I'm a big fan of the Institute for Justice, which fights the good fight on issues like economic liberty and eminent domain. Today they're launching what may be their biggest case ever: a fight to allow compensation for bone marrow donors.
For reasons that aren't entirely clear, the 1984 National Organ Transplant Act forbids people to sell their bone marrow, as well as their kidneys, lungs, and so forth. By which I don't mean that the ban is merely stupid; I mean there's apparently some reason to believe that Congress simply did this as a mistake, adding bone marrow into the bill at the last moment without really thinking things through.
Donating bone marrow is a lot more like donating blood than it is like donating a kidney, because of course, your body just makes more marrow to replace what you give up. These days, they don't even have to stick a big needle into your pelvic bone, as they used to; instead, they give you a drug to stimulate blood stem cell production and filter the cells from your blood, using the same apheresis machine that they use to harvest plasma cells from (paid) donors. The risks are extremely minimal, and mostly limited to the side effects from the drug they give you to stimulate cell production.
Nonetheless, it is very, very illegal to compensate donors. That means that people die for want of a transplant. The problem is worst in minority communities, because of the peculiar problems of marrow donation.
In most transplants, you run the risk that your body will decide that the new organ is a foreign object and send white cells to attack it; this is what's called "rejecting the organ", and it's why you have to use immunosuppressant drugs. In the case of marrow transplants, however, the problem is more serious, because marrow is what produces those white blood cells. The risk you run is that those white cells will decide that your body is a foreign object, and attack everything in sight.
That means that marrow donors have to be matched very, very carefully to the recipients--much more carefully than we match other kinds of organ donations. Since there is a strong ethnic component to the matching, minorities who need transplants have the smallest chance of finding a match--just 25%, according to the folks I spoke to at IJ. That's compared to 75% for whites.
It's true that I don't find any of the arguments about the coercive effects of money on peoples' decisions particularly compelling. But at least in the case of kidneys or parts of livers, I can see how you might want to keep people from making a very permanent sort of mistake. I just don't see that sort of rationale in the case of bone marrow. The worst that happens is that you end up with some unobtrusive round scars over the veins in the crook of your arms. There are dozens of professions that are likely to leave you with more impressive legacies. Moreover, if it's really so awful and demeaning, then probably we shouldn't pay for plasma, eggs, or sperm, either.
The purpose of this lawsuit is not to set up an actual market. There are reasons to think that you can't actually build a functioning market in bone marrow, because the number of matches is typically so small, turning every donor into a monopsonist, and every recipient into a potential monopolist. Instead, the idea is to use market incentives to increase the number of donors. Ultimately, the plan is to set up a foundation to offer some sort of modest grant for those who decide to become marrow donors. The process will remain anonymous, and the donor and recipient will never interact. Nor will the foundation negotiate.
It's a great idea. But in order to implement it, they have to get the law to the point where doing so won't get them sent to the pokey.
Of course, just because the law doesn't make any sense, doesn't mean that it will be struck down. But one can hope . . . and wish the folks at IJ godspeed.
Copyright © 2010 by The Atlantic Monthly Group. All rights reserved.
I'm a fan of the IJ, too, but just because a law is stupid, doesn't mean it's unconstitutional. What's wrong with aiming for repeal instead of suing?
There's what's called a "rational basis" doctrine in law. If congress passes a law that makes no sense whatsoever (and I mean no sense, not just that you can't see what anyone would like it), the courts can invalidate that law for having no rational basis. So for example if Congress allows a process of paid donation for plasma, but that exact same physical process is disallowed for marrow, it can be argued that there is no rational basis for disallowing marrow when plasma is allowed.
I'm sure the IJ has all the legal ducks in a row here--they're not dumb--but my question is more philosophical anyway.
The people of Rome required the Senate to publish the law, engraved on stone in the Forum, that the people might know the law and be governed by it, instead of by the whim of the official on the spot.
Nowadays the law is
But the principle still applies.
It's a bad thing to change the law through the courts instead of the political process.
