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When Altruism Isn't Enough: The Case for Compensating Kidney Donors Paperback – January 16, 2009


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Product Details

  • Paperback: 250 pages
  • Publisher: Aei Press; 1 edition (January 16, 2009)
  • Language: English
  • ISBN-10: 084474266X
  • ISBN-13: 978-0844742663
  • Product Dimensions: 8.7 x 5.9 x 0.8 inches
  • Shipping Weight: 12.8 ounces (View shipping rates and policies)
  • Average Customer Review: 3.4 out of 5 stars  See all reviews (5 customer reviews)
  • Amazon Best Sellers Rank: #1,491,591 in Books (See Top 100 in Books)

Editorial Reviews

About the Author

Sally Satel, M.D. is a resident scholar at the American Enterprise Institute.

Customer Reviews

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The need is real and deserves better consideration than put forward here.
K. F. Vericker
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.
Craig Matteson
It is hard to imagine that any of them would donate a kidney if compensated, yet they universally assume that others will do so.
T. A. Falsey

Most Helpful Customer Reviews

4 of 5 people found the following review helpful By Craig Matteson HALL OF FAMETOP 500 REVIEWER on July 28, 2009
Format: Paperback
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.
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4 of 5 people found the following review helpful By Midwest Book Review on April 10, 2009
Format: Paperback
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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Format: Paperback
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.
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9 of 14 people found the following review helpful By K. F. Vericker on February 9, 2009
Format: Paperback
Dr. Satel's argument fails from the start, and her conclusion that altruism has been tried and failed, is simply not true. There is an organ shortage and people die while waiting, but the fault is not lack of altruism but rather the singular lack of support for altruism in the form of organ donation.

Altruism has worked for 5 decades to provide organ donations both from living donors and deceased donor families, but it simply has not worked well enough. Most people in the field recognize that for the altruism of donation to work, it requires social, legal and cultural support to reduce risk and improve awareness, support that is not currently in place.

Donation, unlike other altruistic social solutions, carries with it burdens beyond the known medical risk. The living donor faces the expense of nonmedical costs, is not protected from insurance discrimination norjob discrimination, not covered under FMLA, etc. Compare this to volunteer firemen, who protect 38% of the US population, but who have legislative and social support in place and it becomes clear that when social altruism is supported, it works very well.

The challenge is to get donation to the same level of support that firemen, blood donors, adoptive parents, military reservists and other altruistic citizens receive. There are new, strong initiatives to address these issues with the goal of taking what works, altruistic donation, and making it more effective.

The book ignores obvious successes of altruism and jumps right to proposing providing a profit to the donors.
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