lists for example.
The other important thing about better care before donation is that you maximise the benefit of donation. One of the leading causes of the failure of transplanted organs is because people cannot correctly take their medication. Another is because they have lifestyle factors that shorten the life of the transplanted organ. Better preventative care would help address both of these.
Paying people to get their own healthcare is an ethical minefield, and in that situation the patient gets the benefit of the healthcare. In this situation we're paying people to severely increase their risk of harm and they do not get any tangible benefit from it. The people who get the benefit are the people who need the organs.
This organisation is proposing a radical change to healthcare ethics. We have a large body of existing work around this, and so they need to show that they've address that, and they have not done so.
I think that the timespan over which the money is important. It means that people who choose to receive $100,000 over 10 years is more likely to be in a financially stable situation where they're...
I think that the timespan over which the money is important. It means that people who choose to receive $100,000 over 10 years is more likely to be in a financially stable situation where they're not in a rush to get that money and can wait, versus someone who has a big student loan debt — and desperation makes people irrational.
$10k/year would have been pretty attractive when I was basically homeless at age 18, but as an adult in my 40s it would make exactly zero difference in my life. Just from my anecdotal experience,...
$10k/year would have been pretty attractive when I was basically homeless at age 18, but as an adult in my 40s it would make exactly zero difference in my life. Just from my anecdotal experience, it seems like this would mostly take advantage of disadvantaged people and not really move the needle anywhere else.
That's fair. My above explanation is not one I exactly espouse; it's my best interpretation of the argument put forward by those who advocate organ transactions. This is a difficult challenge....
That's fair. My above explanation is not one I exactly espouse; it's my best interpretation of the argument put forward by those who advocate organ transactions. This is a difficult challenge.
Personally I think that if we were to facilitate organ donation or transfer, then we need to look it not as a market or pricing problem, but as a gift problem à la gift theory.
I think there is opportunity to very publicly reframe organ donation as organ gifting, where the gift is reciprocal and binds two parties together. A donation has too much of a connotation of "I give some stranger an organ and then goodbye". In a world full of modern alienation, I think that many people yearn for meaningful connection and contribution to the world. Gifting an organ is a way to concretely impact someone's life and to be very intimately connected to their well-being. It connects two individuals and their families and loved ones. The gift recipient receives the gift of life from the gift giver — and in turn should be obligated to reciprocate with some kind of meaningful gift their own to the giver.
I have a lot more thoughts on this but I'll refrain from writing my own essay, haha.
Personally, that sounds awful. What if the people don't like each other? Does the organ donor get compensated for the deep and meaningful relationship they were promised that didn't pan out? How...
Personally, that sounds awful. What if the people don't like each other? Does the organ donor get compensated for the deep and meaningful relationship they were promised that didn't pan out? How much is enough to repay an organ? The difference in opinions between people is a recipe for all kinds of bitter disagreements and harassment and abuse.
Alienation is a big problem, but starting relationships on hugely unequal grounds is a breeding ground for tons of issues.
I think the idea is to find a middle ground between the money being too tempting and monetary incentive having little effect. It seems like that should be possible? Maybe this scheme isn’t quite...
I think the idea is to find a middle ground between the money being too tempting and monetary incentive having little effect. It seems like that should be possible? Maybe this scheme isn’t quite right, though. What would a better approach to it be?
Maybe there should be a higher minimum age than 18?
I'm skeptical that there can ever be a situation where buying poor people's organs with money isn't going to be exploitative. For it not to be, I can only think that the compensation would have to...
I'm skeptical that there can ever be a situation where buying poor people's organs with money isn't going to be exploitative. For it not to be, I can only think that the compensation would have to be of equal value to both rich and poor people -- along the lines of the current system, where you only "gain" the intangible effects of performing an altruistic act.
Possibly something like preferential access to waiting lists for future organ donations going in the other direction, since presumably both rich and poor are both equally invested in being alive?
I think a higher minimum age wouldn't be a bad idea, given what we know about the development of the rational part of the human brain. I know there's some controversy about the supposed 25 year old mark in maturing, but it would be a good place to start.
As long as severe poverty exists, that middle ground cannot. Poverty kills. If the money is enough to matter to someone with a stable financial situation who can adequately care for themselves...
As long as severe poverty exists, that middle ground cannot. Poverty kills. If the money is enough to matter to someone with a stable financial situation who can adequately care for themselves after surgery, it's enough to radically alter the life of someone facing homelessness or food insecurity. That may sound like a positive, but it is absolutely coercive and further props up the systems that have forced them into those positions in the first place. People should not need to sell their organs to survive, and allowing that to become normal and expected in our society will only increase disdain for those facing poverty. I can just imagine the political talking points. "She claims she's desperate to avoid losing her home, and she's applied for financial assistance from the state, but how desperate can she really be? She still has both kidneys."
