Organs don’t work like drugs; allowing sale would greatly encourage smugglers. This would lead to organ theft. Families could also pressure people who don’t earn enough to sell their organs.
It seems to me that the differences between drugs and organs make organ sale easier to regulate. Surgical operations already have plenty of paperwork and administrative oversight (by the government and insurance companies). And patients probably care more about where the organ came from than they do for drugs.
Emile’s counterpoint makes me undecided on whether to believe you without some kind of evidence or citation. What you say rings true but my intuitions with respect to organ theft are pretty bad.
There are ways of preventing theft if you have oversight. The only way to avoid oversight is to do it on the black market, which will be much harder when you have to compete against a legal market.
Families could also pressure people who don’t earn enough to sell their organs.
Maybe the majority of people who sell organs will be idiots who really shouldn’t at that price, but it’s better than not doing it at all.
You could put a price floor on it, although then idiots who don’t need them as much would start selling them, and there’d be costs with all the people waiting in line to sell. Subsidies wouldn’t work at all, since they’d pretty much end up going to the people buying the organs.
It’s unlikely there would be end-to-end oversight. Legal organ harvesters would probably not get looked at very closely (not enough money for inspection) and could easily pass off stolen organ as legitimately bought ones.
I disagree with your characterization of pressured people as idiots. “You aren’t bringing home the bacon and you have poor marriage prospects, so you’d better sell a kidney, or I’ll kick you out of the house” is not idiocy. But that’s not really the point.
I don’t see at all how a price floor helps with that.
It’s unlikely there would be end-to-end oversight.
Why not? It’s outright illegal in every country except one. I would expect it to be heavily regulated if it is ever allowed. If there are problems with stolen organs, they would definitely start regulating it.
Also, I haven’t seen anything saying that this is a problem in Iran. I read it has been a problem in India, so they made it illegal. It’s not the same as regulating, but it shows that they won’t allow that sort of thing to happen.
I disagree with your characterization of pressured people as idiots.
I just mean people selling their kidneys when it hurts them. “Idiots” meaning acting irrationally, not necessarily stupider than average.
I guess it’s possible for it to happen like you describe so that they have an additional incentive to sell, in a bad way. I don’t think that’s likely to happen.
I don’t see at all how a price floor helps with that.
It makes it more likely that it actually will be worth while for them. If it’s never worth while to sell your kidney for below $x, then setting a price floor above $x would at least mean that some of the people selling their kidneys would benefit.
This policy is plausibly superior to the status quo, but I’m not convinced it is the best available alternative. Can you tell me why you think this would be a better way of doing things than, say, mandating organ donation upon brain-death?
Empirically, opt-in vs opt-out doesn’t matter. Kieran Healy writes about this extensively. I think he discusses other things that actually have resulted in large changes in Spain and Italy in this paper. This time series is nice.
One relevant fact is the in virtually all jurisdictions, the heirs can and usually do veto donation. [Edit: Actually, just one of many obstacles, probably a small effect. I forget why I included it.]
One thing that makes the OP a better idea than yours is that no way in a million years (this is hyperbole) will any US political system ever adopt mandatory organ donation.
However just making it opt-out instead of opt-in as suggested by antisuji below seems like it would capture 80-90% of the benefit (wild guess) with 5-10% of the political fallout (another wild guess).
I mostly mean the organs you donate while still alive.
In the case of the organs you can’t live without, it’s pretty much the whole free market thing. It will create incentive for people who want to be able to keep their organs when they die. There’s no more reason to take their organs when they die than there is to take their money and spend it on saving lives.
I’m not entirely convinced that this is the best either. I don’t know how much incentive people really get from stuff that happens after they die. Perhaps it should at least be encouraged with fees to keep your organs, or subsidies to sell them.
You know, it would probably be possible to benefit from your organs’ value while you’re alive. Sign a contract to agree to be organ-harvested after your death, and get a stipend for the average estimated value of your cadaver, today! Free money, from your perspective. You could get more if you contractually agreed not to smoke or take certain dangerous jobs.
You know, it would probably be possible to benefit from your organs’ value while you’re alive. Sign a contract to agree to be organ-harvested after your death, and get a stipend for the average estimated value of your cadaver, today! Free money, from your perspective. You could get more if you contractually agreed not to smoke or take certain dangerous jobs.
That’s a brilliant idea and it is a travesty that it isn’t in place now. (The whole “moral hazard” thing would need to be solved but there are ways to solve it.)
Certainly, but loss-of-autonomy has a cost associated with it, in my utility ordering, at any rate. I think it’s best to allow people to do what they want with their bodies. Creating incentives is far less intrusive, in terms of personal freedom, than forcing a single course of action on everyone. Besides which, leaving aside the provisional issue at hand, I don’t like to think too hard about the legal implications of deciding that people don’t own their bodies and brains.
There’s no more reason to take their organs when they die than there is to take their money and spend it on saving lives.
If people were routinely burning all their assets when they died, preventing anyone from getting any use out of them, I think I would be in favor of a policy that mandated the donation of the property for life-saving purposes. In the property case, one could at least make the argument that mandating redistribution after death would disincentivize people from working hard during their lifetimes. I don’t see a similar disincentive associated with mandatory redistribution of organs after death.
I’m pretty convinced that mandatory organ donation upon brain-death is an unmitigated good thing. Are there any sound arguments against it, besides the pragmatic difficulty of selling the policy to people? So the important question for me is: Should we institute an organ market for living donors in addition to requiring donation upon death? There are costs to the organ market, as has been pointed out in the comments. Also, an organ sold by a living donor is one less organ harvested from a cadaver, so an organ market wouldn’t increase the number of organs available for transplant in the long term. It would skew the allocation of available organs towards the wealthy, which raises equity concerns.
