Home » An unpleasant truth about 10-year-old Sarah Murnaghan’s lung transplant…

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An unpleasant truth about 10-year-old Sarah Murnaghan’s lung transplant… — 25 Comments

  1. The solution to the socialist induced organ shortages is to introduce free markets into the system.

    You will see that when people are dying they and their families will be interested in selling the organs and voila, there will be a dramatic increase in the number of organs.

    Also we won’t have to depend on fascist government bureaucrats like Sibelius deciding who will live and who will die.

  2. No matter how you do it, any system will have ugly-looking results at the margins. At the statist extreme, you’ll have people (or groups) going through politicians, or as in this case, the media, to get special treatment. If you strictly go by free market economics, old rich people will beat out young low-income people every time.

  3. “It is disturbing to think that organ transplantation decisions might turn into popularity contests . . . .”

    I’m not very optimistic about the current state of affairs; I can only see three alternatives:

    1) The aforementioned popularity contests (the most popular rather than the most deserving);

    2) Decisions made by faceless bureaucrats which will probably result in crony awards (who you know rather than who is deserving);

    3) An open market (who can pay rather than who is deserving).

    Neo, as you point out, someone must make a decision with a finite supply, and while no system is perfect, all systems are subject to corruption. All the more so when one’s own life is at stake.

  4. One thing I admire about this blog is its commitment to honesty: first determine what the facts are in any situation and only then give your (conservative or other) interpretation.

    Much as I despise Obamacare, the use of Sarah Murnaghan’s sad case to bash the monstrous ACA is almost totally dishonest: eg “Sarah Palin was right. Here are the death panels she warned about.”

    Yes, Obamacare is going to put some big dumb government bureaucracy in charge of organ allocation, thus effectively having the power to decide who lives and who dies. But guess what, there already is some big dumb government bureaucracy in charge of organ allocation with the power to decide who lives and who dies (HHS’s Organ Procurement and Transplantation Network (OPTN)). If I had to bet, I’d guess Obamacare will actually make the existing system even worse, but the current system is not good.
    ———

    “Factors such as a patient’s income, celebrity status, and race or ethnic background play no role in determining allocation of organs.”

    Somehow I doubt that “celebrity status” is not a factor. For example, Mickey Mantle and David Crosby both went to the front of the line and received liver transplants after destroying their own livers through extreme alcoholism (and drugs in Crosby’s case).

    I don’t think I can go with the totally libertarian solution Harold describes, but the current system is basically a socialized one. And like other socialized systems, there are–surprise!–shortages. Providing some kind of significant incentive for people to donate organs would seem to be a step in the right direction.

  5. Another difficult question: Should decisions be made in part based on the worthiness (and by whose standards?) of the recipient? For example, a gang member vs an exemplary youth if their medical conditions are otherwise the same.

  6. China’s been doing a land-office business for years. Rumors still circulate about execution on demand with a clean head shot.

  7. I’m with the National Kidney Foundation, which “opposes all efforts to legalize payments for human organs for use in transplantation”:

    Offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values as a society. Any attempt to assign a monetary value to the human body, or body parts, either arbitrarily, or through market forces, diminishes human dignity. By treating the body as property, in the hope of increasing organ supply, we risk devaluating the very human life we seek to save.

    Offering money for organs can be viewed as an attempt to coerce economically disadvantaged Americans to participate in organ donation. Furthermore, since the economically disadvantaged have been shown to be less likely to be organ transplant candidates, financial incentives for organ donation could be characterized as exploitation.

    While payment for organs has real potential to undermine the transplant system in this country, its ability to increase the supply or organs for transplantation is questionable. In a recent survey of families who refused to donate organs of their loved ones who have died, 92% said that payment would not have persuaded them to donate.

    More here.

  8. There are many countries where life is held in disregard in a manner similar to our society’s general disregard for the unborn. IMO organs for sale will lead to bounties and there will be those who are willing to collect organs by all possible means. Free and equal access to medicine is impossible. There will be disparities under any system of delivery. Government involvement in medicine, like everything else in life, increase costs; it does not “bend the cost curve”.