Yea thats bunk though. Even the poorst people can do math. "Oh starting next year I'll get a $10k check for the next decade? Great, I'll sell my kidney this year then convince my wife to sell hers...
Yea thats bunk though. Even the poorst people can do math. "Oh starting next year I'll get a $10k check for the next decade? Great, I'll sell my kidney this year then convince my wife to sell hers 9 years from now." Hell, the way things are going now I'd be tempted to do it and I'm not even poor. 18 year olds will sell their kidney premptively to avoid student loans after year one.
Then we have two people with lower chances of survival, given to two people whom are on 'last resort' territory.
I’m reading over a list of the most dangerous jobs and thinking about whether it’s better to risk your life to catch fish, cut down trees, or build roofs for money, versus possibly saving...
I’m reading over a list of the most dangerous jobs and thinking about whether it’s better to risk your life to catch fish, cut down trees, or build roofs for money, versus possibly saving someone’s life by giving them a kidney. Who do you think takes those jobs? Should they be banned?
(And that’s a list of civilian occupations, so it doesn’t include joining the military.)
I think there’s a lot of room for negotiation over what should be required as fair compensation, but a ban is an extreme that we accept based on status quo bias and what seems strange to us.
Personally I think it’s very sad so much of the world is filled with people literally wearing out their bodies for not even enough money to be able to independently afford the healthcare that...
Exemplary
Personally I think it’s very sad so much of the world is filled with people literally wearing out their bodies for not even enough money to be able to independently afford the healthcare that they’ll need from a lifetime of such work. I personally think that it’s a big social problem that the main beneficiaries and distributors of the produce of dangerous labor aren’t the laborers themselves. And it’s honestly for all the same reasons that people have a problem with selling organs, just to a milder extent. No these jobs shouldn’t be banned but we definitely shouldn’t look at the current situation and just take it for granted and we certainly shouldn’t use it as an inspiration to expand these dynamics to even more intimate aspects of our lives and bodies. Honestly, a big part of the issue is how these sold organs will be distributed to people… in my opinion, compensation for organ donation would be a lot less hairy if everyone was guaranteed access to the healthcare system and these organs were just going to a public stockpile of some kind and were actually distributed solely on the basis of need alone.
As a French person, this horrifies me. Here, even giving hair is a free act. Same for all the rest.
The National Organ Transplant Act prohibits compensating kidney donors, which is strange in that in American society, it’s common to pay for plasma, bone marrow, hair, sperm, eggs and even surrogate pregnancies.
As a French person, this horrifies me. Here, even giving hair is a free act. Same for all the rest.
Ned founded, and Matt now leads, an organization that represents nearly 1,000 living [kidney] donors, many of whom serve as mentors to those considering becoming donors. We ensure that each donor candidate is informed and protected to the greatest possible extent. When potential donors talk to a mentor, it roughly triples the likelihood they’ll donate.
Still, eight years ago, when Ned donated, the number of living kidney donors was 6,000. With all the work we’ve done since, the number of living donors is still about 6,000 annually. In the United States, nearly 786,000 people suffer from end-stage kidney disease, more people than can fit in the 10 largest NFL stadiums combined.
…
Increasing transplants is the solution to save lives. And every transplanted patient taken off dialysis saves society more than $1.6 million, according to a recent paper published in the medical journal Value in Health. When people acknowledge the kidney shortage, they may think, “I’m a registered organ donor. I’m doing my part.” Unfortunately, there’s a limit to deceased donation — the numbers don’t work. To be a deceased organ donor, you have to die in a very rare manner (only about 1% of deaths occur in a donation-suitable manner). Even if we maximized our registered organ-donation rate from 60% at present to 100%, we would only increase the available deceased-donated kidneys by about 12,000, compared with the 100,000-plus who qualify to be on the transplant wait list right now.
…
Another way to think about this, as one bioethicist points out: “Every person in the chain of living organ donation, except one, profits.” The hospital gets paid, the doctors and nurses and staff get paid, the pharmaceutical industry gets paid and the recipient is the main beneficiary. Everyone benefits except the donors, who get reimbursed only for their expenses.
…
The ethical concerns regarding compensation are straightforward. Nobody wants to coerce or compel those in desperate financial straits to do something they would not have done otherwise. The challenge, then — until artificial or nonhuman animal substitutes are viable options — is to devise a compensation model that doesn’t exploit donors.
Compensation models have been proposed in the past. A National Institutes of Health study listed some of the possibilities, including direct payment, indirect payment, “in kind” payment (free health insurance, for example) or expanded reimbursements. After much review, we come down strongly in support of indirect payment, specifically, a $100,000 refundable federal tax credit. The tax credit would be uniformly applied over a period of 10 years, in the amount of $10,000 a year for those who qualify and then become donors.
