Tuesday, February 06, 2007

Organ donation?

Disclaimer: this post reflects purely my personal opinions. (All my posts do, but I thought I'd better emphasise that here). At the moment, I don't have a strong opinion on this topic so one good argument could swing me strongly either way. Going on:

Straits Times seems to have been running articles on organ donation. Of course, I can't be sure, since ST Interactive is gated and I can't check the archives! Bummer, right?

Anyway, according to the Ministry of Health website,

The Organ Donor Registry maintains registers of:
People who wish to donate their organs or bodies for transplantation, research or education upon their death, under the Medical (Therapy, Education and Research) Act (MTERA), and
People who wish to register their objection to the removal of kidneys, liver, heart and corneas upon death for the purpose of transplantation, under the Human Organ Transplant Act (HOTA)
Nothing about organ donation I can find here. I'm sure it must be governed somewhere, else it can't be illegal right? Anyway, one of MOH's FAQs says that

Living donor organ transplants are transplants in which a living person donates an organ (e.g. a kidney) or part of an organ (in the case of livers) to another person. The main concern in such transplants is that living donors face medical risks when donating their organs. For example, although donors in living donor kidney transplants have less than 0.1% chance of dying from the operation, donors in living donor liver transplants face a 1-3% chance of dying from the surgery, and a 25% chance of suffering a complication.

Is it illegal to sell organs? I assume it is. Nevertheless, looking at whether it should be illegal, specifically wrt to such living donor transplants where the donor can continue to live a normal life afterwards, we should consider
1) If allowed, many people in need of transplants would be able to find them.
2) However, many poor people may not be able to find donors for free
3) Though, if that was a societal concern, we should be able to set criteria to help co-fund transplants for such people
4) And a person with some future economic value but no money now could borrow against his future income to provide for his donation
5) And if society was genuinely concerned, then concerned members could choose to make their donations only to poor people.
6) At the same time, it may lead to exploitation of poor people who are unaware of the risks involved or future health consequences (eg, the risk of losing their remaining kidney function)
7) though reasonably speaking, are bone marrow or blood donors (or other current, living donors) also fully aware of the risks they face? (and if you tell me there are no risks, you need some education)
8) And it's not clear that making it illegal to sell organs protects poor people from exploitation, since by driving the market underground you actually reduce the level of information in the market.

I'm not a big fan of "this is against social values" arguments, because if society felt strongly about a topic, they would act on their own, exercising their choices in the marketplace and the ballotbox.

The most pertinent questions are:
1) For people discouraged by the ban, would their lives be better without the ban? (Not sure. Some people would benefit, some may get cheated, see above. However, I'm not convinced we can protect everyone from their own stupidity).

2) For people not discouraged by the ban, would their lives be better? (Yes, definitely. For this non-marginal group, having it in the open and regulated by government beats black markets. For reference, you may wish to consider this story, Indian Organ Mafia Busted. If selling organs was allowed, these people would have some recourse).

3) Would lifting the ban negatively impact society as a whole? (Possibly - by accentuating the rich-poor divide).

So, would I sell a kidney, if it was legal? I'm generally paranoid about health, so there's very few people I would donate one to, and if donations go into a common pool I'm totally not going to donate! On the other hand, I'm not attached to health after death, so no objectives to the Human Organ Transplant Act. And lastly, if the price was high enough, I would. But because of my paranoia and risk-aversity I'm pretty sure my price is above the usual price others would accept, so the offered price would not be high enough for me - unless my financial situation changes drastically.

Would I buy? For myself - have to weigh whether I would be able to make back that money over my lifetime, and whether the price would crimp my happiness so badly that living was literally worse than dying. I'm probably far more likely to buy the organ for someone else rather than myself.

There are other solutions, including this suggestion that donors be paid by other means (eg healthcare credit) or by governments or insurers. That's a distinct possibility, since organ donation does seem to provide benefits for society as a whole...

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