The big advantage to the organ market that I see is that it allows for better matching of donors and patients. My understanding is that harvested organs can’t be stored for more than a few days, so if an organ is harvested from a cadaver it might go to waste because of the lack of suitable patients in the (spatial or temporal) vicinity of the donor. If there were an organ market, some organs which would otherwise be wasted in this way would in fact get transplanted. I guess my view on the organ market would hinge on the extent of to which it would mitigate this kind of waste, and that’s an empirical question. If anyone knows of data pertinent to this question, I’d be interested in hearing about it.
Thanks! I was not in fact aware of that. I actually thought about the cryonics objection when I was writing that comment, but I figured neuropreservation would not be a problem. Looks like I was wrong. I probably should have tried harder to follow up on my initial suspicion rather than dismissing it.
If people were routinely burning all their assets when they died, preventing anyone from getting any use out of them, I think I would be in favor of a policy that mandated the donation of the property for life-saving purposes.
But they are making use of their organs. I don’t know why they consider burying them important, but it’s not my place to judge. It might not make them nearly as happy as it would the recipient, but the same can be said of them spending money on luxury when there are people who have trouble meeting their basic needs.
Also, an organ sold by a living donor is one less organ harvested from a cadaver, so an organ market wouldn’t increase the number of organs available for transplant in the long term.
Yes it would. To my knowledge, it’s pretty rare for people to die in a condition where their organs can still be used.
If there were an organ market, some organs which would otherwise be wasted in this way would in fact get transplanted.
I wonder how that would work. Would they move people who need organs to hospitals where people who match them are dying? Why couldn’t they do that now? Perhaps they can, and just don’t because there’s no money in it and it seems really tasteless.
But they are making use of their organs. I don’t know why they consider burying them important, but it’s not my place to judge. It might not make them nearly as happy as it would the recipient, but the same can be said of them spending money on luxury when there are people who have trouble meeting their basic needs.
You are probably much more libertarian than I am. I don’t buy the strong self-ownership assumption that undergirds many libertarian arguments. I think it is within a government’s legitimate sphere of power to legislate against sufficiently widespread wastage of important resources, even if those resources are legally acquired by their owner. If a crazed billionaire began buying up all the silicon in the world in order to bury it on the moon, I think the government should step in to prevent this from happening. When the relevant resource is literally a part of the owner the government should err on the side of liberty, but there can still be cases of waste egregious enough to warrant intervention, and the widespread burial of transplantable organs is sufficiently egregious.
Yes it would. To my knowledge, it’s pretty rare for people to die in a condition where their organs can still be used.
Ah, I didn’t know this. If this is the case, then there is good reason to encourage living people to give up their organs.
I wonder how that would work. Would they move people who need organs to hospitals where people who match them are dying?
I was thinking more about living donors. An organ market would encourage some people to sell their organs while they were alive. Unless something goes really wrong, these organs are presumably going to end up transplanted. If all of those people waited until they were dead, some fraction of those organs would be wasted, either because their former owners died in a way that renders the organ usable, or simply because the organ could not be transported to a suitable recipient in time.
I think it is within a government’s legitimate sphere of power to legislate against sufficiently widespread wastage of important resources, even if those resources are legally acquired by their owner.
The problem is, once you get past the poverty line, additional money doesn’t make you all that much happier. If you’re well past it, anything you do with your money is wasting it. If you stop them from wasting it, you’re just stopping them from earning much money. You’ll destroy incentives. There’s no reason to stop them from wasting resources in one way if it just means that they’ll waste them in another.
We don’t have to choose between the extremes of allowing people to do whatever they want with their resources (as long as they don’t use them to directly harm people) or legislating against any socially suboptimal usage of resources. I think people should have quite a bit of freedom to use their resources the way they want, precisely because we don’t want to disincentivize people from working, and also because a government that is constantly monitoring its citizens to ensure socially optimal resource usage would be unbearably intrusive. But I also think there are cases where the benefits of government intervention outweigh these costs.
Where exactly to draw the line is a difficult question, and there are a number of cases where I’m unsure whether a government mandate is advisable. However, there are also cases that are clearly on one side or another of the line. Banning all luxury consumption, for instance, is definitely a bad idea. I also think its pretty clear that mandating organ donation (perhaps with a religious exemption clause) is a good idea. In this case, the costs aren’t that great. I can’t see any disincentivization of productive behavior, and the additional intrusiveness required to adequately enforce the policy does not seem all that burdensome. And by all accounts the social benefits would be quite significant.
Since the government is hardly going to do the best possible thing with our money, my last comment was vastly exaggerated.
Even so, I don’t think people are generally expected to help others with their money. If they manage to do something particularly wasteful, you can tax them for it to make up for it.
I generally prefer the idea of subsidizing the stuff that does help people, but it works out the same if you add a tiny change in how you do income taxes.
Consider someone who is deciding whether to donate their money to Seeing Eye or use it to dig ditches and then fill them. Seeing Eye is less than 0.05% as effective as the Fred Hollows Foundation, so the difference in social optimality is less than 0.05% of what it could do.
This means that if they dig ditches and then fill them, they are less than 0.05% more wasteful than if they donate to Seeing Eye. Why not just move the line by 0.05%, and let them do whatever they want? You can just tax them an additional 0.05% to make up for it, and they’ll still end up with more incentive. For that matter, you’d probably save enough money on not bothering with regulation to make up for it.
