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Comment by delichon | Hacker News Reader

As relatively smoothly as it went the overall experience sounds more awful then any but the few worst I've ever had. I am not so noble as Mr. Shepherd, and I don't think I'm unusual in that reluctance. I agree with Mr. Berger, who also donated a kidney, but believes that relying on such sacrifice is "part of the problem":

  The people waiting for kidneys aren’t dying because of kidney failure; they’re dying because of our failure — without Congress’s misguided effort to ban organ sales, they would have been able to get the kidneys they desperately needed. -- https://marginalrevolution.com/marginalrevolution/2011/12/organ-donors-for-compensation.html

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The reason it's not allowed is because it's judged to be bad for society to have the lower classes have to sell their kidneys to make ends meet.

For a pure cash sale. But IMO we could be exploring other incentives to donate that don’t have the same issues.

I noted this above, but one proposal is using a tax incentive: https://www.modifynota.org/

Of course it's bad that they have to. But not letting them do it doesn't magically make the ends meet. Right now, today, people have to sell their organs to make ends, but they can't, so they fail to make ends meet.

Your argument amounts to rejecting marginal improvement because it's still not good enough.

No, the argument is that there is no "marginal improvement", it's that it's a net negative for society to have poor people need to sell their kidneys to make ends meet.

"it's a net negative for society to have poor people need to sell their kidneys to make ends meet."

This is, again, not something that is being remedied by the ban. The need hasn't gone away simply because you've taken away the option. People remain poor and struggling in today's world.

Elaine Perlman (the woman I first spoke to) is trying to incentivize kidney donations with a $10,000/yr tax credit for five years for donors. It seems like a reasonable proposal to me.

https://www.modifynota.org/

Ah yes, the constant struggle to enable an even more literal exploitation of the poor by the rich.

How is it exploitation to legalize more types of consensual transactions?

Financial transactions are rarely a matter of consent between equals. There is almost always a power imbalance, particularly when medical issues are involved.

The law, in its majestic equality, allows rich and poor alike to sell their internal organs to try to make their power bill payment next month.

That's without explicit coercion (sure, I'll do X for you, so long as you sell your kidney).

That consent can only occur between equals is a principle that only gets applied to things people want to ban for other reasons.

We all buy things daily from entities with much more power than ourselves, for example.

Focusing on equal relations is missing the point, which is that the corporation (a more powerful entity) is selling you things, not the other way around. “Punching down” isn’t acceptable, and all that.

I think we can all agree that coercion would be bad here. It is currently illegal and should remain illegal.

Hypothetically, if someone wants to sell a kidney to pay the bills, and they are of sound mind, the government shouldn't stop them.

What if I offer someone a million dollars to commit suicide and harvest all their organs? Will desperate people accept that offer? Is it ethical?

That is rhetorical, it is highly unethical. And similarly, desperate people will sell organs under financial pressure and limited or no regulation on the sales tactics or accurate disclosure.

A more effective plan would be to offer $100-$1000 cash payment at time of registration when getting a license to be an organ donor. It is hard to find matches. Better and more economically efficient to have a broader pool of potential donors, for all parties. And since the donors are already brain dead, no ethical dilemma.

Family can object to organ donation from dead relatives where I live.

I don't understand this analogy. If someone is dead they cannot use a million dollars

A million dollars for their family can be life changing.

People have sacrificed their lives for less money for their family than that.

Indeed. The ideal is where all the rich people (hospital, transplant surgeon, OPO chief) make money and the poor person gets nothing for his organ. In this way we have saved the poor guy from exploitation.

Yes, leaving the most important actor out of that juicy money made lot of sense. /s

Exactly. This is the only ethical thing.

I think (definitely not my idea, Alexander discusses it in his post) that a comfortably large tax break in exchange for a kidney donation hits the sweet spot.

You can't get out of acute money problems with a tax break. Arguably still more appealing to the lower middle class than the upper class, but it seems literally impossible to reward people for the sacrifice involved in an organ donation without the marginal utility problem arising.

Still, I think it eliminates all the truly unpalatable failure modes, like impulsively donating a kidney to pay off a gambling debt. If some people choose to make an organ donation so they'll have more of their income over a five year period to invest into their children's college fund, that isn't such a bad thing.

Another incentive, at least in the US, could be to give them free healthcare for life.

That’s a hell of a way to achieve universal healthcare.

And with half as many kidneys to provide medical care for, healthcare costs will go down by 50%!

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