This kind of compensation is certainly not a quick-cash scheme that would incentivize an act of desperation. Nor does it commoditize human body parts. Going forward, kidney donation might become partly opportunistic rather than mostly altruistic, as it is now. But would it be exploitative? Not at all.
I don't think this is a good comparison. almost all of those examples are things that naturally regrow on their own, so selling or donating them is entirely temporary.
eggs do not replenish, but at puberty there are hundreds of thousands of them and about 1000 of them per month are lost naturally, so the argument in favor of selling eggs is that it's a negligible loss compared to what is occurring anyway.
surrogate pregnancy is the only thing on that list that is even somewhat permanent. the majority of the health effects are confined to the 9 months of surrogacy, but pregnancy does cause permanent changes to the body.
and there are already ethical debates over paid surrogacy, to a much greater extent than there are with the other examples they give.
since selling or donating a kidney is an even more permanent life change than pregnancy, I would have liked to see the authors address this, rather than hand-waving over it by mentioning surrogate pregnancies in the same sentence as they talk about selling hair.
when I look at the American healthcare system, "what we need is more profit-seeking" is...uhh...not the first thought that comes to mind.
they give this "nobody wants to..." disclaimer, but it rings hollow. isn't that exactly what they're proposing?
their argument is that the payment will increase the numbers of "donated" kidneys. how would this happen, if it were not for people who were compelled by the payment to do what they wouldn't have done otherwise?
so basically, a form of universal basic income for 10 years, but only for people who sell a kidney?
hoo boy this is stunningly out of touch with reality.
as of 2019, 13% of US households had a household income of $20k/year or less. 5% under $10k/year. that's 16.8 million and 6.5 million households, respectively. we're supposed to believe that $10k/year (tax free) guaranteed for the next 10 years wouldn't encourage any acts of desperation?
just out of random curiosity, what are these authors' current incomes and net worth? have they, at any point in their adult lives, lived below the federal poverty line?
they're trying to argue two contradictory things simultaneously - that the payment for selling a kidney will be large enough to incentivize people to do it, but that it's small enough that it wouldn't incentivize poor people to do it out of financial desperation. it's half Goldilocks, half Schrodinger - just right, because it's both too big and too small?
I would respect this argument so much more if they were just honest about it. "we think poor people with healthy kidneys should be able to sell them, and rich people with kidney disease should be able to buy them". ditch the sugar-coating. ditch the hollow concern about people in poverty selling kidneys out of financial desperation. ditch the neoliberal "make it a refundable tax credit" shit.
instead, they should just argue "look how well it's worked in other countries, the US should do the same":
Kidneys for sale: poor Iranians compete to sell their organs
Organs for Sale: Impoverished Bangladeshis Try to Sell Kidneys on Black Market, End Up Poor and Ill
Desperate Afghans sell kidneys amid poverty, starvation
or, in the form of medical journal articles:
Kidneys for Sale: Empirical Evidence From Iran
Selling a kidney fails to rescue Indians from poverty
Afghans driven to sell kidneys on black market in the face of extreme poverty
the authors fail to mention any of these other countries, which is another indication to me that this is not a serious argument.
if there was a single country they could point to as an organ-selling success story, they'd be shouting it from the rooftops. instead, experiences around the world seem to be uniformly negative, and in the exact way the authors claim wouldn't happen in the US. so they sweep that under the rug and don't grapple with it at all in this piece.
That magical amount of money doesn't exist. Any amount of money that's enough to incentive even a small amount of people will be enough money that some will sell their kidneys out of desperation. I'd bet there are tens of thousands who would sell their kidney for less than $1,000. I would absolutely sell mine for $100,000. That's a good portion of a house where I live!
It would have to be so much money that even wealthy people feel like they are leaving money on the table by not giving up their kidney. At a minimum.
It does suck that the donor gets nothing and I think there's a way to help them, but not by money. Instead donors should get priority for kidney's in the future. They've already given the choice to help someone else so I think it's only fair they get first pick of kidney's should they need one. Could also sweeten the pot by making the procedure free. It's only fair as they put themselves in a much higher danger of needing a kidney by donating.
The reality is that we aren't going to fix organ shortages by making it easier to cut them out of people. Only a medical miracle of artificial organs can really solve it.
In the US, they do. I just received a kidney transplant and my sister-in-law was the donor. If she ever needs a transplant in the future, she'll be right at the top of the list.
This is also the case. My insurance paid for all of her testing, exams, the procedure, and the follow up visits. Her only costs were travel-related which my insurance could also reimburse, but she chose not to pursue it.
Out of curiosity, will her long-term health consequences be covered? For example, if she experiences a health problem 50 years in the future due to having only one kidney or due to complications from the surgery, will your insurance still cover that? Will she have any copays or have to shop around for a doctor who's in the network? What happens if your insurance company goes out of business before then; will another insurance company take on that responsibility?