It seems like digging ditches and then filling them is infinitely more wasteful than donating to Seeing Eye, since it makes an infinitely smaller difference, but that’s not really how it works. The difference is so small it’s lost in rounding.
i disagree with the kind of analysis you’re doing here. Just because a difference is a small percentage of the maximal possible difference does not mean it is a small difference. Suppose you have three mutually exclusive actions available to you: A—play video games all day, B—put in a small amount of effort that will ensure that malaria is eliminated, C—put in a moderate amount of effort that will ensure that everyone in the world lives forever without sickness or deprivation. As a percentage of what you could accomplish by doing C, the difference between doing A and doing B is negligible. But it seems absurd to say that the difference between doing A and doing B is so small that it doesn’t really matter. Sure, it’s small as a percentage, but it’s still a massive difference.
Of course, it still might be the case (in fact, it probably is the case) that in your particular example, the cost of intervention outweighs its benefits. But I have already granted that this is often the case. If your example was meant to provide a general argument against any government regulation of resource usage, I don’t see how it works.
Instead of discussing hypotheticals, why not talk about the actual policy under consideration: Do you think that the cost of a mandatory organ donation policy plausibly outweighs its benefits? If you don’t, do you have other non-consequentialist grounds for opposing the policy?
It doesn’t matter because you could add a rediculously tiny tax to make up the difference.
Also, I think it’s generally a good idea to give taxes and subsidies to get rid of externalities. If this is done correctly, it makes no difference at all how you spend your money.
Meta: Reading through this thread was pleasant and rewarding. I feel like I learned as much about the practical ethics of organ donation in ten minutes here as I would from an ordinary two-hour-long argument in real life, and I feel a lot better now than I’d feel after a two-hour-long argument.
Meta: Is the OP really a political position? The mere fact that the resulting comment thread is highly informative and not contentious at all makes me doubt it...
More precisely, it seems to me that a majority of participants here share values, e.g., saving lives is more important than almost anything else. Most of the refutations of arguments against the OPs position are about updating the map to match the territory. Nobody’s arguing about what course one ought to set through the territory per se.
Consider the contrast between these comments and the abortion debate in the US. I think the essence of the latter is a disagreement about the absolute and relative moral statuses of and rights due to fully grown humans and potential people. I expect it would continue to exist even if everyone agreed on the pertinent biological and medical facts of the matter.
Consider the contrast between these comments and the abortion debate in the US. I think the essence of the latter is a disagreement about the absolute and relative moral statuses of and rights due to fully grown humans and potential people. I expect it would continue to exist even if everyone agreed on the pertinent biological and medical facts of the matter.
I doubt that this is a descriptively accurate characterization of the debate. I’m guessing a majority of the most committed pro-life activists aren’t motivated by a concern for potential people; they actually believe a foetus is a person, not just potentially a person. A number of Christian denominations preach that ensoulment occurs at conception, and that personhood (in the moral sense) is associated with ensoulment. If everyone agreed on the pertinent biological facts—one of which is that there is no such thing as a soul—this justification would no longer work.
I’m guessing a majority of the most committed pro-life activists aren’t motivated by a concern for potential people; they actually believe a foetus is a person, not just potentially a person.
Thanks for catching this. The words “person” and “potential person” were just intended to be labels, but I ended up unintentionally sneaking in connotations. Let’s imagine that in my counterfactual situation no one is doing that either intentionally or unintentionally.
one [pertinent biological fact] is that there is no such thing as a soul
I don’t disagree, but I do think religious people might claim something similar to, “even though the soul is not a physical thing, it still exists in the sight of God”.
Yes. If they thought the utility gained by making potential persons into actual ones, was greater than the negative utility to women who become unwilling mothers (would abort if they could), then they would support forcing all women to be constantly pregnant.
More precisely, it seems to me that a majority of participants here share values
That’s necessary for any disagreement we could have a real discussion about. I’ve gotten into political arguments with people with similar values. I’m largely libertarian, not because I believe in individual rights, but because I believe that it’s what produces the most happiness. There are plenty of people who are socialist, not because they value equality, but because they believe that it’s what produces the most happiness.
Consider the contrast between these comments and the abortion debate in the US. I think the essence of the latter is a disagreement about the absolute and relative moral statuses of and rights due to fully grown humans and potential people. I expect it would continue to exist even if everyone agreed on the pertinent biological and medical facts of the matter.
I think the abortion “debate” is a Blue vs Green, Arguments as Soldiers issue. Pro- or anti-abortion doesn’t follow logically from other positions held by each party. Counterfactually, if the two US parties had chosen different positions on abortion due to some historic accident, then I would expect their electorate to still support each party along current divisions.
I think the abortion “debate” is a Blue vs Green, Arguments as Soldiers issue.
I agree. That’s why I set up my counterfactual.
Counterfactually, if the two US parties had chosen different positions on abortion due to some historic accident, then I would expect their electorate to still support each party along current divisions.
I have the contrary expectation—I can’t conceive of a historical accident that would swap the parties’ positions on abortion without also swapping their respective bases.
Agreed. But I also think that the government should buy some of those organs at market value (Edit: they could negotiate for better prices like any other large buyer, but not force any supplier to sell), to be distributed according to the current system. (But then, I’m for socialized medicine in general, since it appears to be more efficient: countries with socialized medicine achieving better outcomes at lower costs.)
How would that work? You have an option to either buy a kidney or wait in line and hope for the best? If your insurance doesn’t cover kidneys, you wait for a government one?
