Wednesday, June 15, 2011

China Considers a Market-Based Approach to Solve Its Kidney Shortage, Maybe the U.S. Can Follow?

The chart above illustrates a very serious and escalating health care crisis in America:  The number of kidney transplant operations has remained flat for the last six years, and there were actually fewer last year (16,968) than in 2006 (17,095).  Meanwhile, the number of registered transplant candidates continues to grow, at an average rate of more than 4,500 new candidates in every year since 2005.  In 2010, the chances of receiving a kidney for the almost 88,000 patients on the waiting list fell below 20% for the first time ever, and those odds probably won't improve any time soon.   

Reason? It's illegal for Americans to receive any kind of financial compensation for providing a kidney to save the life of a stranger, and without financial compensation there's no way to solve the growing kidney shortage.  The number of kidney donations and transplant operations will remain flat, the kidney waiting list will grow, and the pain, suffering and death for those waiting will continue to escalate as the waiting list becomes a sure death sentence for a large majority of patients.  

By relying exclusively on altruistic kidney donation in the supposedly market-friendly U.S., the kidney shortage will surely continue to worsen.  But there's now hope for a more rational, market-based approach in historically market-unfriendly China, according to AEI scholar Sally Satel in Slate.com

"Last month, the China's health ministry announced a proposal that could expand the pool of organs available for transplant surgeries. Huang told the Chinese press that his office was considering several possible incentives. These include tax rebates, deduction of transplant-related hospital fees, medical insurance, tuition waivers for donors' family members, or deduction of burial fees for people who donated in death. 

Unfortunately, much of the international transplant establishment—including the World Health Organization, the Transplantation Society, and the World Medical Association—focuses exclusively on obliterating illicit organ sales. While this may seem like a reasonable approach to abhorrent practices, in reality it is a lethal prescription."

Sally concludes:

"The only way to save lives and starve underground markets abroad is to provide more transplants at home. And the only way to do that is to break radically—and ethically—with a status quo that forbids an informed donor to be rewarded for saving the life of a stranger."

36 Comments:

At 6/15/2011 10:49 PM, Blogger Benjamin said...

This is a fascinating moral and economic issue.

We know that many people will take serious risks for economic gain, ala coal miners and contractors in Iraq, etc. I suppose, since we now have a mercenary military, US soldiers are in this group.

I wonder how many doctors will perform profit-oriented kidney removal. The Hippocratic oath and all that.

BTW, there is a rich vein of urban legends of tourists being fed mickies, and waking up minus a kidney.

 
At 6/15/2011 11:18 PM, Blogger Evergreen Libertarian said...

How about we abolish motorcycle helmet laws?

 
At 6/16/2011 1:07 AM, Blogger Diane Franks said...

@Benjamin - a lot of countries now do not have the hippocratic oath. It was stopped a while back. Apart from which the oath was to "save lives". Not to judge people on their motives for donating. If you are using the Hippocratic oath then doctors should not be using altruistic donors anyway as they are not saving the live of the donor but potentially harming it by performing a totally unnecesary operation. So that theory is out the window.

@Evergreen Libertarian - hahaha!

What I always fail to read in this type of article is that governments will do more to educate people on organ donation. Also there should be opt out systems in place before any bribery of potential donors. I also feel some donors will be put off. I wonder how many true altruistic donors would not put themselves forward because they find the idea of receiving payment for saving a life quite abhorrent. I suppose they can refuse payment assuming that option is available. But would you really refuse lifelong free medical care for your family or other such incentives? Everyone has their price as they say.

More money should be put into education and research. If they can clone a sheep surely they can clone a kidney?

I know someone in Pakistan who was kidnapped and taken to a hospital and had his kidney removed because he owed money to the person he worked for and also rented his house from. The kidney paid for one months rent. I know this for a fact as I was part of the group that tried to bring the person to justice in the courts. But money talks and he was never brought to justice.

 
At 6/16/2011 1:26 AM, Blogger Ron H. said...

"I wonder how many doctors will perform profit-oriented kidney removal. The Hippocratic oath and all that."

Are they doing harm if they remove a kidney from a seller as opposed to a donor? What is different medically?

You have missed the mark on this one.

 
At 6/16/2011 1:39 AM, Blogger Ron H. said...