I am a citizen of both the US and Australia. Since getting Australian citizenship, I am far more willing to donate a kidney now than I was with only US citizenship (i.e., there is a far larger pool of people I'd be willing to donate a kidney to now than there was before). I'm so much less scared of falling between the cracks here.
They didn’t spell it out, but I think the reasoning might be that the first payment wouldn’t be until next year, so that wouldn’t be useful for someone who needs to raise money quickly. There would be compensation, but it wouldn’t be something someone would do on impulse or out of desperation.
I’d guess the stories from other countries might be good reasons to be reluctant to give people immediate cash?
It’s a short op-ed article and I can understand not being entirely convinced, but I don’t get the contempt.
You can already get a loan on your tax return, or if you have an annual disbursement you can sell it to get cash up front. This will absolutely create that industry around kidney sale tax credits.
I'm not the previous poster but I share the distaste for the veneer of rationality covering over the "poor people with healthy kidneys should be encouraged to sell them to rich people with kidney disease."
Yes, it might be possible to get loans based on these things, or alternatively, entirely unsecured loans are available. Someone could run up their credit cards based on income they expect to have.
But I expect that the worst decisions are made people who aren’t thinking like this? And there could be other hoops. An op-ed isn’t a complete policy proposal.
I guess there’s little point in arguing about distaste, but I do find it odd that having a few hoops to discourage making impulse decisions is more distasteful than making no attempt at all.
Great, so instead of them getting safe money, now they get locked into horrible interest ridden debt. Thereby only increasing their issues.
You say it's not something someone with good financial sense would do, but those willing to sell their lives are not making good choices already. I'm sure they'd continue making bad choices after the sale.
Hoops are not what is distasteful. Selling organs is. And pretending this is a logical solution and not still the same one with hoops to distract you (and to reinforce the idea that poor people make bad financial decisions rather than just being in bad situations) is very distasteful
Provide UBI and universal healthcare to everyone - and I suspect living organ donations would in face rise. Because people have a safety net and a societal culture of community care.
But that would require something of the rich, not just the poor
I don't understand your accusation about not having read the article. The first commenter in this chain quoted huge chunks of it. I absolutely read the article and I still feel this practice would be coercive. The only relevant part that the first commenter didn't quote was the author's extremely thin rebuttal:
No explanation as to how or why it wouldn't be exploitative. It just won't! The most charitable interpretation is that if you don't get your benefits quickly, it's not exploitation. That's extremely unconvincing to me.
Because rich folks are statistically more likely to get organ donations. Because they're more likely to have health insurance or be able to pay additional costs out of pocket. (The tax credit covers the donator, the recipient is still on the hook for medical costs)
They're more likely to have the resources to address the disqualifying factors for receiving an organ. And there's no guarantee of healthcare for the donor who now is statistically more likely to need additional medical treatment.
If you don't find coercion to be a valid argument I'd still encourage looking at the articles shared that discuss the outcomes of organ sales in other countries. I, like @GenuinelyCrooked am unconvinced that it wouldn't be about as exploitative as handing people the cash. (and they'd be handed the cash by tax credit advance people)
the government tax credit is only used as an incentive to encourage more kidney donors/sellers. there is still the cost of the kidney transplant surgery itself. this estimates the out-of-pocket cost, without insurance, as $442,500.
despite the Affordable Care Act trying to make coverage universal, there are still 27 million people in the US without health insurance. those people almost certainly don't have half a million dollars sitting in a savings account for a rainy day. so there's 27 million people, 8.3% of the US population, who are not rich and are not going to get a kidney transplant, regardless of any of the changes proposed in this op-ed.
if the transplant patient does have health insurance, plans in the US are ranked based on their actuarial value - an average of what percentage of overall costs the insured person ends up paying out-of-pocket.
plans range from a Platinum plan, where the insured can expect to pay 10% of the costs, to Bronze, where they pay 40%.
so obviously this is full of "it depends on the exact insurance company and their policies" caveats, but that gives us an estimate that someone with a Platinum plan would still end up paying ~$44k for a kidney transplant, while someone with a Bronze plan would have to pay ~$175k.
rich people can definitely afford kidney transplants. middle-class people might be able to, it seems likely they'd have to go into a significant amount of debt, and/or cash in some of their retirement savings (assuming they have some). lots of poor people will be unable afford them at all, even if the proposal in this op-ed was implemented and worked the way the authors hope.
Tildes tries to operate on the principle of charity. please assume the best about people you disagree with, including that they're not lazy and that they read the same article you did, just reached different conclusions.