I think it would be a lot better if the government finds the people that likely would end up waiting in line (like the people on medicare or medicaid) and just buy them organs immediately. Either that or just buy them for everyone.
The organ market is legal in Iran, and there are indeed enough for everyone, including some people from other countries who came there just for the organs.
At least, for kidneys and stuff. I’m not even sure if you’re allowed to sell stuff like your heart when you die there. From what I understand, even if you mandated everyone give away their heart, there still wouldn’t be enough since it’s rarely an option. In those cases, I suspect there will still be a significant increase. Also, it makes it so that people have more of an incentive to work hard so that they can afford health insurance that will pay for those organs. If you’re going to have inequality anyway, you might as well take advantage of it.
If you need a kidney, you find someone who has an extra, and you buy theirs. Also, you can opt to sell your organs when you die, instead of just donating them.
This scenario provides several strong incentives for unscrupulous agents to harvest people’s organs without asking for permission (in addition to any existing incentives that may exist in our current society). Thus, I believe that the total utility of legalizing the organ market (as I currently understand it) would be highly negative.
If that becomes a problem, have the government check to make sure that the people who are listed as selling kidneys both gave permission (preventing people from just harvesting without telling you) and is actually missing the organ (preventing people from claiming they gave an organ that was harvested from someone else). The only other option is for the entire operation to be off the books. This would be prevented the same way it is now, along with the fact that people are less likely to buy organs on the black market if there’s a legal option.
Also, even if that was the only way the organ market worked, for every organ stolen there’d be a life saved. It seems like it would still be positive unless they actually killed the people they were taking organs from, and even then only if they only took one organ each. How could it be highly negative?
If that becomes a problem, have the government check to make sure that the people who are listed as selling kidneys both gave permission...
How would the government achieve this in practice ? For example, let’s say there’s a demand for livers this month. How would the government know whether the liver A for patient B came from a legitimate donor, some unfortunate homeless person within our country who was robbed of his liver against his will, or from some foreign national who lives in one of those totalitarian and/or lawless countries where human life isn’t worth much ?
Furthermore, let’s say that people could sell their organs after they die—by proxy, presumably—as per your scenario above. Doesn’t this create a powerful incentive for unscrupulous agents to speed their demise ?
Also, even if that was the only way the organ market worked, for every organ stolen there’d be a life saved.
I don’t think this is true. Firstly, organ transplant procedures do not have a 100% success rate, due to rejection issues, surgery complications, etc. Secondly, what do you mean by “a life saved” ? All lives will end eventually. Would it be worthwhile to shorten someone’s life by, say, 10 years (due to their loss of a kidney), in order to grant someone else 5 extra years of life (by using that kidney) ?
How would the government know whether the liver A for patient B came from a legitimate donor, some unfortunate homeless person within our country who was robbed of his liver against his will, or from some foreign national who lives in one of those totalitarian and/or lawless countries where human life isn’t worth much ?
If it didn’t come from a legitimate donor, either the doctor has to explain why he didn’t say who the donor was, why the donor doesn’t know about it, or why the “donor” still has a whole liver.
As for the foreign country, just don’t accept organs shipped across national lines if the other nation doesn’t check the stuff. I suspect it’s a bad idea to ship organs across national lines anyway, as opposed to just shipping the donor, but I don’t really know all that much about how organ donation works.
Would it be worthwhile to shorten someone’s life by, say, 10 years (due to their loss of a kidney), in order to grant someone else 5 extra years of life (by using that kidney) ?
No, but I’m willing to bet that’s not what the ratio will be. If losing an organ hurt you more than it helped the person getting it, nobody would ever consider donating them.
Edit:
Furthermore, let’s say that people could sell their organs after they die—by proxy, presumably—as per your scenario above. Doesn’t this create a powerful incentive for unscrupulous agents to speed their demise ?
You mean their next of kin? I don’t see how it’s much more of an incentive than it would be to kill them just for the inheritance. Also, I suspect that the health insurance company would normally take the money, since most people aren’t going to be in a position to donate their organs and people tend to be loss-averse.
Organ transplantation costs tens to hundreds of thousands of dollars, including the costs of doctors, hospital time for recovery, drugs, etc. Paying less than $5,000 for a legal kidney (at prices in Iran), or even $25,000 in rich countries with more expensive surgical staff, makes for a trivial portion of the overall cost of the operation. Why make the whole operation illegal (making it hard to advertise, recruit employees and customers, avoid imprisonment, etc) by not using voluntary donors to reduce costs by a few percent?
Consider that the surgeons make up a much larger portion of the cost. Should we fear that legalizing organ transplantation will drive a criminal industry kidnapping and enslaving surgeons to perform organ transplants? We don’t see such an industry for coronary bypass operations, so we shouldn’t expect it for organs.
It’s likely an international organ market would move organs from poor countries to rich ones. This would create great resentment in poor countries, while not being that huge a source of revenue.
This would create great resentment in poor countries, while not being that huge a source of revenue.
That seems odd. They don’t have to sell their organs to foreigners. You could make laws about only doing it within the country. I’d be against that, for much the same reasons as I’m against all protectionist policies.
That seems odd. They don’t have to sell their organs to foreigners.
Perhaps it would be odd for the particular people who are selling their organs to feel resentment. But it doesn’t seem all that odd if people in poor countries who need organ transplants feel resentful that the organs which would otherwise be harvested from cadavers and given to them are instead being bought up by rich foreigners.
The big supply change from organ markets is incentivizing things like kidney or marrow donations from living donors. Those donations would not be made otherwise (and the overwhelming majority of organs of the dead are of far worse quality, since people tend to be old and sick when they die, and sudden causes of death like car accidents have a tendency to wreck the body).