"I wonder how many true altruistic donors would not put themselves forward because they find the idea of receiving payment for saving a life quite abhorrent."

How many true altruistic donors do you know? Obviously there aren't enough to meet the needs of current kidney candidates, so it doesn't much matter.

"I suppose they can refuse payment assuming that option is available."

Perhaps I'm just not reading this correctly. I can't think of even one situation in which I'm forced to accept payment for something even if I don't want to be paid.

Are you imagining some government agency forcibly harvesting kidneys and then forcing money into the unwilling donor's hands?

 
At 6/16/2011 4:28 AM, Blogger Michael E. Marotta said...

China executes people for minor crimes. Organ transplants for the gerontocracy is offered as a key factor. So, this is a step up for them.

The so-called "Hippocratic Oath" is variously published and is not legally binding. It is more like a marriage vow to love, honor, cherish, and obey. The original version prohibited teaching medicine to anyone other than the son of a doctor. Also, it prohibited the termination of a pregnancy. Neither of those applies today.

While paying someone for a body part makes us squeamish it is hard to find a moral argument that overrides personal agency.

As bilaterally symmetrical creatures, we could make do with one kidney, one lung, one eye, half a thyroid, or half a brain. However, I believe that the long run solution is to grow your own or have an artificial implant.

 
At 6/16/2011 5:05 AM, Blogger rjs said...

what happens when you create that kind of incentive?

http://www.zdnet.com/blog/gadgetreviews/chinese-boy-trades-kidney-in-exchange-for-ipad-2-regrets-it/25254

 
At 6/16/2011 5:09 AM, Blogger Methinks said...

This has to be the biggest no-brainer there is. Why should a donor be expected to make such an enormous sacrifice on behalf of a stranger? Should we also not pay the doctor performing the surgery because it is unseemly to profit from another's misfortune?

This is absurd. Everyone associated with the transplant gets paid except the donor.

 
At 6/16/2011 5:25 AM, Blogger geoih said...

Quote from Benjamin: "I wonder how many doctors will perform profit-oriented kidney removal. The Hippocratic oath and all that."

Because doctors don't profit from the transplants they do now? In today's situation everybody involved profits from a transplant except the donor.

 
At 6/16/2011 5:28 AM, Blogger Larry G said...

this is a fascinating issue that has to do with the essence of open markets and the essence of govt role.

For instance, if there was NO govt involvement at all - what would the open market do?

Should the govt be involved at all - and if so - on what basis?

Would you have the govt be the one to decide what body parts could be sold - to essentially "restrict" the open markets?

 
At 6/16/2011 9:58 AM, Blogger geoih said...

Quote from Larry: "Would you have the govt be the one to decide what body parts could be sold - to essentially "restrict" the open markets?"

What business is it of the government? If a person owns their own body, then they should be free to do what they want with it.

 
At 6/16/2011 11:34 AM, Blogger Whiskey Jim said...

Mark,

There is something fishy about these numbers, for it makes no sense that even without a market in kidneys that the number of transplants should stagnate.

Something is clearly constraining hospital surgery supply, is it not?

Of course there could be many reasons hospitals seem to have reached peak kidney transplants. Nevertheless, there it is.

 
At 6/16/2011 11:41 AM, Blogger Larry G said...

" What business is it of the government? If a person owns their own body, then they should be free to do what they want with it. "

I'm not advocating that it is.... just suggesting that govt thinks it has a role....

in prescription drugs, illegal drugs, abortions, and body parts.

are there any countries in the world that do not regulate body parts?

If there are, that suggests that as long as there are one or more countries that opt out of it that a "free" market still exists... at least in part.

 
At 6/16/2011 12:07 PM, Blogger Evergreen Libertarian said...

re Whiskey Jim's comments. My intention in an earlier comment was to point out the law of unintended consequences. It might be interesting to look for a possible relationship in the decline of highway fatalities and organs available for transplant.

 
At 6/16/2011 12:09 PM, Blogger Ron H. said...

"what happens when you create that kind of incentive?"

"Boy trades kidney for iPad2"

Hopefully you're not suggesting just because someone may act against their own best interest, that everyone should be prohibited from engaging in that activity.

 
At 6/16/2011 12:15 PM, Blogger Larry G said...