Poverty is duress.
say I'm an elderly billionaire with kidney failure. I (realistically, I'd probably have my butler do it) go up to a homeless man and offer him $100,000 for one of his kidneys, if we're a match. not the $10k/year tax credit this op-ed suggests, but a cashier's check for $100k when he wakes up from the surgery.
isn't what you said equally true in that case? there's no coercion, duress, or compulsion. both the homeless man and I are fully-informed, consenting adults. why shouldn't this be allowed?
laws in the US, as they stand now, wouldn't permit doctors to do that transplant surgery. no problem, I have a private jet, I'll have it fly us both to a country with looser regulations. or, since this op-ed is discussing changing US laws, why shouldn't we go all the way and allow unrestricted buying & selling of organs?
like I said, I respect this version of the argument more than the sugar-coated version the authors of this op-ed present. I still disagree with it, but I respect its honesty.
for example, why is the price of a kidney fixed at $100k in this op-ed's proposal? isn't that inefficient, top-down, central planning by the federal government? shouldn't the invisible hand of the free market determine the price of a kidney?
maybe that homeless man is in his 40s, and he's a frequent alcohol drinker. his kidneys might work better than my failing ones, sure, but they're still in bad shape. market price of one of those kidneys is $25k, maybe $30k tops.
but I'm willing to pay top-dollar for a high-quality kidney.
the best strategy for that, I think, would be to find a bunch of young poor people, and convince as many of them as I can to go through the testing process, to increase the odds that I find a match.
maybe I'd go to a community college somewhere with deep poverty like West Virginia, and offer $100 to anyone who'll go through the process of getting blood drawn and tested.
say I find a 20-year-old in good health, with pristine kidneys. hell, maybe they're a Mormon, which would mean those kidneys have never been subjected to alcohol or even coffee. (now that I think of it, Utah or southern Idaho might be an even better spot to look for kidneys than West Virginia - Mormons in poverty is the perfect demographic)
maybe that kid isn't willing to give up their kidney if the payment is only $100k. maybe they won't budge for less than $5 million. that's fine, my private jet cost more than that. I get a new kidney, that kid gets set up for life. isn't that win-win? why should that be illegal?
my proposal, to allow a completely free market in kidney sales, would also save lives. what do you think of it?
To be fair, a $10,000 tax credit will not benefit anyone who doesn’t pay at least $10,000/year in taxes. So those with 20k/yr incomes do not have an incentive in this scenario. Ball parking here, but a single individual with no 401k contributions or other tax complexities would need to make roughly 80k before their tax burden is 10k/yr
I am assuming it's a refundable credit which means the overage would be part of a refund check
Quickly skimming through Google, it looks like most cases of renal failure are caused by high blood pressure or diabetes. Given that both of those are extremely preventable, maybe let’s manage that better (eg free meds, free meal planning or assistance, free psych care, etc.) first before considering buying organs from poor people? Even if, as that bioethicist pointed out, all the middlemen in the healthcare industry would profit from doing so.
There are certainly cases where blood pressure and/or diabetes cause renal failure, but it's fairly common for the opposite to be true. I (39M) was recently diagnosed with renal failure after going to the hospital with migraines caused by high blood pressure. An autoimmune issue with my kidneys was to blame, and they failed to adequately get rid of excess water, causing the high blood pressure. The docs were on high alert for diabetes as well, constantly checking my blood sugar, which was consistently normal. The doctors told me that "the big three" as they called them often come as a set and any can cause any of the others. They also warned that some people who receive transplants end up getting diagnosed with type 1 diabetes later in life.
Since getting a transplant, my blood pressure has returned to normal and the migraines have stopped completely.
That was me. Lost a kidney to cancer, ended up with diabetes and (for a time) high blood pressure. And, seeing as I have rather a personal stake in the question at hand, I would say to the original article - absolutely not. Because I've also lived paycheck to paycheck, and worked with many people who are in that situation or worse, and I've witnessed the ways in which people living in poverty often don't have the luxury of choice. I think GenuinelyCrooked passed it very succinctly: poverty is duress. Erase poverty and you may have an argument for financial incentives, but as it stands, all the arguing doesn't convince me that this 'solution' won't be most deleterious to those living in poverty - people who may genuinely feel they cannot afford to say no, but also will not be able to afford the lifelong additional healthcare and medication that may result down the road. But that right there is the catch with poverty. Often the only choice they do get is 'bad' or 'different bad'. I would argue that the authors should be arguing for universal basic income and universal healthcare. More people with kidney problems under control because they can afford treatments and have the bandwidth for better self care, more people living healthy, secure enough lives to have the bandwidth (and healthy kidneys) to consider the benefits to others than themselves should they donate... exactly what they want, without the exploitation that cannot just be erased by claiming 'good intentions'. Additionally, it will benefit a lotof other people with other health problems.
Although there’s often more people could do to improve their health, opposing medical treatment because you blame them is both ignorant and heartless. You need to learn more about diabetes. Maybe start with the difference between type 1 and type 2.
Sorry — if my response seemed harsh, it’s because I’m tired of moralistic opinion pieces that try to reframe problems into false binaries that inevitably disadvantage the already disadvantaged while barely addressing the problem. I’d imagine that you posted this because someone you care about has been affected by CKD, and I’m very sorry to have started an argument in a thread about saving the life of one of your loved ones.