It means that the law is not what it says, it is whatever the court decides it is. You may say that we are already in that predicament, but that "rational basis" doctrine would remove any remaining restraint on rule by judicial fiat.
Fortunately things are not quite that bad yet. There are still some restraints on the courts. The Supreme Court fairly recently ruled that while Congress continually extending copyright might be bad policy, it was not unconstitutional. (Was that "Eldred v. Ashcroft"?)
We still have people claim that the 2000 election was stolen because the Supreme court ruled for GWB. Many of those people backed the original lawsuit asking for a manual recount.
Copyright extension, as passed, should have been ruled unconstitutional. The People had a deal with the media producers. The media producers get monopoly use of the work that they produce for a time and the public domain possesses the work when that time is up. Simple quid pro quo.
I'm not a lawyer, but I'd think the prohibition on ex-post-facto laws might apply here?
If you want to extend the copyright on new works, okay, fine. But to alter a quid-pro-quo contract between the people and the producers which was already made seems, at best, like another Kelo.
BobW: I'm not terribly happy with the state of the law in many respects, but the average American can get a look at it more easily than the average Roman could. GPOAccess will get you the US Code, the Code of Federal Regulations, and the Federal Register, without having to take a trip to Washington to look at stone tablets. Lexis makes the last ten years worth of state and federal case law available for free. Most federal agencies and state governments have similar web-based information available, and many municipalities have their codes online.
(Researching that information, and interpreting it, can be a pain. But I'd guess that the average Roman found it so too. :-) )
Ryan W.: I'm not happy with the copyright extension, and it doesn't fit my understanding of the reason for granting limited monopolies on copying works. But it didn't criminalize actions taken before the extension came into effect, so it's not ex post facto.
(And since no one owns the public domain, removing works from it isn't a taking a la Kelo.)
It's a bad thing to change the law through the courts instead of the political process.
It's a bad thing until you're the victim of a bad law and Congress has other priorities.
replying to Michael S.
That's where the Hitchhikers quote comes in. I get the impression that law school consists of learning the technical terms plus how to look up the law and research court cases.
It really takes a lawyer to do it, and only a skilled and experienced lawyer practicing in the jurisdiction in question can give you an opinion on what it all means.
Rule by judicial fiat makes any money spent consulting a lawyer more likely to be wasted. If a judge can say that a law has no "rational basis" then there is no certainty left.
"What's wrong with aiming for repeal instead of suing?"
Unfortunately, you can sue with a few hundred thousand dollars and some good counsel. To get a law repealed will require millions and a massive team of lobbyists. It is, sadly, far more practical to appeal to the courts than to your elected "representatives".
As bone marrow donations require such a specific match, if you want to help out and join the registry here:
http://www.marrow.org/JOIN/index.html
Insert disclaimers here - I know there's an official marrow donor list, and this is what I found after googling for it. If it's actually a front for an alien conspiracy to create some kind of evil hybrid, don't blame me.
I think you have your definition of monopolists and monopsonists flipped. The donor is the single seller of the marrow (aka monopolist) and the recipient is the single buyer of the marrow (aka monopsonist).
I agree that encouraging donations of bone marrow is likely to help many people. Doing it financially does raise some key concerns for me - particularly in implementation. I agree paying people to donate bone marrow could be very helpful - the question is where the money to do so comes from. If a monopolist determines whether someone lives or dies, one can guess how much rent the monopolist could extract from the person whose life is at stake. So if a market could be set up it would need to be done very carefully: if not, the donors would take their reservation wage, the recipients would pay their reservation price (i.e. the price not to die), and the market makers capture the spread. Ah the beauty of being a market maker! Would the market makers be doctors? Doctors could in theory operate with other doctors to capture this spread. Or it could be the foundation - if run for good, it could be very beneficial. If run for the foundations' singular benefit, we would have quite a cost benefit analysis to perform.
Therefore, we should allow all to suffer to assure that none may benefit. (?)
No, Ed. That was not at all what I said. Please read the comments again.
