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When Altruism Isn't Enough: The Case for Compensating Kidney Donors Paperback – January 16, 2009
The Amazon Book Review
Author interviews, book reviews, editors picks, and more. Read it now
About the Author
Sally Satel, M.D. is a resident scholar at the American Enterprise Institute.
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Organ donation,much like assisted-suicide,is a hot-button issue where lawmakers tend to vacillate and fall behind the learning curve.This de-synchronization leads to poor legislation that in turn has potentially deleterious consequences.
Altruism is a kind gesture without any shadow of doubt,but then a kind gesture isn't enough to inform judicious decision making about public policy.
Dr.Satel assiduously explains the pitfalls of relying on altruism alone when it comes to organ donation,her experience being organic and based on a thorough understanding of reality.She clarifies the subject and offers a panacea.
The irrefutable indispensability of Dr. Satel's research cannot be brought into question-this book is a must-read.
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."
There's so much more to this book, such as a look at whether family members or altruistic strangers would be less likely to donate in a compensated system, what human dignity means in a system where one can essentially sell a body part ... it's all very thoughtfully presented and documented, and worth a read if you wonder about compensating donors or about what is wrong with the current system.
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.
-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. Richard Epstein also provides a chapter on the uneasy embrace of altruism, markets regulated and not, and quantifying the benefit of a new kidney.
Hippen and Satel then discuss the issue of compensated kidneys suppressing donated kidneys and what impact this issue might have on organ procurement for transplantation. Michele Goodwin discusses the way the federal government has inserted itself in this issue and why it would be better to return to state by state regulation. Dr. Satel then provides the books conclusion.
Appendix A is particularly useful and interesting because it discusses the way legislation has been created to deal with transplantation from 1968 to 2008.
Whatever your own views, you should at least be willing to become informed on this issue and wrestle with serious arguments for and against this idea of compensation. People are dying and this approach might save lives.
Reviewed by Craig Matteson, Ann Arbor, MI