"Hopefully you're not suggesting just because someone may act against their own best interest, that everyone should be prohibited from engaging in that activity. "

boy sells kidney for IPAD... loses other kidney... govt steps in and gives him free dialysis until they can find him another "free" kidney.

Wrong?

 
At 6/16/2011 12:37 PM, Blogger Ron H. said...

""boy sells kidney for IPAD... loses other kidney... govt steps in and gives him free dialysis until they can find him another "free" kidney.

Wrong?
"

Wrong.

Your suggestions that government "thinks", can be "the one to decide", "steps in", or otherwise act as a sentient being is just bizarre.

This view interferes with your ability to think logically, and resulting in your making nonsensical comments.

Consider that only people think and act , perhaps through government as their agent, and you will have a clearer view.

 
At 6/16/2011 12:41 PM, Blogger Larry G said...

" This view interferes with your ability to think logically, and resulting in your making nonsensical comments."

well.. I think mine conform to the realities..

and yours to ideology that is theoretical.

I'm not advocating but pointing out that pragmatic realities.

in that regard - my thinking is clearly IN TOUCH with the way things actually work ....

and yours are inside your own mind - disconnected from the real world around you.

 
At 6/16/2011 12:42 PM, Blogger Whiskey Jim said...

It is at least somewhat ironic that the latest health care bill arguably attempts to have taxpayers pay for a woman's 'right' to terminate her pregnancy (some would say murder a viable human being) on the grounds that she owns her own body, while denying her the same right to sell one of her body parts, much less have the taxpayer compensate her for it.

 
At 6/16/2011 12:44 PM, Blogger Larry G said...

" It is at least somewhat ironic that the latest health care bill arguably attempts to have taxpayers pay for a woman's 'right' to terminate her pregnancy (some would say murder a viable human being) on the grounds that she owns her own body, while denying her the same right to sell one of her body parts, much less have the taxpayer compensate her for it."

the govt ALSO regulates abortion separate from who the health care provider/payer is.

what gives the govt the right to decide how taxpayer money is spent vs how non-taxpayer money is spent?

 
At 6/16/2011 1:15 PM, Blogger Ron H. said...

"I'm not advocating but pointing out that pragmatic realities."

You're not addressing the issue, as is usual with you. The issue is whether or not sales of one's own body parts should be legal.

To prohibit a person from selling their own body parts because they might later impose welfare costs, is also an argument for prohibiting a person from donating their body parts. In other words, it's nonsensical.

If you see this as a problem, then your argument should be with the idea of forcing others to pay for the medical costs the donor or seller might incur, not with their right to donate a body part.

Whether or not they are paid for it is irrelevant.

The fact that some people might act foolishly, is not a good reason to forbid an activity.

 
At 6/16/2011 1:23 PM, Blogger Larry G said...

" To prohibit a person from selling their own body parts because they might later impose welfare costs, is also an argument for prohibiting a person from donating their body parts. In other words, it's nonsensical."

it may be to you but not to the people who make policy in this country.

that's why I say you are disconnected from the realities even as you say my views are "non-nonsensical"

again..I'm not advocating one direction or the other here but I'm pointing out how govt CURRENTLY views these things - as a REALITY no matter your personal views that are disconnected from these realities.

so if you want to say "non-nonsensical" go right ahead but you're talking about all the folks who make the decisions on these issues verses folks like you that are a distinct minority.

I merely point out to you - the current realities. You are free to disagree but characterizing it as you do is hilarious given your position in the bigger scheme of these things.

 
At 6/16/2011 1:23 PM, Blogger Larry G said...

" To prohibit a person from selling their own body parts because they might later impose welfare costs, is also an argument for prohibiting a person from donating their body parts. In other words, it's nonsensical."

it may be to you but not to the people who make policy in this country.

that's why I say you are disconnected from the realities even as you say my views are "non-nonsensical"

again..I'm not advocating one direction or the other here but I'm pointing out how govt CURRENTLY views these things - as a REALITY no matter your personal views that are disconnected from these realities.

so if you want to say "non-nonsensical" go right ahead but you're talking about all the folks who make the decisions on these issues verses folks like you that are a distinct minority.

I merely point out to you - the current realities. You are free to disagree but characterizing it as you do is hilarious given your position in the bigger scheme of these things.

 
At 6/16/2011 1:29 PM, Blogger Ron H. said...