    I’m not overly fond of the various insurance companies I deal with, but I’ll gladly deal with and pay for private insurance as opposed to dealing with government bureaucracies.

  9. Sarcasm on
    Hey wasn’t it great when those on the left let us know Bush was an idiot for suggesting animal human hybrid research? I mean it’s not as though one of the most obvious things you could do with that information would be to take a pig or goat, genetically engineer its surface proteins to be compatible with a human, then implant organs from that now biocompatible animal into a person. (Since of course they knew it wouldn’t work even though they really hadn’t done the experiment to figure out if it would or would not work.)

    sarcasm off

  10. To be serious one of the best ways to actually solve this problem would be if we could perfect therapeutic cloning combined with genetic engineering. Too bad everybody seems to hate that.

  11. I think the free market is the best way to go. As Harold noted, it will first and foremost increase the supply of organs. And with an increase in supply, the price will come down and more people would be able to afford replacement organs.

    JuliB: Probably both. While there will be private transactions between willing buyers and willing sellers for a mutually agreed upon price, nothing would prevent a person from auctioning his organs on eBay. Some might choose to donate their organs, just as people donate money and clothing to charity.

    Without a free market, we are left with a situation where the supply is limited and somebody gets to choose who gets a transplant and who doesn’t.

    Ann:

    Offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values as a society. Any attempt to assign a monetary value to the human body, or body parts, either arbitrarily, or through market forces, diminishes human dignity. By treating the body as property, in the hope of increasing organ supply, we risk devaluating the very human life we seek to save.

    I have a real problem with that paragraph. It sounds anti-capitalist. “Our values as a society”? That smacks of collectivism.

    As long as my body is my private property, how does that devalue my life? It’s my choice whether to sell or donate my organs, or not.

  12. Selection for a scarce resource has been a systemic issue for a very long time. Cast your minds back, if old enough, to the early days (~1972) of kidney dialysis, when there were very few dialysis machines and lots of failing kidneys. Local Boards were established for each machine to pick the lucky few; the Board members were anonymous; most were local community folks.

    The egalitarian selection criteria have not changed in the past 40 years, though now applied to transplants only, since dialysis access ceased to be a limiting factor. Any type of market factor was deemed unethical then, as now. An old bum was the equal of a young and otherwise fit person from the selection standpoint; the only commonality was that both had end-stage renal disease.

    So we are left with the market fact that it is OK for a Chinaman to sell one of his kidneys, but such buying or selling is not allowed to Americans for Americans. Donations only, please!

    (As an aside, I do not get Neo’s complaint about health insurance companies in this context. Why are we mixing reimbursement issues into a discussion about the donation of organs?)

  13. “As long as my body is my private property, how does that devalue my life? It’s my choice whether to sell or donate my organs, or not.”

    Yes, that is your right. However, that will not be the salient issue if there is a free market for organs. If there is a global free market for organs, organs will be harvested by force. Hellfire, there are certain zones in the USA were organs for transplant will be harvested by force. Rival gangbanger organs will become a money machine equal to cocaine. Never under estimate the potential for a black market to develop where there is a scarce or lucrative commodity.

  14. parker Says:
    June 19th, 2013 at 8:20 pm

    “As long as my body is my private property, how does that devalue my life? It’s my choice whether to sell or donate my organs, or not.”

    Yes, that is your right. However, that will not be the salient issue if there is a free market for organs. If there is a global free market for organs, organs will be harvested by force.

    If force is involved, then it is by definition not a free market. A free market means willing buyers and willing sellers, trading voluntarily.

    I know that our society is moving away from the free market. The key phrase in my earlier quote was “as long as”. In a socialist/communist/fascist/collectivist state, my body is not my own and in fact belongs to the state, which can harvest my organs on demand against my will and give them to cronies in the nomenklatura.