Since we are talking about the division of surplus, and people currently are gathering some surplus from donations, changes that we make to the system may affect the division of surplus going forward - implementation is key. And the donors' and recipients' level of surplus could be affected negatively by introducing such a monetary change as well. After all, as you say, policy that produces fully anticipatable bad consequences is bad policy.
"I mean there's apparently some reason to believe that Congress simply did this as a mistake, adding bone marrow into the bill at the last moment without really thinking things through."
Thinking things through is not the strength of the Congress of the United States. As we have learned recently, reading and understanding the bills they seek to enact is not their strength either.
The Law of Unintended Consequences does not excuse the occurrence of fully anticipatable consequences.
Policy that produces fully anticipatable bad consequences is bad policy.
This lawsuit has a 0% chance of being successful. But I don't think it was launched to win. I think it was launched for publicity.
I know next to nothing about bone marrow or bone marrow transplants, but Megan's post seems convincing. There is a case for criminalizing the sale of organs -- whether or not you agree with it, I don't think anyone can say it is ludicrous. But if bone marrow is really not risky and completely reversible, with no long-term consequences, then there's no reason to permit payment to incentivize more donation.
I agree, this looks like a publicity stunt and I wish people wouldn't use the courts for things like this. I'm willing to write my Congressman if there is a bill being presented.
Rational basis test = court affirming challenged statute
"the number of matches is typically so small, turning every donor into a monopsonist, and every recipient into a potential monopolist."
Shouldn't the words "monopsonist" and "monopolist" be reversed in this case, or am I missing something?
"Since there is a strong ethnic component to the matching..": that can't be right, it must surely be "racial" rather than ethnic. Unless the meanings of the words have been changed again.
I suspect that ethnic Finns may have better luck finding matches among other Finns, but mostly I think she was trying to avoid the PC police.
The divisions are finer than are called racial nowadays.
There was a case where a little girl needed a donor. Her father was black and her mother was of Russian descent. I remember the stories: her best chances were among people of mixed black and Russian descent.
Fair enough, but I thought we were taught that "ethnic" could refer to cultural origins, rather than racial or sub-racial origins. Or so I inferred from a remark on the cover sheet on the last British census form. Mind you, that census forn later contradicted itself. Anyway, can I take it that in the US "ethnic" refers to racial, and finer, genetic divisions? (What about the "races are a social construct" loonies? Don't they object to attempts to match donors and recipients?)
Rational basis test = court affirming challenged statute
True, unless you can somehow tie it to sex, preferably with donkeys and with an audience. Then you have a fighting chance at defining your place in space and more transcendent dimensions.
I always knew you preferred donkeys and an audience...
Not me, SCOTUS.
Donating bone marrow is a lot more like donating blood than it is like donating a kidney, because of course, your body just makes more marrow to replace what you give up.
Compelling argument. As a conservative I am perfectly willing to restrict liberty in certain spheres and one of the most important is zero-sum games. I think polygamy should be illegal because each man with ten wives means that nine other men go wifeless. Similar reasoning applies to selling organs. The poor are basically selling their bodily integrity to someone else. It too is a zero sum game. Rich people gain a kidney and poor people lose one. But clearly that would not apply to bone marrow.
A conservative in favor of universal health care. Interesting.
The zero-sum game issue seems to cover too much-- lots of things are zero-sum games, like ownership of real property (they're not making any more land), yet we don't stop people from buying land on Manhattan island on the grounds that if they own it, someone else won't be able to.
Conversely, is polygamy okay as long as it's a group marriage with equal numbers of men and women? If licenses are controlled so that the number balances out overall? ("Sorry, you and your proposed fourth wife can't marry till the county gets another MMF triad.")
A better conservative argument might be the pragmatic observation that historical forms of polygamy are strongly contingent on inequality between the sexes. (Generally, polygyny with the wives legally subordinate to the husband.) While a legal structure for polygamy in our current egalitarian context may be possible in principle, the burden is on the people pushing for it to a) propose the specific laws they want, and b) show that the benefits of the change (which accrue mostly to those who wish to practice polygamy but currently can't) outweigh the costs in greater legal uncertainty and unwanted consequences.