In places where getting a $25 microloan is a big competitive advantage, a $5000 organ donation would be absolutely disruptive (according to this article kidneys go for anywhere from $20,000 to hundreds of thousands depending on country). If you were an entrepreneur in such a country you would basically never be able to compete with anyone else who donated organs without donating one yourself. That could definitely cause a lot of resentment.
In places where getting a $25 microloan is a big competitive advantage
I think this is an exaggeration. The severely poor are demarcated as earning less than $1 per day.
There are many millions of migrant workers from poor countries working in richer countries, e.g. Somalian taxi drivers in New York, Bangladeshi janitors in Dubai, and so forth. They make many thousands of dollars per year. They send remittances, and sometimes come home. This doesn’t seem to cause terrible resentments or anger. Rather, the money significantly boosts the standard of living back home, allowing the purchase of more imports and raising wages for local workers (paid out of the remittances and by the returnees).
I think the organ market should be legal. The arguments against it are far to weak to justify so many people dying.
Organs don’t work like drugs; allowing sale would greatly encourage smugglers. This would lead to organ theft. Families could also pressure people who don’t earn enough to sell their organs.
It seems to me that the differences between drugs and organs make organ sale easier to regulate. Surgical operations already have plenty of paperwork and administrative oversight (by the government and insurance companies). And patients probably care more about where the organ came from than they do for drugs.
Emile’s counterpoint makes me undecided on whether to believe you without some kind of evidence or citation. What you say rings true but my intuitions with respect to organ theft are pretty bad.
There are ways of preventing theft if you have oversight. The only way to avoid oversight is to do it on the black market, which will be much harder when you have to compete against a legal market.
Maybe the majority of people who sell organs will be idiots who really shouldn’t at that price, but it’s better than not doing it at all.
You could put a price floor on it, although then idiots who don’t need them as much would start selling them, and there’d be costs with all the people waiting in line to sell. Subsidies wouldn’t work at all, since they’d pretty much end up going to the people buying the organs.
It’s unlikely there would be end-to-end oversight. Legal organ harvesters would probably not get looked at very closely (not enough money for inspection) and could easily pass off stolen organ as legitimately bought ones.
I disagree with your characterization of pressured people as idiots. “You aren’t bringing home the bacon and you have poor marriage prospects, so you’d better sell a kidney, or I’ll kick you out of the house” is not idiocy. But that’s not really the point.
I don’t see at all how a price floor helps with that.
Why not? It’s outright illegal in every country except one. I would expect it to be heavily regulated if it is ever allowed. If there are problems with stolen organs, they would definitely start regulating it.
Also, I haven’t seen anything saying that this is a problem in Iran. I read it has been a problem in India, so they made it illegal. It’s not the same as regulating, but it shows that they won’t allow that sort of thing to happen.
I just mean people selling their kidneys when it hurts them. “Idiots” meaning acting irrationally, not necessarily stupider than average.
I guess it’s possible for it to happen like you describe so that they have an additional incentive to sell, in a bad way. I don’t think that’s likely to happen.
It makes it more likely that it actually will be worth while for them. If it’s never worth while to sell your kidney for below $x, then setting a price floor above $x would at least mean that some of the people selling their kidneys would benefit.
So tax organ sales enough to pay for the inspection costs.
This policy is plausibly superior to the status quo, but I’m not convinced it is the best available alternative. Can you tell me why you think this would be a better way of doing things than, say, mandating organ donation upon brain-death?
Or, for that matter, making organ donation opt out rather than opt in.
Empirically, opt-in vs opt-out doesn’t matter. Kieran Healy writes about this extensively. I think he discusses other things that actually have resulted in large changes in Spain and Italy in this paper. This time series is nice.
One relevant fact is the in virtually all jurisdictions, the heirs can and usually do veto donation. [Edit: Actually, just one of many obstacles, probably a small effect. I forget why I included it.]
In the United States it’s kind of neither. When you get an id card there is a yes/no checkbox you need to check.
It already is in Italy (and I’d guess in much of the rest of the EU too).
One thing that makes the OP a better idea than yours is that no way in a million years (this is hyperbole) will any US political system ever adopt mandatory organ donation.
However just making it opt-out instead of opt-in as suggested by antisuji below seems like it would capture 80-90% of the benefit (wild guess) with 5-10% of the political fallout (another wild guess).
I mostly mean the organs you donate while still alive.
In the case of the organs you can’t live without, it’s pretty much the whole free market thing. It will create incentive for people who want to be able to keep their organs when they die. There’s no more reason to take their organs when they die than there is to take their money and spend it on saving lives.
I’m not entirely convinced that this is the best either. I don’t know how much incentive people really get from stuff that happens after they die. Perhaps it should at least be encouraged with fees to keep your organs, or subsidies to sell them.
You know, it would probably be possible to benefit from your organs’ value while you’re alive. Sign a contract to agree to be organ-harvested after your death, and get a stipend for the average estimated value of your cadaver, today! Free money, from your perspective. You could get more if you contractually agreed not to smoke or take certain dangerous jobs.
That’s a brilliant idea and it is a travesty that it isn’t in place now. (The whole “moral hazard” thing would need to be solved but there are ways to solve it.)
That has a pretty similar result as the government forcing you to donate and slight change in the tax system.
That part would be useful.