  15. I went through the initial process representing a friend of mine who was in a drug induced coma. When I went before the transplant committee. they laid it out very simply. That someone will die without it is not considered as everyone on the list will die without an organ. Next the organ goes to whoever will provide the best home for it. Therefore drug and alcohol abuse, bad. Attempted suicide, bad. Other health problems, bad. Also the recipient must meet a certain minimum health standard since it is a waste to give it to someone who may still die of other issues.

    By using a criteria of what is best for the organ much of the conflict about who is most deserving goes away.

  16. Glen says:
    “By using a criteria of what is best for the organ much of the conflict about who is most deserving goes away.”

    I disagree. If, in algebraic terms, you can solve for X, it does not matter if your starting point is the inverse of X.

  17. Glen,

    I do think ‘the best home’ for the organ is a clarifying point of view. After all, if the organ does not survive in its new environment, neither does the recipient. And if the recipient dies prematurely for other reasons, the organ then dies without helping anyone.

    To some extent that approach is also responsive to the problem of worthiness I posed above–how to choose between a gang member and an exemplary student if the medical conditions are otherwise the same. It might not help in the choice between a college student genius and a high school drop-out of average intelligence, medical conditions otherwise equal.

    Although I would consider worthiness a valid criterion, I can understand the argument against making such a judgment.

  18. rickl,

    It has been a long, long time since there was a market remotely ‘free’ in this country. However, in the past ‘free markets’ have not been immune to the use of force in various forms. So while I favor as few regulations as possible on markets, I recognize some level of oversight is necessary in the market place.

    Organs for transplant are a matter of life or death. When life or death is on the line many people will be willing to do anything to meet the demands of that market.

  19. The ‘best home for the organ’ strikes me as not facing the thorny ethical issues involved. The ‘best home’ will always be the otherwise healthy (not necessarily a Sarah: cystic fibrosis involves other organs too, not just the lungs) and the young. This leads to the same problem as Ezekiel Emanuel’s QALY (Quality-Adjusted Life Years) approach to health care rationing. By definition, the more sick are flushed in favor of the less sick, the older in favor of the younger. The chance of benefit is greater that way, you see….but the morality dilemna is avoided.

  20. Jim Nicholas

    “It might not help in the choice between a college student genius and a high school drop-out of average intelligence, medical conditions otherwise equal.”

    No system is perfect. However as the chairman of the transplant committee told me, my friend’s case was the first in over a thousand cases that he had been involved with that was not obvious.

    This makes sense since they can only consider those that are on the list at that time. Once you start eliminating based on local, compatibility, current and past health conditions, smoking, drugs, alcohol, suicide attempts, and other criteria what’s left may is not likely to be very many.

    In fact it is probably not going to be between two good choices but two bad ones. Such as a 70 year old in excellent health who was hit by a drunk driver and a 45 year old who has been smoking for 30 years and needs new lungs. I vote for the 70 year old.

  21. “By treating the body as property, in the hope of increasing organ supply, we risk devaluating the very human life we seek to save. ”

    I think if you analyze this statement, Ann, you’ll find that you are claiming that saving life (by increasing organ supply) devalues life.

    Neo-neocon, an excellent post. The organ-transplant system should not be hijacked by a popularity contest. On the other hand, Kathleen Sibelius is not the person who should be able to override the system, especially in the light of the IRS targeting scandal.

    Death Panels will be part of any healthcare system that is not entirely dependent on patients paying their own way. The advantage of a corporate death panel, versus a government death panel, is that you can choose which corporate panel will be overseeing your case, and they are beholden to you as a customer. The government does not allow for competition, and ensuring the government a monopoly is what Obamacare is ultimately about.

  22. Corporate death panels are beholden to profit, and profit is controllable when the money comes from the tax payer.

    The government death panels are beholden to power. No single citizen has a candle’s light of power compared to the nuclear furnace of the United States federal government.

    If ever that proved not the case, civil war would already be here.

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