(Which unwanted consequences? Depends on the law being proposed, which is the responsibility of the proponents to supply. But we already have girls socially pressured into polygamous relationships with older men in some parts of the US even without legal sanction, for example.)
Same-sex marriage is much simpler, by comparison, because the heavy lifting of making spouses' sex largely irrelevant legally had already been done. If same-sex marriage had been remotely politically possible fifty or more years ago, it would still have had to contend with the fact that "husband" and "wife" were legally distinct roles-- wives needed their husbands' consent to enter into contracts, for example, but not vice versa. So the question "which of you is the husband and which the wife?" wouldn't have been mere snark then. For polygamy, questions like "If A, B, and C are married to each other, can C divorce B but remain married to A?" don't have obvious resolutions unless you already have a structure in mind.
(And I'd expect to see a lot of wrangling over the details between proponents of traditional patriarchal polygyny, like the FLDS and some traditionalist Muslims, and proponents of a formalized egalitarian polyamory. From a conservative perspective, it's their job to convince the rest of the country that this is worth spending public attention on in the first place, rather than the rest of the country's job to explain why we shouldn't make a radical change in the marriage laws.)
The poor are basically selling their bodily integrity to someone else. It too is a zero sum game. Rich people gain a kidney and poor people lose one.
That's not zero-sum. By any rational metric the kidney is worth far more to the recipient than the donor.
Your kidney example completely ignores the fact of diminishing returns. Zero kidneys = death. One kidney = life. Two kidneys = life, with a bit of redundancy. There are most definitely gains from trade to be made there.
As for polygamy, you're making the implicit assumption that it's many-wives only(I know that's the literal definition of "polygamy", but presumably what would be legalized is all forms of plural marriage, not just one). If a woman would genuinely prefer to be one of many, what's to prevent men from preferring the same thing? It's only zero-sum(even using your loose definition of the term) if polygamy happens and polyandry doesn't.
The poor are basically selling their bodily integrity to someone else. It too is a zero sum game. Rich people gain a kidney and poor people lose one.
I think you've just stumbled on the method Congress is going to use to make FedMed pay for itself!
Rob Lyman,
I think philosophically the problem with the court challenge is this:
1. If we've gotten to the point that we're no longer knocking at the door of the legislature to change the laws, but going right to door number two and asking the courts, we are no longer living in a democracy.
2. When dealing with problems involving changing technology, it's certainly not clear to me that justices have the knowledge and foresight to craft a law that won't cause as many problems as it solves going down the road.
3. When legislatures draw lines like this, banning some things and allowing others, you often get lines that are not rational in themselves. They are the results of a variety of collective judgments. If courts are brought into invalidate these lines, you ultimately strengthen the all or nothing camps.
Like I said earlier though, I would write my Congressman in support of repeal of this law if such an opportunity existed.
Right, but you're responding to the opposite question from the one I asked.
I guess I am. I obviously can't answer the opposite one.
Here is what I think is the answer to the one you asked:
IJ presumably thinks the law is both bad policy and literally beyond Congress's reach.
For example, IJ probably believes that the Commerce Clause should be read much more narrowly and that Lochner was correctly decided. If that is your worldview, and I am not taking a stand one way or the other, then why shouldn't IJ make every attempt to strike down laws that interfere with one's right to contract or purely intrastate transactions?
The more crass answer is that litigation creates more press than mere lobbying, and exposure in the press inspires donations to the IJ, which then funds more litigation.
Well, it doesn't matter what IJ thinks. It matters what the law is. Filing lawsuits that you know will lose is frivolous and a clear breach of ethics. Even if you think you are right.
For instance, Orly Taitz may really believe that Obama was not born in the US. She still has to stop filing all those frivolous suits.
I'm not accusing IJ of frivolity here. It's not unusual for groups to use litigation strategies instead of lobbying strategies. The most famous is the NAACP civil rights campaign. Among the most notorious were the ridiculous class action suits against McDonalds. While this suit has a 0% of winning, I don't think it's outrageous relative to what else happens.