Certainly, but loss-of-autonomy has a cost associated with it, in my utility ordering, at any rate. I think it’s best to allow people to do what they want with their bodies. Creating incentives is far less intrusive, in terms of personal freedom, than forcing a single course of action on everyone. Besides which, leaving aside the provisional issue at hand, I don’t like to think too hard about the legal implications of deciding that people don’t own their bodies and brains.
If people were routinely burning all their assets when they died, preventing anyone from getting any use out of them, I think I would be in favor of a policy that mandated the donation of the property for life-saving purposes. In the property case, one could at least make the argument that mandating redistribution after death would disincentivize people from working hard during their lifetimes. I don’t see a similar disincentive associated with mandatory redistribution of organs after death.
I’m pretty convinced that mandatory organ donation upon brain-death is an unmitigated good thing. Are there any sound arguments against it, besides the pragmatic difficulty of selling the policy to people? So the important question for me is: Should we institute an organ market for living donors in addition to requiring donation upon death? There are costs to the organ market, as has been pointed out in the comments. Also, an organ sold by a living donor is one less organ harvested from a cadaver, so an organ market wouldn’t increase the number of organs available for transplant in the long term. It would skew the allocation of available organs towards the wealthy, which raises equity concerns.
The big advantage to the organ market that I see is that it allows for better matching of donors and patients. My understanding is that harvested organs can’t be stored for more than a few days, so if an organ is harvested from a cadaver it might go to waste because of the lack of suitable patients in the (spatial or temporal) vicinity of the donor. If there were an organ market, some organs which would otherwise be wasted in this way would in fact get transplanted. I guess my view on the organ market would hinge on the extent of to which it would mitigate this kind of waste, and that’s an empirical question. If anyone knows of data pertinent to this question, I’d be interested in hearing about it.
Are you aware that it would mean no more cryonics?
(Even if you want to preserve the head only, the injection of anti-ice fluids makes the rest of body unusable for transplantation.)
Thanks! I was not in fact aware of that. I actually thought about the cryonics objection when I was writing that comment, but I figured neuropreservation would not be a problem. Looks like I was wrong. I probably should have tried harder to follow up on my initial suspicion rather than dismissing it.
But they are making use of their organs. I don’t know why they consider burying them important, but it’s not my place to judge. It might not make them nearly as happy as it would the recipient, but the same can be said of them spending money on luxury when there are people who have trouble meeting their basic needs.
Yes it would. To my knowledge, it’s pretty rare for people to die in a condition where their organs can still be used.
I wonder how that would work. Would they move people who need organs to hospitals where people who match them are dying? Why couldn’t they do that now? Perhaps they can, and just don’t because there’s no money in it and it seems really tasteless.
You are probably much more libertarian than I am. I don’t buy the strong self-ownership assumption that undergirds many libertarian arguments. I think it is within a government’s legitimate sphere of power to legislate against sufficiently widespread wastage of important resources, even if those resources are legally acquired by their owner. If a crazed billionaire began buying up all the silicon in the world in order to bury it on the moon, I think the government should step in to prevent this from happening. When the relevant resource is literally a part of the owner the government should err on the side of liberty, but there can still be cases of waste egregious enough to warrant intervention, and the widespread burial of transplantable organs is sufficiently egregious.
Ah, I didn’t know this. If this is the case, then there is good reason to encourage living people to give up their organs.
I was thinking more about living donors. An organ market would encourage some people to sell their organs while they were alive. Unless something goes really wrong, these organs are presumably going to end up transplanted. If all of those people waited until they were dead, some fraction of those organs would be wasted, either because their former owners died in a way that renders the organ usable, or simply because the organ could not be transported to a suitable recipient in time.
The problem is, once you get past the poverty line, additional money doesn’t make you all that much happier. If you’re well past it, anything you do with your money is wasting it. If you stop them from wasting it, you’re just stopping them from earning much money. You’ll destroy incentives. There’s no reason to stop them from wasting resources in one way if it just means that they’ll waste them in another.
We don’t have to choose between the extremes of allowing people to do whatever they want with their resources (as long as they don’t use them to directly harm people) or legislating against any socially suboptimal usage of resources. I think people should have quite a bit of freedom to use their resources the way they want, precisely because we don’t want to disincentivize people from working, and also because a government that is constantly monitoring its citizens to ensure socially optimal resource usage would be unbearably intrusive. But I also think there are cases where the benefits of government intervention outweigh these costs.
Where exactly to draw the line is a difficult question, and there are a number of cases where I’m unsure whether a government mandate is advisable. However, there are also cases that are clearly on one side or another of the line. Banning all luxury consumption, for instance, is definitely a bad idea. I also think its pretty clear that mandating organ donation (perhaps with a religious exemption clause) is a good idea. In this case, the costs aren’t that great. I can’t see any disincentivization of productive behavior, and the additional intrusiveness required to adequately enforce the policy does not seem all that burdensome. And by all accounts the social benefits would be quite significant.
Since the government is hardly going to do the best possible thing with our money, my last comment was vastly exaggerated.
Even so, I don’t think people are generally expected to help others with their money. If they manage to do something particularly wasteful, you can tax them for it to make up for it.
I generally prefer the idea of subsidizing the stuff that does help people, but it works out the same if you add a tiny change in how you do income taxes.
Consider someone who is deciding whether to donate their money to Seeing Eye or use it to dig ditches and then fill them. Seeing Eye is less than 0.05% as effective as the Fred Hollows Foundation, so the difference in social optimality is less than 0.05% of what it could do.
