Response to “Organs for Sale”

“Organs for Sale” is an argument written in response to the on-going ethical debate of a market-based incentive program to meet the rising demands of organ transplants - Response to “Organs for Sale” introduction. With many on the waiting list for new organs and few organs being offered, the author, Sally Satel, urges for legalization of payment to organ donors. Once in need of a new kidney herself, Sally writes of the anguish she encountered while facing three days a week on dialysis and the long wait on the UNOS list with no prospective willing donors in sight.

She goes on to list several saddening researched facts on dialysis patients survival rates, length of time on the UNOS wait list, and registered as well as deceased donor numbers. While Sally is very much for the compensation of organ donors being legalized she does make note of the current altruistic system. She suggests that having both the altruistic system and the market –based incentive program would be the best way of tackling the detrimental numbers of wait listed patients. She strengthens this argument by offering four different ideas on how to set up the market for organs; the easiest, and my favorite, being private contracts.

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Dr. Satel admits that there will be challenges in the implementation of donor compensation, but presumes it is the right step to take in hopes of closing some of the gap between those needing organs and available donors. I believe Sally Satel’s theory of legalizing a market-based incentive program for organs is extremely useful because it sheds light on the growing gap of those needing organs to donors. In the argument, Sally mentions four intriguing ways to implement a compensation for donation of organs. The first idea she mentions is “a forward market for cadaver organs”.

In this form of compensation either the government or insurance companies would pay a small amount to people that join the donor registry. It also suggests that people could join the donor registry anticipating a larger amount being paid to their estates if their organs are utilized upon death. Personally, I think that they could probably successfully use both of these ideas simultaneously with a bit of modification. Everyone that joins the registry now could get a small payout just for the act of putting their name on the list. Then if their organs are used upon death, a larger donation could be made to their estate.

They could also add in that if the person decides to dedicate themselves as a live donor as well, he or she would receive a larger amount paid at the time of the live donation. Money drives people, and this could definitely drive some to undergo the inconvenience and risks of a live donation. After all, people can often be selfish and wonder how donating a kidney to a stranger could benefit them any. With few deceased donors and even fewer live donors, I feel this would help to equalize the sides as well as produce increases to both.

Unfortunately, I don’t think the process of taking a chance on payment to the estate if the organs are used would work alone. We live in a nation that is impatient and skeptical. I believe many would doubt the promise of payment from the government or insurance companies to their estates, as many have lost faith in both. Also, in a time of high speed technology, get rich quick schemes, microwave dinners, and paying an arm and leg for overnight shipping, I find it hard to believe many would join the donor list at all without a definite small payment upon registry.

Sally Satel then offers the solution of “the centralized single compensator”. In this option, she suggests that the donor could choose how he or she wanted to be compensated. With compensation ranging from deposits to a retirement fund to lifetime health insurance benefits, you really can’t go wrong with this route. She does go on to note that some would be unimpressed and even upset with the fact that undereducated or irresponsible spenders would simply choose to donate for the quick payment and then spend frivolously.

Honestly, I don’t see how any one would think they have the right to mandate the way someone spends their money, or legally obtains it at that. If a person chooses to be a plumber and then spend all of their paycheck on beer, they have every right to. And this should be the case with a volunteer compensated donor. Next, Mrs. Satel mentions the “multiple compensator” option. She does not elaborate much on this possibility, but she does mention a sort of arranged triangle between the donor, compensator, and hospital. She explains that charities or insurance companies could be the compensators.

With the lack of detail on this option, and my lack of understanding, I’m afraid I can neither agree nor disagree with this option. Lastly, she gives detail on “private contracts” being another form of compensation. This is by far my favorite solution and easily the one I would implement if I were able. Can you imagine seeing ads on Craigslist. Org: “Kidney Needed-will pay $5000” or “Willing Donor-asking $4000”? Or even a new swap website where you can barter for your new kidney or offer work, “Will work for kidney”, for those that simply don’t have the funds to pay. That would definitely be a sight, but I can certainly picture it.

Considering women currently get compensation for their eggs, men for their sperm, and plasma donors for their plasma, I find it odd that this isn’t already taking place. What differentiates eggs, sperm, or plasma, all parts of the human body, from a kidney? If anything you would think that the kidney would take precedent being that it is a life threatening organ if failing. And there could always be an alternative way for the less fortunate to enter into a contract like charitable donations. I think the thing I love most about this article is that Sally does not leave out the altruistic system presently in place.

Unfortunately, often times the spiritual benefit of this system falls inferior to the palpable benefit wanted. While some may think placing a price to a body part is sick or unethical, I believe Sally is on the right track by suggesting compensation to donors. I definitely feel it would be a step in the right direction in solving the devastatingly low numbers of donors compared to the high number of patients needing new organs. So, I will agree with Mrs. Satel’s suggestion of legalizing a market-based incentive program for organs.

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