I wouldn’t blame you if you don’t, but if you would permit me a second shot, here is a longer argument (partially) in bullet form. My conclusion isn’t any different, but maybe the context will help see why I disagree extremely strongly with the author’s take but not the problem itself:
This is a citationless and poorly argued claim. Here is another: the solution to saving lives is preventing most of 800000 people from acquiring an extremely preventable disease. Here is a quote from an article that is not an LA Times opinion piece about chronic kidney disease globally, not just in the USA:
Conclusion: Organ transplants are not bad. Encouraging more people to be organ donors, and helping prevent deaths is not bad. Statistically, there will always be a need for organ transplantation as many illnesses are not preventable, and arguing for a sufficient organ supply to meet that is not bad. Finding some way to help all 800000 people is not bad, and in the extremely short term that could make paid organ donation the most ethical option.
Reframing a medical reality so that the only path towards saving lives is exploiting people who would trade their left kidney for a few bucks is more than horrific. The author is either extremely uninformed or intentionally trying to manipulate readers.
It is better for the patient to never get a preventable disease. It is better for the donor to keep their organs inside them. And, contrary to the article’s position, it is better for the economy to focus on solving actual problems (such as genetic treatments for type 1 diabetes, xenobiotic organ transplants, or another sci fi tech that would be accomplishable if not for this BS) than to try to solve a natural outcome of systemic poverty and discrimination resulting in preventable illness by slapping some kidneys onto the symptom.
To say that I am sick and tired of these types of opinion pieces is an understatement. This can go burn with the “by your own bootstraps”, “it’s a natural cycle”, and “it’s a choice, not biologically determined” arguments in whatever rhetorically appropriate afterlife may be invoked in polite internet conversation.
Thanks for explaining. I still see it differently, though.
Many newspapers have pretty strict word limits for op-ed articles and sometimes they don’t allow citations either. Although it seems like an obsolete tradition to me, I’m generally willing to give their authors a pass on a lack of detail, because I assume the format is rather limited.
Maybe I should have looked for a more in-depth article. Their policy website is Coalition to Modify NOTA but like a lot of political websites, it’s not very good. It’s disappointing that they don’t seem to have published a longer essay somewhere else. (There are videos but I didn’t watch them.)
It seems like your contempt is at least partly because you’re reacting to what others have said on the Internet about different subjects? Is “not biologically determined” referring to anti-gay rhetoric? It doesn’t seem much related to people who need a kidney.
The authors of this article didn’t write those things and I don’t see anything in the opinion piece that opposes research, prevention, or funding for alternative treatments. You claim they argue that it’s the “only path forward” but I think they’re just very focused on making the case for removing this particular restriction.
I did see a link to this piece on Marginal Revolution and it was posted by Alex Tabarrok, whose writing style I somewhat dislike based on vibes. But I think it would unfair to judge the opinion piece by who linked to it.
My rebuttal of that article's claims is based entirely on the content of the article itself. If you don't feel that the author is pushing a narrative (ie. give me your kidneys; CKD happens), that's fine, I do and have written a TED Talk about it apparently. Coincidentally, so has Ned Brooks (the man actually pushing this, who operates a kidney donor charity that raked in ~$800000 last year and spent more than half of it on salaries -- nice), and given another 15 minutes he still couldn't find the time to explain how many, many more lives could be saved by prioritizing giving people adequate medical care before resorting to second hand kidneys. But I digress.
Separately -- since I was called heartless (and poorly read?) in an earlier draft of a parent comment -- I alluded to other topics which attract similarly well written op-eds to provide the emotional context for my snide post. I wanted to show how I am only a little heartless, but I am a lot angry at platforms that publish simplistic takes to complex problems. Feel free to pick nits at my emotional reaction to this (my amygdala isn't as big as Ned Brooks', so I can't handle feelings this large), but my argument was that the article is reductive, poorly motivated, and has flaws so massive you could drive a fully loaded ambulance packed with welfare kidneys through them.
I'm not willing to give professional writers on a copy edited platform the benefit of the doubt the same way I'd grant it to a tildeser.
(edit)
No worries! I think it's healthy for people to disagree; we're all on the same page that the medical system should try to reduce all the suffering and death that it can, at least. Surprisingly that can be a point of contention, so I'm glad to have spent ... two hours refining my perspective on kidney transplants! Hopefully this whole thread hasn't been too draining for you; it seems like there've been several other dissenting discussions going on.
I don't think this conversation was fun for anyone, so I guess I'll chalk it up as another failure.
It's disheartening to post what I thought was a not-bad idea argued reasonably well and see not only the idea condemned, but its authors as well. They're strangers we never heard of before. We never heard of their charity before either. It seems like a quick rush to judgement to assume that the charity does bad work? I don't even know what they do, but I can imagine salaries being paid for good or bad reasons.