This means that if they dig ditches and then fill them, they are less than 0.05% more wasteful than if they donate to Seeing Eye. Why not just move the line by 0.05%, and let them do whatever they want? You can just tax them an additional 0.05% to make up for it, and they’ll still end up with more incentive. For that matter, you’d probably save enough money on not bothering with regulation to make up for it.
It seems like digging ditches and then filling them is infinitely more wasteful than donating to Seeing Eye, since it makes an infinitely smaller difference, but that’s not really how it works. The difference is so small it’s lost in rounding.
i disagree with the kind of analysis you’re doing here. Just because a difference is a small percentage of the maximal possible difference does not mean it is a small difference. Suppose you have three mutually exclusive actions available to you: A—play video games all day, B—put in a small amount of effort that will ensure that malaria is eliminated, C—put in a moderate amount of effort that will ensure that everyone in the world lives forever without sickness or deprivation. As a percentage of what you could accomplish by doing C, the difference between doing A and doing B is negligible. But it seems absurd to say that the difference between doing A and doing B is so small that it doesn’t really matter. Sure, it’s small as a percentage, but it’s still a massive difference.
Of course, it still might be the case (in fact, it probably is the case) that in your particular example, the cost of intervention outweighs its benefits. But I have already granted that this is often the case. If your example was meant to provide a general argument against any government regulation of resource usage, I don’t see how it works.
Instead of discussing hypotheticals, why not talk about the actual policy under consideration: Do you think that the cost of a mandatory organ donation policy plausibly outweighs its benefits? If you don’t, do you have other non-consequentialist grounds for opposing the policy?
It doesn’t matter because you could add a rediculously tiny tax to make up the difference.
Also, I think it’s generally a good idea to give taxes and subsidies to get rid of externalities. If this is done correctly, it makes no difference at all how you spend your money.
One argument per comment, please. I disagree with your first response and agree/appreciate your second.
You can do either, or both. The two policies don’t really affect each other.
Meta: Reading through this thread was pleasant and rewarding. I feel like I learned as much about the practical ethics of organ donation in ten minutes here as I would from an ordinary two-hour-long argument in real life, and I feel a lot better now than I’d feel after a two-hour-long argument.
Meta: Is the OP really a political position? The mere fact that the resulting comment thread is highly informative and not contentious at all makes me doubt it...
More precisely, it seems to me that a majority of participants here share values, e.g., saving lives is more important than almost anything else. Most of the refutations of arguments against the OPs position are about updating the map to match the territory. Nobody’s arguing about what course one ought to set through the territory per se.
Consider the contrast between these comments and the abortion debate in the US. I think the essence of the latter is a disagreement about the absolute and relative moral statuses of and rights due to fully grown humans and potential people. I expect it would continue to exist even if everyone agreed on the pertinent biological and medical facts of the matter.
I doubt that this is a descriptively accurate characterization of the debate. I’m guessing a majority of the most committed pro-life activists aren’t motivated by a concern for potential people; they actually believe a foetus is a person, not just potentially a person. A number of Christian denominations preach that ensoulment occurs at conception, and that personhood (in the moral sense) is associated with ensoulment. If everyone agreed on the pertinent biological facts—one of which is that there is no such thing as a soul—this justification would no longer work.
Thanks for catching this. The words “person” and “potential person” were just intended to be labels, but I ended up unintentionally sneaking in connotations. Let’s imagine that in my counterfactual situation no one is doing that either intentionally or unintentionally.
I don’t disagree, but I do think religious people might claim something similar to, “even though the soul is not a physical thing, it still exists in the sight of God”.
Yes. If they thought the utility gained by making potential persons into actual ones, was greater than the negative utility to women who become unwilling mothers (would abort if they could), then they would support forcing all women to be constantly pregnant.
They’re deontologists—it’s a mistake to attempt to predict their ethical reasoning using consequentialist or utilitarian terms.
That’s necessary for any disagreement we could have a real discussion about. I’ve gotten into political arguments with people with similar values. I’m largely libertarian, not because I believe in individual rights, but because I believe that it’s what produces the most happiness. There are plenty of people who are socialist, not because they value equality, but because they believe that it’s what produces the most happiness.
Maybe this was already obvious to you, but it wasn’t to me until just now. Thank you for that.
I think the abortion “debate” is a Blue vs Green, Arguments as Soldiers issue. Pro- or anti-abortion doesn’t follow logically from other positions held by each party. Counterfactually, if the two US parties had chosen different positions on abortion due to some historic accident, then I would expect their electorate to still support each party along current divisions.
I agree. That’s why I set up my counterfactual.
I have the contrary expectation—I can’t conceive of a historical accident that would swap the parties’ positions on abortion without also swapping their respective bases.
Agreed. But I also think that the government should buy some of those organs at market value (Edit: they could negotiate for better prices like any other large buyer, but not force any supplier to sell), to be distributed according to the current system. (But then, I’m for socialized medicine in general, since it appears to be more efficient: countries with socialized medicine achieving better outcomes at lower costs.)
How would that work? You have an option to either buy a kidney or wait in line and hope for the best? If your insurance doesn’t cover kidneys, you wait for a government one?
I think it would be a lot better if the government finds the people that likely would end up waiting in line (like the people on medicare or medicaid) and just buy them organs immediately. Either that or just buy them for everyone.
How much do you expect markets to increase the supply of organs? You seem to be assuming there’ll be enough for everyone.
The organ market is legal in Iran, and there are indeed enough for everyone, including some people from other countries who came there just for the organs.
