Chinese judicial officials are reported to execute prisoners on account of the black market value of their body parts. The lawful sale of organs would legitimise human sacrifice. The specific virtues of a scheme of sale of organs is that each transaction remains one of personal consent, and an incentive is provided to donate organs.
The donor card scheme, by which individuals carry a card indicating their intention to donate organs is scarcely a difficult or unknown means of showing true consent. In the wake of the public outrage in early following the practice at Alder Hay Hospital of removing organs from deceased children without the consent of the parents, it is evident that a system of presumed consent would be unacceptable. The victims of the system would be a family already grieving for the loss of the relative.
Any improvements to the efficiency of the donor and transplant arrangement cannot compensate for the simple absence of organs. The sale of organs would increase the number available at home and allow surgeons to search for the parts overseas. The sale of organs is a poor solution to a pressing problem. This scheme would allow doctors to assume that the organs of a deceased patient can be used for transplant unless the patient or his family have made a contrary request.
Alternatively, the BMA has advocated radical revision of the inefficient system by which patients are matched to donors. The U. Department of Health and Human Services HHS has proposed the development of a website that would link patients, surgeons and donors nationwide. A legitimate market in human organs would not be inconsistent with either public or private healthcare services.
The transplant surgeon, the nursing staff and even the pharmaceutical companies producing the anti-reaction drugs receive payment for each operation performed. Why should the donor of the organs, arguably the most important actor in any transplant, not also receive remuneration? The United States already tolerates markets for blood, semen, human eggs, and surrogate wombs. Is there a moral difference between a heart or a lung and an ovum?
It is remarkable that a lifesaving treatment should apparently have no financial value. The market in body parts that thrives in the United States is neither successful nor to be welcomed. The sale of embryos, eggs and sperm in the United Kingdom is prohibited by the Human Fertilisation and Embryology Act But the supply has also failed to meet the demand. Legalising selling will not solve this problem. It will benefit the wealthy, while the poor will not be able to obtain the organs since it is most likely that a bidding system will start.
The poor will be exploited, forced to sell their organs. It might bring them money but they will end up risking their own health. Those in need of human organs cannot rely on altruism alone; there must also be a legal system to create the necessary supply.
The sale of human organs should indeed be legalised. In order to tackle black marketing and organ trafficking, the government can issue permits to organ sellers and maintain their credentials to track miscreants.
If the sale of organs is made legal, it will make organ transplant easier. The lack of access to organs takes away thousands of lives every year.
Countless organ rackets thrive underground in developing countries like India. Hundreds of hapless Indians are duped to sell their organs for peanuts; at times they are even murdered by organ harvesters who feed black markets. So this is for Amy. And I do so asking her in the reality of, now the market exists.
The market that Dr. Friedman wants to have, now exists. Friedman the following. Would you advise your year-old patient to accept a or year-old, when the insurance company of this patient is saying, we can get you to India tomorrow, and we can have a twen—. We can get you to Manila tomorrow, and we can have a year-old kidney for you. If the alternative is that the patient could go out of country for a year-old, versus your market system that will only provide the or year-old, what would you advise.
Your patient. Is this patient going out of country, is the patient going out of country or not? Okay, Lloyd, you get a chance to ask a question. Now, unlike the other participants in this debate, I'm not a good and generous person. I posted this on my web page, and other people have downloaded it and amended their wills accordingly. Now, I ask you, Dr. Pangloss, I'm sorry, I mean Dr.
Delmonico… [LAUGHTER] Is your objection to my estate profiting from the salvaging of my organs so strong that you think it just and right to threaten innocent sick people with prison for purchasing my organ? Is there some great ethical principle that I do not understand under which the sick should be condemned to die rather than obtain organs from the self-interested and even selfish? They won't want your organs, Lloyd. They're going to go to Manila for the twenty year old. Well, yes it is an answer.