Well, it doesn't matter what IJ thinks. It matters what the law is. Filing lawsuits that you know will lose is frivolous and a clear breach of ethics. Even if you think you are right.
Good faith arguments that the law should be changed are neither frivolous nor unethical. So, it is not enough to say all that matters is what the law IS.
If we've gotten to the point that we're no longer knocking at the door of the legislature to change the laws, but going right to door number two and asking the courts, we are no longer living in a democracy.
Either that, or we just need a complete replacement of the legislature. I was in that corner even before reading your comment...
Bone marrow harvest often means general anesthesia. I don't know the history of Congress' decision to include it with solid organs in the legislation, but general anesthesia tends to be a bit of a line when it comes to informed consent, so perhaps that was a consideration.
The risk for repeated stem cell harvest would be related to multiple doses of the G-CSF used to stimulate the marrow. I'm not sure the risks for the kind of use anticipated for a person who would be making multiple donations is known. Given the recent issues with eythropoietin, it's probably not reasonable to assume it would be safe.
I was told that I could make two donations in my life. They did not give me anything to stimulate bone marrow production. They just drilled into my pelvis, sucked it out, and sewed it back up. A little over two years later, I can't even see any sign of a scar.
G-CSF is given before the stem cell harvests that Megan described, but not the bone marrow harvest you underwent.
This is a little out of sequence, but I wasn't at all bored by your story and thank you for sharing it. Your generosity was, and is, commendable.
Being a taxi driver means being on the roads a lot more than most people. The longer you are on the roads the more risk of death. But we don't ban people from being taxi drivers.
One thing that would help is publicising how trivial the donation is these days. I, for one, still thought it involved drilling into bone.
The first thing is to stop calling it "bone marrow" and call it "stem cell donation"
Megan wrote:
This would be an argument for banning living donation, not compensation.
I donated bone marrow anonymously about 29 months ago. It was not the type of donation the article talks about. I was knocked out and the made two incisions in my lower back, drilled into my pelvis, and extracted the marrow. It was the most selfless act of my life. Compensation would have made no difference in my decision to do this. And if I get another call from them, I will do it again.
But on reflection, there were some moments that I was very uncomfortable and I am not talking about my recovery. I had the extraction done on a Thursday and was back at work on Monday. Every step of the way, from the multiple blood extractions leading up to my surgery to the very day I was getting my IV hooked up, they kept asking me if I wanted to back out. The time from contact to surgery was about two months. I ended up doing the donation on my birthday. What pissed me off was on the day of my surgery, they again asked me if I wanted to back out. At that point, my recipient had her marrow killed off and if I had just said no, then she was a dead woman. I think what needs to be changed is when the recipient is past the point of no return, the donor should also be given no choice.
It was a year after our surgery that we were put in contact with each other. Talking to my recipient was wonderful. Just knowing that my donation made a difference is an unbelievable feeling that I can't describe. It was also at this time that I found out what she had gone through and it made the minor inconvience I went through seem trivial. I found out that none of her siblings or parents were matches. I also discovered that my marrow was her doctors third choice. There were two others that were better matches. But because it was a marrow extraction rather then the stem cell procedure, they both backed down. She will be taking drugs for the rest of her life. But without my little inconvience, she wouldn't be here.
Signing up is easy. In most cases it is free to sign up. But some places make the donors pay to get on the list and this is definately wrong. Signing up should be free. Minorities are under represented on our national roles and an out reach has to be done to get more people involved. I have run into many people that have signed up, but few are ever called. I forget the math now, but the odds of an anonymous match are something like 1:60,000 or 1:600,000. I did a lot of research before the surgery, but many of the details are slipping.
I hope I haven't bored you with my tale. But if I can convince one person to sign up, then it is worth it.
Okay, you talked me into it. I have ordered my marrow/cell donor registration packet and I will sign up. I'm already listed as an organ donor, but I hope it will be a while before anybody takes me up on that. :)
You won't regret it. I won't tell you that it is painless. The kit itself is painless, just swabbing your mouth. But the feeling you get from it is well worth it. This is way you can help your fellow human.