At least, for kidneys and stuff. I’m not even sure if you’re allowed to sell stuff like your heart when you die there. From what I understand, even if you mandated everyone give away their heart, there still wouldn’t be enough since it’s rarely an option. In those cases, I suspect there will still be a significant increase. Also, it makes it so that people have more of an incentive to work hard so that they can afford health insurance that will pay for those organs. If you’re going to have inequality anyway, you might as well take advantage of it.
What exactly do you mean by “organ market” ?
META: How should I vote if I’m neither for nor against your viewpoint, but if I simply do not understand it ?
If you need a kidney, you find someone who has an extra, and you buy theirs. Also, you can opt to sell your organs when you die, instead of just donating them.
This scenario provides several strong incentives for unscrupulous agents to harvest people’s organs without asking for permission (in addition to any existing incentives that may exist in our current society). Thus, I believe that the total utility of legalizing the organ market (as I currently understand it) would be highly negative.
If that becomes a problem, have the government check to make sure that the people who are listed as selling kidneys both gave permission (preventing people from just harvesting without telling you) and is actually missing the organ (preventing people from claiming they gave an organ that was harvested from someone else). The only other option is for the entire operation to be off the books. This would be prevented the same way it is now, along with the fact that people are less likely to buy organs on the black market if there’s a legal option.
Also, even if that was the only way the organ market worked, for every organ stolen there’d be a life saved. It seems like it would still be positive unless they actually killed the people they were taking organs from, and even then only if they only took one organ each. How could it be highly negative?
How would the government achieve this in practice ? For example, let’s say there’s a demand for livers this month. How would the government know whether the liver A for patient B came from a legitimate donor, some unfortunate homeless person within our country who was robbed of his liver against his will, or from some foreign national who lives in one of those totalitarian and/or lawless countries where human life isn’t worth much ?
Furthermore, let’s say that people could sell their organs after they die—by proxy, presumably—as per your scenario above. Doesn’t this create a powerful incentive for unscrupulous agents to speed their demise ?
I don’t think this is true. Firstly, organ transplant procedures do not have a 100% success rate, due to rejection issues, surgery complications, etc. Secondly, what do you mean by “a life saved” ? All lives will end eventually. Would it be worthwhile to shorten someone’s life by, say, 10 years (due to their loss of a kidney), in order to grant someone else 5 extra years of life (by using that kidney) ?
If it didn’t come from a legitimate donor, either the doctor has to explain why he didn’t say who the donor was, why the donor doesn’t know about it, or why the “donor” still has a whole liver.
As for the foreign country, just don’t accept organs shipped across national lines if the other nation doesn’t check the stuff. I suspect it’s a bad idea to ship organs across national lines anyway, as opposed to just shipping the donor, but I don’t really know all that much about how organ donation works.
No, but I’m willing to bet that’s not what the ratio will be. If losing an organ hurt you more than it helped the person getting it, nobody would ever consider donating them.
Edit:
You mean their next of kin? I don’t see how it’s much more of an incentive than it would be to kill them just for the inheritance. Also, I suspect that the health insurance company would normally take the money, since most people aren’t going to be in a position to donate their organs and people tend to be loss-averse.
Organ transplantation costs tens to hundreds of thousands of dollars, including the costs of doctors, hospital time for recovery, drugs, etc. Paying less than $5,000 for a legal kidney (at prices in Iran), or even $25,000 in rich countries with more expensive surgical staff, makes for a trivial portion of the overall cost of the operation. Why make the whole operation illegal (making it hard to advertise, recruit employees and customers, avoid imprisonment, etc) by not using voluntary donors to reduce costs by a few percent?
Consider that the surgeons make up a much larger portion of the cost. Should we fear that legalizing organ transplantation will drive a criminal industry kidnapping and enslaving surgeons to perform organ transplants? We don’t see such an industry for coronary bypass operations, so we shouldn’t expect it for organs.
It’s likely an international organ market would move organs from poor countries to rich ones. This would create great resentment in poor countries, while not being that huge a source of revenue.
That seems odd. They don’t have to sell their organs to foreigners. You could make laws about only doing it within the country. I’d be against that, for much the same reasons as I’m against all protectionist policies.
Perhaps it would be odd for the particular people who are selling their organs to feel resentment. But it doesn’t seem all that odd if people in poor countries who need organ transplants feel resentful that the organs which would otherwise be harvested from cadavers and given to them are instead being bought up by rich foreigners.
The big supply change from organ markets is incentivizing things like kidney or marrow donations from living donors. Those donations would not be made otherwise (and the overwhelming majority of organs of the dead are of far worse quality, since people tend to be old and sick when they die, and sudden causes of death like car accidents have a tendency to wreck the body).
I could see ways in which it would be disastrous.
In places where getting a $25 microloan is a big competitive advantage, a $5000 organ donation would be absolutely disruptive (according to this article kidneys go for anywhere from $20,000 to hundreds of thousands depending on country). If you were an entrepreneur in such a country you would basically never be able to compete with anyone else who donated organs without donating one yourself. That could definitely cause a lot of resentment.
I think this is an exaggeration. The severely poor are demarcated as earning less than $1 per day.
There are many millions of migrant workers from poor countries working in richer countries, e.g. Somalian taxi drivers in New York, Bangladeshi janitors in Dubai, and so forth. They make many thousands of dollars per year. They send remittances, and sometimes come home. This doesn’t seem to cause terrible resentments or anger. Rather, the money significantly boosts the standard of living back home, allowing the purchase of more imports and raising wages for local workers (paid out of the remittances and by the returnees).
More disasterous than someone dying? Is there going to be hundreds of people resenting per donation?
Kidneys are worth $2,000 to $4,000 in Iran, according to this article. They are illegal to sell in any other country.