The answer is that they're going to be in a position when you have legalized markets to say, who wants your organs in your circumstance when I can go to Manila to buy one from a twenty year old? We can do that now.
I can go to Manila now, so I don't see why having a mechanism where organs can be compensated for by a third party makes any difference at all. And the rich people will, why should we stay here? Okay, we can ping pong on this back and forth. David, you have one last shot at asking a question. Oh really? Let me pick Sally, because if I recall correctly, some of your affiliation is with a group that doesn't like all kinds of regulations that some of us do like. Your think tank is not known for its pro-regulatory system.
DAVID ROTHMAN Given what we know about Enron, given what we know about mortgage, works, given what we know, at least according to some, about the way hedge funds work, given these examples, what makes you confident that a regulatory system where everyone could enter the market could possibly work? Everything we know about regulation suggests that this would be a disaster, and to move us to a regu-, to count on regulation as you do, as Amy did earlier, you're out of your league. Now, the kind of system I have in mind, really is a straw man I think you guys keep setting up, we are not talking about a classic commercial free for all, or a free market, or an eBay system.
For example, today you, Ira, could decide to give a kidney. And they would do it. Everything else is the same, the, the screening you go through, the same medical check up, everything. IRA FLATOW Okay, we now have time for question and answers from the audience, and please make your way out to the microphone, or have the microphone meet you, or a meeting of minds some place in the middle of the aisle.
Go ahead, you can stop there and ask, go ahead. Technology problem with the mic, is it working? All right, go ahead. By disclosure, I was a transplant surgeon at the University of Pittsburgh for twenty years, and now at the Cleveland Clinic. During my years at the Cleveland Clinic, at the University of Pittsburgh I was fortunate to have been involved in the care of Robert Casey, who was then the Governor of Pennsylvania, having been part of the team that had performed a combined heart and liver transplant on him.
And shortly after his transplant he met the family of the donor. And as it turns out, to maybe, perhaps the audience doesn't realize, is that, funeral directors charge an additional amount on top of the costs of the preparation for the body on the order of about three hundred dollars because of the donation process. And so Governor Casey at the time, along with some of the transplant procurement centers in the state, came up with Act , which provided the opportunity for citizens of Pennsylvania to donate a dollar as part of their annual tax— IRA FLATOW.
JOHN FUNG So the question, all right, and anyway, the three hundred dollars that was assigned to be allowed to pay for these funeral expenses was never implemented, even though it was approved by the state legislature, and the reason was because we didn't, it was thought to be against the federal regulations, the National Organ Transplant Act. So I think one of the comments for the pro side of this is, why not allow a pilot study? You made your point, thank you. Any comments? Why not allow, why not allow a pilot study to see how…?
Fung was just alluding to didn't trouble a lot of folks. Not heaven, huh? Oh, I'm sorry. We have to give them equal time now. But I can't emphasize enough that the excitement and the interest and the concern about this issue doesn't come from the, you know, the couple of hundred bucks in the cadaver world— IRA FLATOW David, I have to get to the question, and that was, why not give it a try?
Okay, Frank, what--would you be willing to give something a try, or anything that they, some, some form of it? This crowd wouldn't be here if we were debating three hundred bucks for burial expenses.
Why not do an experiment, because so much of what we have said today, on both sides, is actually a matter of speculation. Clearly if forty thousand people die every year waiting for these, waiting unsuccessfully for kidneys, and seventy-five thousand suffer on dialysis and lose their strength waiting for kidneys, then the current system is not working despite what James Childress says.
Now you pointed out before that there may be some long term consequences to donors, but the number that always appears in literature is that only point oh three percent of donors die as a result, in the long term or even in the short term, of donating a kidney. So, it sounds like a very safe thing to do. Why aren't the major advocacy organizations doing more pilot research to assess whether there are any long terms risks, and also doing research on what types of compensation systems would mitigate some of the objections raised by the other side?