But I won't investigate or defend it further. This has become another "contempt trial" where people condemn something and I try to say "hey, maybe it shouldn't be held in contempt? These arguments for summary dismissal are terrible." But I'm not really all that invested in this subject, it's just out of the perceived unfairness of it all that I take the other side.
What was I expecting? I don't expect a short op-ed about a controversial idea to convince anyone, but I guess I hoped that, even if people disagreed, it was worth debating rather than condemning.
(And I do get snippy about immediate dismissals, and made hasty judgements of my own. Not one of my better moments.)
With a lot of opinion pieces (and also science fiction that are true social commentaries and attempts at solutions) I feel it's important to take a step back from the idea and the solution(s) it proposes and first decide if there is a way for society to avoid getting to the point where that solution is necessary or practical. Because if you take every Cool New Idea at face value a lot of them sound good -- they may be well-reasoned, they may be emotionally gripping, they may pay into personal or cultural biases or play against them, heck they might just be downright fascinating -- and then you're invested in a potential solution that maybe never should be needed because there are Other mechanisms, ideas, religions, whatever, that propose a way of doing things that, if we continue on that Other route, we'd never get to a point where we need that Cool New Idea.
Discussions of bringing back species that humans made extinct are a good example of this. We more or less have the technology, so could talk about how, why, at what scale, and who should pay for bringing back extinct species. But first we should ask ourselves "Shouldn't we solve the socio-political, environmental, and other problems that cause extinctions in the first place? Should we pay money into one industry to bring back a species that we're paying money into other industries to make extinct?"
This is getting awfully abstract, but sure, one more post.
There are always alternatives worth considering. In the abstract, it's fair to argue for doing something else instead.
However, I think it can be taken too far. An alternative to spending money is anything else you could spend the money on. Does an idea have to defended against every other idea? That doesn't seem fair. Arguing that something is a good idea doesn't mean you necessarily think it's the best possible use of funds, or that you've considered every other possible use of funds. Even limiting that to medical spending for the same health issue, it's a very broad comparison to ask people to make.
But even that assumes some kind of rough equivalence between choices. When it's not a real choice we're making, it's easy to suggest alternatives that we don't even know how to do. "A way for society to avoid getting to the point where that solution is necessary or practical," if you mean avoiding kidney transplants for people who need them now, sounds more like one of those ideas.
Sometimes being able to imagine an alternative, however costly, unlikely, vaguely sketched out, or utopian, is treated as a convincing argument against an idea, if it avoids something more immediate and practical that's distasteful. That can be pretty frustrating.
Of course with politics, everything is difficult, and it's not really up to us, and this isn't really my issue, so I should just let it go. I leaned that an unpopular idea is unpopular.
Solar freaking roadways
It's perhaps clumsily worded, but free healthcare that looks at the full range of bio-psycho-social factors that people with T1 or T2 diabetes struggle with would be good for those people, and would reduce the number of people with diabetes who need kidney transplants.
As you probably know it would not eliminate the need, because i: people are complicated and ii: T1 diabetes is often accompanied with autoimmune conditions too.
But still, asking for better care for people doesn't seem heartless.
Preventative care wouldn’t help the people who already need a kidney transplant. What other medical procedures do people oppose using this sort of reasoning?
To answer your question not my personal beliefs but as a case manager and hearing unsolicited opinions about work ive helped coordinate. I would say bariatric surgery and addiction treatment especially suboxone get high scrutiny.
Current events wise abortion which is a medical procedure.
I'd also argue liver transplants get significant pushback from a public viewpoint.
I don't understand the question - most healthcare focuses on prevention if possible, and treatment if needed. I am not saying "don't give these people kidneys". I'm saying there are better ways to get kidneys - opt out donor lists for example.
The other important thing about better care before donation is that you maximise the benefit of donation. One of the leading causes of the failure of transplanted organs is because people cannot correctly take their medication. Another is because they have lifestyle factors that shorten the life of the transplanted organ. Better preventative care would help address both of these.
Paying people to get their own healthcare is an ethical minefield, and in that situation the patient gets the benefit of the healthcare. In this situation we're paying people to severely increase their risk of harm and they do not get any tangible benefit from it. The people who get the benefit are the people who need the organs.
The closest UK ethicists came is to suggest paying for the funerals of organ donors, and that didn't go anywhere.
This organisation is proposing a radical change to healthcare ethics. We have a large body of existing work around this, and so they need to show that they've address that, and they have not done so.
I don’t quite grasp why this scheme of tax credits is not considered exploitative compared to cash payments, does anyone have any insight?
I think that the timespan over which the money is important. It means that people who choose to receive $100,000 over 10 years is more likely to be in a financially stable situation where they're not in a rush to get that money and can wait, versus someone who has a big student loan debt — and desperation makes people irrational.