Larry, do you believe your comments become less silly if you submit them more than once?

 
At 6/16/2011 1:42 PM, Blogger Larry G said...

nope. I did not submit them more than once but blogger did burb... so I consider such questions as coming from morons who don't know better.

wanna keep trading insults?

I bet I can last longer than you.

 
At 6/16/2011 1:42 PM, Blogger Larry G said...

nope. I did not submit them more than once but blogger did burb... so I consider such questions as coming from morons who don't know better.

wanna keep trading insults?

I bet I can last longer than you.

 
At 6/16/2011 1:50 PM, Blogger Ron H. said...

"It is at least somewhat ironic that the latest health care bill arguably attempts to have taxpayers pay for a woman's 'right' to terminate her pregnancy (some would say murder a viable human being) on the grounds that she owns her own body, while denying her the same right to sell one of her body parts, much less have the taxpayer compensate her for it."

And, it's worse than that: The definition of a human being changes, depending on whether the mother or someone else causes the death of a fetus.

 
At 6/16/2011 1:53 PM, Blogger Ron H. said...

Larry, do you have anything meaningful to contribute to a discussion of organ donation and/or sale?

 
At 6/16/2011 2:01 PM, Blogger Larry G said...

but could a women sell her kidney to pay for her abortion?

 
At 6/16/2011 5:15 PM, Blogger Benjamin said...

Regarding the Hippocratic oath: I only asked; I did not say doctors would refuse to cut into another human being for no medical purpose (for that human being).

I know if I were a doctor I would refuse. Many doctors do believe they can only treat their patients, they cannot get into politics, moral equations etc. They cannot perform n operation that will harm a patient. A kidney removal operation harms the patient, immediately, then in risk of infection, then in risk of future kidney failure.

Should such operations be legal? I fear so, just as I believe we must tolerate prostitution, drug use, and many other sordid aspects of life. They may not seem sordid to another person.

 
At 6/16/2011 8:36 PM, Blogger Jim said...

it occurs to me that the kidney market and the government subsidy of abortion is even more deeply ironic than i previously posted.

For surely many folks would be more than happy to pay the pregnant woman for her fetus, if the government was not subsidizing its disposal. So in this case, the government is not only denying the demand for babies, it is actively aiding in the suppression of the market.

it would be like the government subsidizing women who wished to throw away their 'good' kidneys.

What am i missing?

 
At 6/16/2011 8:41 PM, Blogger Larry G said...

I don't think you are missing anything but have recognized that when we talk about "free markets" and govt regulation that morality is involved and subjective reasoning tied to individuals.

For instance, in a truly free market, as you point out, women could sell their kids .....rather than see them as a threat to their economic livelihood but as a society, we cannot accept that level of "free market" so we want govt to restrict/regulate.

 
At 6/17/2011 2:46 AM, Blogger Ron H. said...

"They cannot perform n operation that will harm a patient. A kidney removal operation harms the patient, immediately, then in risk of infection, then in risk of future kidney failure."

Bunny, in your world, a doctor couldn't perform ANY operation, as any operation harms a patient and exposes them to risk. At the very least, all cosmetic surgery would be forbidden, as well as circumcision.

 
At 6/18/2011 9:08 AM, Blogger VangelV said...

This is a fascinating moral and economic issue.

There is no moral component to it. People own their own bodies and their own kidneys. They should certainly be able to sell one if they wish.

 
At 6/18/2011 9:22 AM, Blogger VangelV said...

what happens when you create that kind of incentive?

http://www.zdnet.com/blog/gadgetreviews/chinese-boy-trades-kidney-in-exchange-for-ipad-2-regrets-it/25254


Adults should be able to do what they wish with their own bodies. End of story.

And I do not believe that the story you cited involved an adult. What was done was probably illegal under current laws and under the proposed changes.

 
At 6/19/2011 12:29 PM, Blogger Ron H. said...

"what happens when you create that kind of incentive?

chinese-boy-trades-kidney-in-exchange-for-ipad-2-regrets-it
"

Nothing is being created. The incentive already exists. There is already a market in body parts, but it is illegal.

Surely you don't believe that this one bad outcome, or even many bad outcomes caused by stupidity, justifies allowing tens of thousands of people to die because they can't buy a needed kidney.

 

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