I'm amazed that the advocacy organizations have adopted such a do nothing position. And finally, let me just ask Dr. Right now we can have a donor who has no medical insurance whatsoever come and donate a kidney because the recipients insurance pays for it, but we have no mechanism after they get through the early post-operative period to pay for their care.
And that's a part of what would need to be in a regulated system. And thank you very much, all of the advocacy organizations, the American Society of Transplant Surgeons, the American Society of Transplantation, the government, and everybody at this table, on both sides, very much agrees that we need to capture the information about donors, we just can't afford to, and in the absence of universal health care or a single system, we can't do it because they just escape, we can't track them.
Frank, did you want to respond? Four thousand people dying on the list, forty percent of the people who are dying are not in need of kidneys. They would not, the market system would not affect them by having more organs available, because you can't buy a heart, you can't, unless you're in Egypt you can't buy a liver, you can't buy a lung. One of the problems of the proposal is that, and David brought this up, the assumption that those patients would still have a cadre of deceased organs available.
But that experiment has been done in Hong Kong and in other places. When you have markets, there is no, the deceased donation is negatively impacted. So, right away, when you say four thousand people are dying on the list, not quite, but almost half are dying in need of organs that he market system will not impact. Now, next, on the kidney front, of those that are dying, we need to make an assessment of why they're dying, and whether or not that is simply because they have not received an organ.
Some of the patients that are dying on the list have been on that list for an extended period of time, inactive. And this was a point that we didn't get an opportunity to discuss. Inactive means that you do not receive an offer for a kidney.
The market system will not impact an individual that is inactive on the list. Currently, thirty-three percent of the list, waiting for kidneys, twenty-four thousand patients are inactive on the list. That needs to be evaluated further before we go down the road of a market, we better assess the wait list of the premise to have markets.
I have never said that our current system. I think we have a good system, not yet a great system, and I think we need to do a lot more to improve it, and I think we can do so. If we can't afford to do that, then we cannot afford to do what we need to do to make a market in living vendors and sellers for kidneys work.
We cannot, I would argue, destroy, we should not, I would argue, damage or destroy our system, which is not working as well as it should, and we need to improve, by adopting a flawed market in organs. Sally, you have two minutes. And this is why we need to compensate donors. Altruism, or whatever is in that area between being paid and giving an organ is not enough. And insisting that it remain the basis for transplant policy is a reckless and derelict stance that will only guarantee a future of suffering, and not just for the patients, but for, who will languish and die on dialysis, but for black market donors as well.
Our opponents hate the black market, well so do we. But somehow we learned something they never did, that the only way to stop elicit transactions is to sanction legal ones. Simply clamping down on elicit sales only drives it further underground, or causes it to blossom somewhere else, and the only way out of this tragic bind is to increase the supply. And the only way to do that is through a fair, transparent, safe, and legal means of exchange.
Until then, the fate of third world donors and the patients who need their organs to live will remain tragically entwined. And until then, our opponents, who refuse to allow even experimentation with compensation, will be complicit, yes complicit, in fostering the organ trade. In closing, unless we establish a legal market for kidneys in some form, we should brace ourselves for more needless suffering and death.
Our side refuses to stand for that. So should you. If you're dying in need of a heart, you can't buy a heart. Next, a dearth of creative ideas? Sally and I have met on a number of occasions to talk about what we can do differently to provide care for live donors that does not exist in this country, but is not a cash payment.
When Amy says you can't go out of the country, and Sally says, well, you can go right now out of the country. She could have gone, and they do go. And where are they going? And why wouldn't they go? Sorry, Ira. Moving on to the for side, Amy Friedman. Been there, done that. We have no intention of stopping efforts to increase the number of deceased donor organs.
This does not, in any way, affect those efforts. We can't afford independently, as transplant centers, or independent societies of transplant surgeons for example, to follow these live donors. What we propose is the only solution to closing the dangerous black market. We propose an approach that preserves the rights of donors, and compensates them for the risks they do assume.