$10k/year would have been pretty attractive when I was basically homeless at age 18, but as an adult in my 40s it would make exactly zero difference in my life. Just from my anecdotal experience, it seems like this would mostly take advantage of disadvantaged people and not really move the needle anywhere else.
That's fair. My above explanation is not one I exactly espouse; it's my best interpretation of the argument put forward by those who advocate organ transactions. This is a difficult challenge.
Personally I think that if we were to facilitate organ donation or transfer, then we need to look it not as a market or pricing problem, but as a gift problem à la gift theory.
I think there is opportunity to very publicly reframe organ donation as organ gifting, where the gift is reciprocal and binds two parties together. A donation has too much of a connotation of "I give some stranger an organ and then goodbye". In a world full of modern alienation, I think that many people yearn for meaningful connection and contribution to the world. Gifting an organ is a way to concretely impact someone's life and to be very intimately connected to their well-being. It connects two individuals and their families and loved ones. The gift recipient receives the gift of life from the gift giver — and in turn should be obligated to reciprocate with some kind of meaningful gift their own to the giver.
I have a lot more thoughts on this but I'll refrain from writing my own essay, haha.
Personally, that sounds awful. What if the people don't like each other? Does the organ donor get compensated for the deep and meaningful relationship they were promised that didn't pan out? How much is enough to repay an organ? The difference in opinions between people is a recipe for all kinds of bitter disagreements and harassment and abuse.
Alienation is a big problem, but starting relationships on hugely unequal grounds is a breeding ground for tons of issues.
I think the idea is to find a middle ground between the money being too tempting and monetary incentive having little effect. It seems like that should be possible? Maybe this scheme isn’t quite right, though. What would a better approach to it be?
Maybe there should be a higher minimum age than 18?
I'm skeptical that there can ever be a situation where buying poor people's organs with money isn't going to be exploitative. For it not to be, I can only think that the compensation would have to be of equal value to both rich and poor people -- along the lines of the current system, where you only "gain" the intangible effects of performing an altruistic act.
Possibly something like preferential access to waiting lists for future organ donations going in the other direction, since presumably both rich and poor are both equally invested in being alive?
I think a higher minimum age wouldn't be a bad idea, given what we know about the development of the rational part of the human brain. I know there's some controversy about the supposed 25 year old mark in maturing, but it would be a good place to start.
As long as severe poverty exists, that middle ground cannot. Poverty kills. If the money is enough to matter to someone with a stable financial situation who can adequately care for themselves after surgery, it's enough to radically alter the life of someone facing homelessness or food insecurity. That may sound like a positive, but it is absolutely coercive and further props up the systems that have forced them into those positions in the first place. People should not need to sell their organs to survive, and allowing that to become normal and expected in our society will only increase disdain for those facing poverty. I can just imagine the political talking points. "She claims she's desperate to avoid losing her home, and she's applied for financial assistance from the state, but how desperate can she really be? She still has both kidneys."
Yea thats bunk though. Even the poorst people can do math. "Oh starting next year I'll get a $10k check for the next decade? Great, I'll sell my kidney this year then convince my wife to sell hers 9 years from now." Hell, the way things are going now I'd be tempted to do it and I'm not even poor. 18 year olds will sell their kidney premptively to avoid student loans after year one.
Then we have two people with lower chances of survival, given to two people whom are on 'last resort' territory.
Sorry, paying for organs is a strict no.
I’m reading over a list of the most dangerous jobs and thinking about whether it’s better to risk your life to catch fish, cut down trees, or build roofs for money, versus possibly saving someone’s life by giving them a kidney. Who do you think takes those jobs? Should they be banned?
(And that’s a list of civilian occupations, so it doesn’t include joining the military.)
I think there’s a lot of room for negotiation over what should be required as fair compensation, but a ban is an extreme that we accept based on status quo bias and what seems strange to us.
Personally I think it’s very sad so much of the world is filled with people literally wearing out their bodies for not even enough money to be able to independently afford the healthcare that they’ll need from a lifetime of such work. I personally think that it’s a big social problem that the main beneficiaries and distributors of the produce of dangerous labor aren’t the laborers themselves. And it’s honestly for all the same reasons that people have a problem with selling organs, just to a milder extent. No these jobs shouldn’t be banned but we definitely shouldn’t look at the current situation and just take it for granted and we certainly shouldn’t use it as an inspiration to expand these dynamics to even more intimate aspects of our lives and bodies. Honestly, a big part of the issue is how these sold organs will be distributed to people… in my opinion, compensation for organ donation would be a lot less hairy if everyone was guaranteed access to the healthcare system and these organs were just going to a public stockpile of some kind and were actually distributed solely on the basis of need alone.
As a French person, this horrifies me. Here, even giving hair is a free act. Same for all the rest.
From the article:
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