Transplant Brokers in Israel Lure Desperate Kidney Patients to Costa Rica | Hacker News Reader

Transplant Brokers in Israel Lure Desperate Kidney Patients to Costa Rica

nytimes.com

19 pointseroo10 comments

The article devotes just 3 sentences, in a short aside, to the idea that kidney sales could be encouraged, in an orderly and fair manner, rather than prohibited. (It's the prohibition which creates black market profits and kills thousands waiting for kidneys.)

For more on this possibility:

http://reason.com/archives/2008/05/13/kidneys-for-sale

http://www.cato.org/publications/policy-analysis/organ-sales...

Virginia Postrel, a former editor of Reason who actually donated one of her kidneys to a friend, has also written about donor chains and compensation:

http://www.theatlantic.com/magazine/archive/2009/07/with-fun...

Unless health turns out to be like education and clean water - potentially better served by an other than completely private market, whether for reasons of inelasticity of demand, public utility of 99.9% literacy, etc.

In that case there could be payment for organs, but for everyone else's too.

Also in this case, besides communal funding, compulsory "donation" might also work. (Or compulsory "donation" but with compensation from communal funding, and a private market might conceivably ride on top of that.)

edited to remove mention of "right" as it is not necessary for the analogy

If health is a human right, how is prohibiting someone from paying to be healthier productive? Note that prohibition even includes purchase of organs from the estates of dead donors.

If you want funds to come from a communal pot to reduce the problem of rich people getting more health than others that's one thing, but prohibiting the practice unless you have that sort of thing is kind of weird.

The current policy of compensation-prohibition, derived from fuzzy sloganeering like "health is a universal human right" [your pre-edit wording], is resulting in thousands of unnecessary deaths a year.

And until you get 100% of what you want – perfectly equal health care for everybody? – are we just supposed to see those deaths as a price worth paying? When your ideal is finally implemented, be it next year, or maybe in a decade, or maybe a century from now, will those who died be happy to know they were noble martyrs for a good cause, a necessary demonstration of suffering to help bring the laggards around?

My favorite blogger that touches on these issues is Al Roth (http://marketdesigner.blogspot.com), a professor now at Stanford.

One of the coolest ideas there is the "organ donation chain." Think of one patient's spouse donating their kidney to another patient, and vice versa; now add an intermediary couple, and you've got a chain where more kidneys reach better compatible hosts. Unfortunately, because someone could always get cold feet, a lot of these chains had been carried out simultaneously, which naturally limits the size of such a chain.

So the cherry on top is a "non-directed" starter kidney. With this initial gift of altruism there's a little more leeway to arrange the matches and it's a disappointment but not a showstopper when someone finally stops the chain.

Anyways, it's always nice to think about the stopgaps between now and the sci-fi organ-growing future.

> Some physicians and ethicists question the relative morality of allowing thousands to die just because the means of saving them is considered repugnant. A regulated marketplace, they say, could all but eliminate the shortage.

If synthetic organ synthesis (or regenesis) is successful, the field of transplantation will explode and the driver for this black market will disappear. Until that time, we're stuck with an ethically delicate situation. Curious to hear what HN thinks of creating such a regulated market, and whether it's fundamentally different from unpaid donations or chained donations.

> If synthetic organ synthesis (or regenesis) is successful

I'm rooting for it and I think we should devote more resources to further that field. Apart of being able to completely eliminate both organs shortage and the problem of organ black market, we can expect lab-grown meat to appear as a side effect of early research. There are lots of problems - not only ethical, but related to energy and fossil fuel usage - that we could solve if we didn't have to kill that cow to eat our burger.

carbocation, I know of the Ott lab's work on regeneration (or rather, recellularization) of explanted organs[1].

Do you know of other pioneering work in the field, or similar efforts to follow?

1. http://ottlab.mgh.harvard.edu/?page_id=205

I'm not up to date on the latest, but my understanding of the state of the art seems similar to yours.

I remember reading this in the economist a long time ago: http://www.economist.com/node/8173039 It advocates a market-based solution.

At the time I thought it made a lot of sense. I still think it does.

Reply on news.ycombinator.com