Not boring at all. Indeed, it was an interesting tale, especially the part about giving you the option of backing out at the last moment. I am guessing it is a regulation of some kind they have to follow. If I may ask, did they make it clear to you when the recipient was going to be beyond the point of no return?
I am on registry from a blood donation I did over 10 years ago with the Red Cross (at least, I assume I am still on it). Have never been called, though.
Yes, they told me they had to ask. When they asked me, I said "Isn't she going to die if I back out?" They said "Yes." I then said "How dare you ask me." It was then they told me they had to. It freaked out the husband of my recipient when I told him this.
I would like to add to my tale that everyone associated with my donation treated me like I was royalty. They even brought me a birthday cake into recovery and sang Happy Birthday. I had my surgery at Moffit Hospital in Tampa. Just walking around and seeing the patients reinforced my determination to go through with it. When you see very sick people fighting for their lives, you just feel that you must do whatever you can to help. I lost both my parents to cancer. Both of my grandfathers too. I can't go in a lab and find a cure. This was the only way I could say FU to cancer. I was told that my recipient stood a 15 - 20% chance of surviving one year without my donation. And here it is over two years later and she is still around. It just gives me a warm feeling inside knowing I did a little something to help.
We got to the point a long time ago that we are going directly to the courts for redress instead to the legislature. If you think that means we don't live in a democracy . . . well, that ship sailed a long time ago.
One quick step to get more people on the donor list is to make it free to sign up. I personally could care less about getting paid to do it, but I only signed up once I got a code to do it for free.
***SIGN UP AND DONATE***
My initial registration has turned out 2 matches so far. I have my advanced blood work tomorrow for the second and will know in about 6 weeks if there will be the final testing in early December. Imagine if you are on the receiving end needing the donation to have a life.
This doesn't cost you a penny... you help save a life for the price of a few needle pricks. Nothing big.
Compensation? Great!
Knowing you personally saved a life? Priceless!
Sluf
Thank you for what you are doing. If you are having the surgery, make sure you ask about an autaologus (sic?) donation for yourself. It adds a couple of visits before the surgery, but it is worth it. It helped greatly with my quick recovery.
Re: Nonetheless, it is very, very illegal to compensate donors. That means that people die for want of a transplant.
Are you sure? I know something about this for personal reasons, and my understanding is that the really big problem is that finding a bone marrow match is very hit-or-miss -- it's far more difficult than matching blood types. Usually you need a close relative to have even a good shot at finding a match. Before I see the need to start paying bone marrow donors (and thereby ratcheting up healthcare costs further and perhaps needlessly) I would like to see how often it happens that a person with a matching bone marow type refuses to provide his/her marrow for transplant.
I can only tell you from what I heard from my recipient about this. There are two types of donations. One is a stem cell extraction that is similar to giving blood. The other is a bone marrow extraction which requires surgery. My recipient had two better candidates from the list. But when they heard that it was for the surgery, they both backed down. I asked about this when going through the interview process and was told that it was the recipients doctor that makes the call as to which type is needed. I had never had surgery before in my life, so it did scare me. But I will also tell you I had worse experiences at the dentist than I did from this.
I think most of the gains from this will have less to do with getting matches to follow through and more to do with adding people to the pool of possible donors in the first place. Personally, I've never gone in and done the testing. I could hypothetically be a match for a person who is dying right now, and neither of us would ever know. If going in, getting tested, and finding out I was a match meant a payday of a few grand, I'd be way more likely to do it.
Or if you prefer, you could spread the payday out - pay people for getting tested, if and only if they sign a legally binding contract to donate if they're found to be a match. Not sure what the ratio of tests to matches is, so the overlay of a few grand per match might be twenty bucks or something equally meaningless, but it might work if it's a couple hundred, enough to get people to do it significantly more often.
