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This is a very interesting and very challenging book because its various authors (edited by Dr. Sally Satel) make a case for compensating people who donate kidneys. Why? Because there are not enough kidneys being donated for altruistic reasons and people are dying unnecessarily. This is discussed by Sally Satel in the introduction.
Arthur J. Matas then discusses the risks to kidney donors, which turn out to be minimal. As a reasonable person, this would be my largest concern. But it turns out that most healthy people have plenty of kidney capacity with one and those who have donated over the decades have not hard significantly increased adverse outcomes.
Huang, Thankur, and Meltzer then tackle the cost effectiveness of renal transplants by comparing it to no treatment, hemodialysis, and what this might mean to the valuation of a kidney. Julio J. Elias provides a framework for a compensation system. This is obviously more for providing something reasonable to discuss than as a final proposal.
James Stacey Taylor and Mary C. Simmerling deal with the reasonable objections: -Will a legal market create a black market? -People will be coerced into donating. -People will fake their eligibility for donation to get money. -The poor will be exploited to save the wealthy. -Because of subsequent health problems, donors will be actually be worse off. -Medical conditions. -Compensation will actually lead to fewer organs becoming availability.
Satel comes back with a chapter dealing with the issues of human dignity, the way money taints donation, and the romaticization of altruism.Read more ›
If people were willing to risk their own lives to help others universally, the world would be a better place - but it's not. "When Atruism Isn't Enough: The Case for Compensating Kidney Donors" is a look at the ethical issues around America's organ shortage. When someone needs a kidney, finding a good match is hard, and the good match is not always willing. But throwing money at the problem presents another issue - is it ethical to sell one's organs for profit to save a life? Is it ethical to deny one a kidney if it means their death? Intriguing and a very real issue many doctors face today, "When Altruism Isn't Enough" is a scholarly look at this serious ethical debate.
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Over the holidays, I finished "When Altruism Isn't Enough," which lays out the case for compensating living donors and describes a couple of possible systems for doing that. I had an interest because I was an "altruistic" kidney donor in June of 2009.
As the book notes, the issue for kidney transplants is this: If everyone in the United States donated his/her organs at death, it wouldn't make all that much difference for people waiting for a kidney transplant, because less than 1 percent of all deaths yield usable kidneys. So organ donor cards are important, but not for kidney transplants. Living donors are key to saving lives.
The book explores the economics of kidney transplants, and how expensive dialysis is, compared with transplant, even if we included donor compensation. It also offers two models for compensating living donors. One is a government incentive, and the other is a little more free market. Both seem workable, if properly regulated. All the screening for whether someone was physically and mentally fit to donate would remain in place.
Look, about 100 people like me come forward in the U.S. each year to donate a kidney to a stranger. I'd love to think we could get that number up to where it would need to be to retire "the list," but it's unlikely. Is paying donors unethical? No. Letting kidney patients die when there is a way to get them a needed organ is unethical.
This quote from the book's editor, Dr. Sally Satel, hits the nail on the head: "... the critics [of donor compensation] have a far greater allegiance to abstract ideas about dignity and the visceral wisdom of queasiness than to actions that could avert needless misery.Read more ›
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I came looking for honest debate on the issue and I left feeling cheated. There is nothing new presented, just the same old unproven theory that the authors' good intentions will solve the problem of deaths due to the lack of transplantable organs. The authors (and there are many) address many issues, but they fail to prove the only one that will support their conclusion - that this radical idea will help save lives. In fact, the little evidence that is presented would appear to disprove their theorem.
The arguments presented are both one-sided, and short-sighted. The authors come from various perspectives, a `health economist' an `ethicist', a `medical doctor', a `transplant surgeon', and `legal scholar' among them. The arrogant attitude of "we are right and everyone else is wrong" becomes tiring. It is hard to imagine that any of them would donate a kidney if compensated, yet they universally assume that others will do so. The evidence? Sadly there is none of that.
The book argues that Congress should change federal law to permit states to experiment with incentives that `might' help increase donation. Fifty states each opening a different version of Pandora's Box opens the door for massive abuse and failure, but it is exactly what is advocated here.
Despite the system that saved Dr. Satel's life, she insists the current system is a failure - tell that to the more than 28,000 people who receive life-saving transplants each year. The current system is not perfect by any means, but we cannot risk those thousands of lives that rely on altruism for a chance at life. There are many proven opportunities to improve the transplant system - none of which are presented in this book.