Isn't that treating them in a most dignified manner? This is supposedly an academic debate, and David even called it an exercise, but the ninety-nine thousand people currently waiting for organs, who are there for so long that they become inactive because they're too sick to get the transplant then, need real solutions, and they need you and us to be willing to think out of the box. Your two minutes. Well, some quick principles. First, beware of doctors who play regulators and economists.
Why not have immigrants do it? Sally came out with a formulation which those of us in New York are a little scared about. The only way to stamp out illicit behavior is to legalize it. You want to do the poor a favor, start thinking in terms of economic development, watch what China did, watch what India is in the process of doing. Massive infusions of capital, growth, real change.
You want to do something for the poor, do it in a real way, spur economic development. Finally, you're not doing the middle class any favor here either. So much pernicious, pretentious foolishness to refute, so little time.
I was at first, and then it became clear. The prospect of an effective organ market places our opponents behind the eight ball. A market that would recover vital organs now being fed to worms would be the salvation of thousands of patients. As against the saving of innocent lives, poetic statements about the dignity of human life being degraded by commercialism would be revealed as empty moral pieties.
Our opponents would therefore prefer to believe that a market would not work, and demand that we must prove that it will. The obvious way to demonstrate the efficacy of a market is to permit one, but of course the law forbids that. So what other evidence or theory can I offer? First, consider the thriving organ markets in living donors in places like India. A market in the US where the interest of donors would be safeguarded by American law would, of course, be much more successful.
And what does the success of living donor markets say about a market in cadaver organs? The sacrifice is incomparably greater for the living donor than for the deceased, so the supply of deceased donors will be far more responsive to a positive price. Second, look to the very reason that our opponents have such faith in the efficacy of altruism, and at the same time restrict its required application to organs rather than extend it to surgical services, nursing, and hospital care.
They believe that altruism should work for transplant organs, because they are of no value to the dead, and of enormous value to the ill. Whatever this vast disparity should say about the power of altruism, it speaks volumes in the world of markets.
Everywhere we look markets move goods from low valued uses to high valued ones. If you are against the motion, press two. And if you're still undecided, press three. And while you're doing that I would like to take this opportunity to thank all of our debaters up front here. Lloyd Cohen, professor of law at George Mason University. Francis Delmonico, professor of surgery at Harvard Medical School, and director of medical affairs for the Transplantation Society. And finally, David Rothman, professor of social medicine, and director of the Center on Medicine as a Profession at Columbia.
This is the last debate of the second Intelligence Squared US series. This program has been a huge success because of the support of people like you out there in the audience, audience members like yourselves who have been very enthusiastic about hearing both sides of big issues, and great issues they are, arguments that are brought here in all the series debates that have been hosted.
Intelligence Squared would also like to thank the Asia Society and Museum for being our venue, right here in this beautiful auditorium, thank you from the very beginning.
And as many of you already knew, due to the overwhelming success, and the demand for tickets, they're going to be moving out of this auditorium and into a bigger place. Intelligence Squared is going to resume in the fall at the larger Caspary Auditorium at Rockefeller University. You know that big building that looks like the geodesic dome there at the Caspary Auditorium? And that first debate is going to be on Tuesday, September 16th.
An email alert and a brochure is going to be coming out in the coming weeks, so you're not going to be able to avoid that. You can check the website also for updates. These debates are also heard on more than a hundred and fifty NPR member stations, and of course, as they say, please check your local member station listings for the dates and times outside of New York City. And now here is the result of the final polling. Before the debate we had forty-four percent for the resolution, after the debate we have sixty percent.
Against, against the debate, before we had twenty-seven percent, and it moved up just four points to thirty-one percent against. But it was the, of course, the undecideds who decided this, from twenty-nine percent to nine percent, a twenty point move. So we had sixty percent for, thirty-one percent against, nine percent undecided. Download PDF. Live Audience.
Online Audience. Against The Motion. Change in voter behavior. For The Motion. July 07, May 05,
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