I am sitting in the dark in my 4 year old daughter's hospital room in Los Angeles. She has a rare blood disease that only a bone marrow transplant (BMT) can cure. I have been told the best chances for a match are from her full blooded sibling and those chances are 25%. The next best chances are the parents, at 5%. Everyone else has the same odds of matching, something less than 1%. Unfortunately neither Maya’s parents nor her brother are matches. So we are faced with the challenge of finding a match through the National Marrow Donor Registry. We could not do this by ourselves and we have found the National Marrow Donor Registry (www.marrow.org) to be an excellent resource (not alien recruitment Mr. Moore :), not only for registry and matching but also in learning about BMTs and centers that perform them, costs, etc.
You are correct Alsadius, it is a numbers game. The more people on the registry the better the odds are for matches to occur. We have been telling anyone who will listen that you can register for Maya and the bonus is if you are not a match for her, you may be for someone else.
Thank you to BIG for your very big gift.
If you care to learn more about our little warrior Maya, or want links, please goto: www.caringbridge.org/visit/concentrate. You can find a drive near you if you’d like to talk with someone face to face about the entire process. Or you can sign up via the website and have a kit mailed to you with a pre-paid return envelope. It’s free, though they do ask for a donation. Thank you all.
Links can be found on the Resources tab, or at www.caringbridge.org/visit/concentrate/reources. Thanks
Jon, I suspect the hope of compensation would get more people to sign up, thus increasing the chance that a match could be found.
When I was going through this, I talked with a lot of people around me. I had a friend that lived about two miles from the hospital and he offered to drop me off and pick me up and let me stay at his place for a few days of recovery. He was from Cuba and told me that he would never do this. He tried to explain that it was just not part of his cultural upbringing to do this. I'm not sure if this is true or not, but this is what he told me. He said helping me was the best he could do.
I'm not sure if compensation is the right way to go or not. But signing up for the list should be free. It was in my case. I did get a bill for my surgery from the hospital about eight months afterward. But a couple of phone calls corrected this mistake. Making an anonymous donor pay is definitely wrong. The recipients insurance paid for my surgery.
I'm waiting for a kidney and a pancreas, so I'm engaged with this issue. In the early days of transplantation, doctors got burned by some weird and problematic mental health problems form donors and recipients, and so have been gun shy about those effects cropping up regularly. At the time, they assumed people were going to die anyways, so death is better than being stalked by the widow of your donor (which happened).
This was the context in which these rules were formed. I think the rules need to change because
the social context has changed, and we understand the social interactions better.
That being said, one of the reasons the no compensation clause was put in still applies. The donor, or the donor's family shaking down the recipient post transplant happened, and still does. It's illegal now, and needs to stay obviously illegal. People avoid transplant to avoid feeling obligated, and leaving the compensation question open increases that anxiety. Having good transplant candidates refuse transplantation from fear of being shaken down later is very costly.
Megan,
This happens quite rarely, but I have to agree with you. This is simple and it would increase everyone's utility; at least insofar as bone marrow is concerned.
I'm less persuaded this would be a good thing for other organs.
This is a step in right direction but the real key is to actually build the minority base of potential donors. That involves finding a way to attract large numbers of minorities to submit to testing (a simple mouth swab now I think) and most importantly be locatable and willing to submit to further testing and eventual harvest if determined to be suitable donor.
Hopefully this will be mostly moot in 20 years as we figure out how to grow people new organs with their own cells.
Of course, if we pass the health care deform bill that puts a 40% tax on medical innovation this is much less likely...
I donated a kidney to my brother 5 years ago. I was and am in excellent health. The transplant docs told me everything, checked everything and I had a second opinion on donating from an uninvolved nephrologist. All signs were go and we did it. Success all around. I was out of work for 10 days. My brother is off dialysis and has his life back. Talk about a huge middle.
Any healthy person should be able to get tested thoroughly for free and matched through the organ donation list with a recipient. Donors would receive a set price ( details could be worked out... say 50K) and a lifetime of going to the head of the list. Insurance would be happy to pay to avoid the more costly dialysis. Donors would have money and a warm feeling from making a great contribution. Recipients get their life back. No black market, no dieing on a waiting list.
We allow people to enlist in the Army for money or work in coal mines etc. Who are we protecting. Let's go!!!!