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May 31, 2007

Kidneys

Entertaining as a reality show where a dying woman chooses between three contestants who want her kidney will be, I'm confused: Why would the woman have only one kidney to donate? Shouldn't she have two?

May 31, 2007 | Permalink

Comments

Did Matthew Yglesias write that first sentence?

Posted by: mrgumby2u | May 31, 2007 11:28:39 AM

It is not clear in the article whether the sick woman will donate her kidneys pre-death, or post-death. In the pre-death situation, normally she can select to donate one kidney to another person (but not both, as that would kill her). Post-death, she has only the choice of donating or not donating - the waiting list is/should be selecting the recipient.

But let's not kid ourselves, the wealthy have ways of bypassing the waiting lists for organ transplants here and in other countries. The rich can travel to whereever they can find an organ.

The transplant system we have works pretty well (when not bypassed), but I fully expect to see human organs on eBay not far in the future. Money determines nearly everything else, so the pressures will push in that direction.

What is tragic is that so few organs are donated at death, and so I expect that 'incentives' will be the 'market solution' touted by the 'conservatives' to overcome this shortfall. One can almost hear them saying 'leave a larger bequest to your family - a competitive market will obtain the highest value for this precious commodity.' And of course, no estate tax will apply.

They will claim that 'medical need' is too subjective, and we need to balance supply and demand just like we do for pork bellies in commodity exchanges.

Posted by: JimPortlandOR | May 31, 2007 11:47:43 AM

Seriously, I think she's about to find out that that decision is AWFUL. She'll want to pick them all, and have to tell two of the three she won't be saving their lives after all. I would hate to be in that position, so I can't imagine voluntarily setting up that choice and then showing everyone. I can only think she'll regret this.

Posted by: Megan | May 31, 2007 12:05:09 PM

Without getting too gruesome, the processes of a natural death, as well as the preliminaries of terminal care, are likely to make the donation of organs, after death, mostly impractical.

Posted by: Bruce Wilder | May 31, 2007 12:34:41 PM

Bruce, I think for my sake you'll going to have to get gruesome to explain why donor organs are all no good when just about all of them come from recently dead people. Do we really only harvest organs from accident victims?

Posted by: diddy | May 31, 2007 12:57:02 PM

I'm confused, what about this is entertaining. I speak as someone who had the "pleasure" of seeing my eight year old niece kept alive on machines until *her* organs could be donated.

aimai

Posted by: aimai | May 31, 2007 1:07:29 PM

She's donating pre-death. Thus one only.

Diddy: yes, almost all accident victims (and strokes, heart attacks etc sometimes). Certainly not cancer. The closing stages mean organs are unusable.

"The transplant system we have works pretty well (when not bypassed), but I fully expect to see human organs on eBay not far in the future. Money determines nearly everything else, so the pressures will push in that direction."

The "kidney" transplant system works horribly. Thousands die each year waiting for them. E-Bay specifically bans the sale of human organs (yes, someone did try it).

The problem is that money is not determining this system. There's one country that has a (heavily regulated) market for human kidneys. Payments are about two times annual median income to the live donor. It's also the only country in the world without a waiting list. I realize that no one's going to be very happy learning lessons from Iran but that's where the problem has been solved.

We really all do need to learn that kidneys are far too important not to be a market system.

Posted by: Tim Worstall | May 31, 2007 1:09:55 PM

Oh, and diddy, its not the deadness of the donor that matters, its a combination of the cause of death and the amount of time the organs had to degrade. A person who is so sick that they have time to appear in a tv series and to know they are dying in advance is probably suffering from something that is degrading all their organs every second. By the time they actually die (presuming that the laws haven't been changed and they aren't going to harvest all useable organs from a living person and leave her gutted on the table) her organs will most likely be in no condition to do anyone any good. When a person is brain dead and donating healthy organs the same considerations apply in terms of length of time the person is kept functioning on machines. Its not a given that a person who dies young and healthy will, in fact, have healthy organs to donate by the time organs can be harvested.

aimai

Posted by: aimai | May 31, 2007 1:10:23 PM

Jim,

You have a little confused on the organ incentives.

Most serious proposals involve incentives being put in place for supply, but demand still be mediated via UNOS (the organization that determines the medical need list). In other words, this is not a buyer-seller transaction between those who can supply organs and those who need them. This would encourage people to consent to organ donation when they are alive (just like today without the incentive). Patients that need organs would still have to go through the same mechanism, but there would be more supply, hence fewer people dying on the waiting list.

I understand it makes people queasy, but this is nothing at all like pork belly commodity exchanges.

Posted by: wisewon | May 31, 2007 1:14:31 PM

One clarification to my post: these proposals would only allow organ donations post-death, not from healthy donors.

Posted by: wisewon | May 31, 2007 1:18:01 PM

"would only allow organ donations post-death, not from healthy donors."

Which is one of the problems with them. Kidney donation is less dangerous to the donor than pregnancy is to someone renting out their womb.

Why allow money to be used in one transaction and not the other?

Posted by: Tim Worstall | May 31, 2007 1:59:33 PM

Tim,

"Kidney donation is less dangerous to the donor than pregnancy is to someone renting out their womb."

Source?

I've managed care of pregnant women/delivered babies and done kidney transplant surgery on donors (medical school is a great thing). I find that extremely hard to believe.

Posted by: wisewon | May 31, 2007 2:11:48 PM

And one other thought. The situations are not the same from a medical ethics perspective.

For kidney transplants, increased donation post-death would solve the problem by itself, so there isn't necessarily a need to ask patients to risk their lives with love donors.

There are no other options to have a child with your DNA if you've had a hysterectomy.

Posted by: wisewon | May 31, 2007 2:14:55 PM

This a horrific idea for a programme and violates all sorts of medical ethics, although you wouldn't expect any better from Endemol. It does have an obvious title though: Survivor.

Posted by: Ginger Yellow | May 31, 2007 2:21:08 PM

The show sounds pretty ghoulish, but according to the report the producers claim its purpose is to focus public attention on the shortage of organ donors.

Government data suggests the maternal mortality risk (risk of death of a woman from a pregnancy/childbirth) is about 1 in 8,000, while the risk of death from living kidney donation is about 1 in 3,000. So the risk from donating a kidney is higher, but in absolute terms the risk is low in both cases. So the question of why it should be illegal to sell a kidney if it's legal to rent out your womb as a surrogate mother seems quite pertinent.

Posted by: JasonR | May 31, 2007 6:05:15 PM

For kidney transplants, increased donation post-death would solve the problem by itself, so there isn't necessarily a need to ask patients to risk their lives with love donors.

Perhaps there wouldn't be a need for live donors if more people donated after death, but they don't. The ethical and legal questions about living kidney donation apply to the world we actually live in, not the world as you might like it to be.

There are no other options to have a child with your DNA if you've had a hysterectomy.

And there are no other options but a living donor if you need a kidney and can't obtain one from a dead donor. The burden of having to forgo procreating with your own DNA would seem to be rather smaller than the burden of death.

Posted by: JasonR | May 31, 2007 7:38:57 PM

JasonR--

Read a little more carefully. The proposal is to provide incentives for post-death kidneys (prior to death, i.e. you consent now for a $x incentive to be given to your heirs when you die) to a level to provide sufficient supply.

If you do this, you don't need living donors.

If you want any credibility on this site, you'll at least explicitly acknowledge your mistake on this one.

Posted by: wisewon | May 31, 2007 8:07:32 PM

wisewon,

I wasn't talking about any such proposal. I was responding to your claim that "the situations are not the same from a medical ethics perspective," and your statements elaborating on that claim, which I quoted above my responses.

Posted by: JasonR | May 31, 2007 8:32:23 PM

JasonR,

If you read the whole thread, you'll see that I mentioned the proposal first, then later said in the post you referred to that if you put that in place, there would be "increased post-death kidney donation" hence there wouldn't be a need to live donors, hence the situation is different than surrogate parenting.

So you took my quote out of context, jumping on certain phrases from posts halfway down the thread, rather than taking the time to read everything that was written.

Again, an apology is in order-- let's see if you can do it.

Posted by: wisewon | May 31, 2007 8:37:12 PM

Perhaps there wouldn't be a need for live donors if more people donated after death, but they don't.

That's maybe because "after death" doesn't necessarily actually mean "after death" when some organ-hungry ER doctor is jumping the gun on declaring me brain dead so he can use me for spare parts.

I have repeatedly told everyone I know who might be in a position to make a decision about something like this: I don't want my organs donated, period.

Posted by: Jason | May 31, 2007 11:59:09 PM

I bow to the better statistics up above: my source was The Economist.

Posted by: Tim Worstall | Jun 1, 2007 7:58:05 AM

"I bow to the better statistics up above: my source was The Economist."

The Economist isn't a source-- they are providing the information second hand (I doubt they did the analysis themselves, that's not what they do). What is the source of the data?

Posted by: wisewon | Jun 1, 2007 8:56:12 AM

ooooo clever

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Posted by: judy | Oct 6, 2007 12:02:29 AM

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