A U.S. Organ Trafficking Conviction

Slightly similar, the tissue trafficking case a few years back – they got rather longer in jail and were rather more obviously unethical…
http://news.bbc.co.uk/1/hi/world/americas/6064692.stm

The profit margins Rosenbaum charged were quite startling.
“A New York man born in Israel, Elahn Quick, told the judge that he sold his kidney for about $25,000 in 2008 in a transplant organized by Rosenbaum.
Becky Cohen, the daughter of the man who bought the kidney, testified that the family paid Rosenbaum $150,000 for the organ. ”

Those are even bigger than heroin-trade markups. Or, more appropriately, than US-healthcare-system markups. He should have gone into military procurement.

The businessweek piece reads a bit like an O. Henry story.

Although, ironically, she did review a book about organ donation by another sociologist, also named Kieran Healy, for the New York Times.

bq. Although, ironically, she did review a book about organ donation by another sociologist, also named Kieran Healy, for the New York Times.

It’s a very common name, you know, among Irish people. And _even more common_ among sociologists working on the organizational aspects of organ donation. Among the latter it’s damn near ubiquitous.

It may be the boring thing to say, but here goes anyway: I’m struggling to see the objection to Rosenbaum’s behaviour. He brought together donors and donees, and in so doing saved lives. Mr. Quick thought that donating his kidney was a good deed – he was right! And it doesn’t stop becoming a good deed because someone pays you. Nor does Rosenbaum stop being a hero by making money out of the deal – if a life is worth saving, it’s worth saving at a profit.

Now, if Rosenbaum made huge sums out of the transactions (which he disputes) then all that really says is that we need more and better organisations in that line of work. No wonder it’s dysfunctional when it’s illegal! Depending on your broader outlook, you might think we should deregulate and let the invisible hand guide, or you might think the government can use its economies of scale and ability to capture externalities to run the service itself. Either way, I view Rosenbaum as a lifesaver who deserves to be imitated not condemned.

Salem, I think what this chap did is a bit like people smuggling. It may be necessary and at times heroic, but most people like to hope there’s a better way that these problems can be solved. I wouldn’t be surprised if Kieran doesn’t see this as an example of the need to reform the organ donation system, for example.

Hey, I had not previously realised that book, as reviewed by Virginia Postrel, was now out in a reasonably priced paperback and Kindle edition. Now there’s even less excuse for bloggers writing about the subject to not be familiar with the literature.

Yes, Al has done some very nice work on simulating the conditions under which living-donor chains will work, and whether long chains are really needed or likely to occur. There are some people at CMU and also MIT who are working on the same problem (some economists and some more operations-research/algorithmic/graph theory people). Al thinks long chains are viable and will tend to benefit harder-to-match candidates. Earlier models have tended to assume away histocompatibility and just look at blood groups, and in that case you tend to get lots of short chains. I have a working paper with Kim Krawiec (a friend who teaches in the Law School here) looking at some of this stuff. In practice, so far, even the longest chains are often really several big simultaneous multi-way swaps (with a couple of longer gaps). The prospect of this NEAD approach becoming more common raises the possibility of reneging on promises to give/participate in the chain. This is something that the Econ/simulation literature hasn’t addressed, in part because they’ve focused on making sense of the matching problem given a pool of mutually incompatible donor/patient pairs. Lots of interesting stuff being done.

Maggie, kidney donation does not impact ones health more then any other surgery of similar scope. Long term you can live with one kidney just fine. We let people work around benzene for far less money, with far more of a health impact.

Yeah, and so does working at an oil refinery. This whole “some risks are too high for us to allow others to take money to take” schtick is really an excuse for “oh icky” unless you feel the same way about firemen and others who take risks to save lives for which they are compensated. What makes some risks okay to take out of avarice and others not?

Watson Ladd, #21:

This whole “some risks are too high for us to allow others to take money to take” schtick is really an excuse for “oh icky” unless you feel the same way about firemen and others who take risks to save lives for which they are compensated. What makes some risks okay to take out of avarice and others not?

You find it hard to find even quite simple (not deeply theoretical) arguments? Just what springs to mind…

1. Suitability for being a sustainable career, filling a sizeable chunk of the subject’s working life.
2. Level of risk of coming out of it with one’s physical integrity intact — still the expectation for a firefighter, while inherently impossible for the organ donor. Note also that there are occupations (eg. American football player) that are becoming less acceptable as the inherent risk is coming to light.
3. Perceived degree of urgency of having the job in question performed in this risky way. Right now, a number of already very sick people die prematurely (compared to their life expectancy had an organ be available). Arguably — and you and I may disagree — our cost-benefit analysis of resolving this issue by buying organs comes out less favorably than the one for avoiding the burning-down of neighbourhoods, people and property by hiring willing people to fight fires. In addition, it could be argued that were a less risky way of fighting fires (say, remotely piloted robots) available, we would not accept for human beings to be exposed to the risk.
4. Impact on social cohesion and potential for stigmatisation and exploitation of participants.

Also, “avarice” is surely the wrong term for the motivation of firefighter’s choice of occupation, and indeed also for the hypothetical organ seller.

This post also seems to contradict the official CT policy of never, ever allowing criticism of anything ever done by an Israeli. CT has a strong reputation as a hard line Zionist blog and such posts are going to tarnish this hard earned status.

Many kidney donors would be young and thus proportionately more likely to be in good health. While having only one kidney may not make a difference to them now, if they develop adult onset diabetes in their 50s it might make a very great difference indeed. And I’m sure we’re all familiar with tales of someone donating a kidney to her boss, then being fired, and having health insurance run out and refuse to take her on again as she have a preexisting condition? God willing and Mitt Romney takes his white ass back to Utah, the lady won’t get turned down for pre-existing conditions, of course.

08:24 “Kidneys will become the new mobile phones”. I’m gonna rip that one off at every opportunity. Ajay scoops the Internet for July.

Mr. Quick thought that donating his kidney was a good deed – he was right! And it doesn’t stop becoming a good deed because someone pays you.

In a moral sense, surely it does? If I give a bottle of water to a thirsty man, that’s a good deed, for which I deserve moral credit. If I sell him a bottle of water for 80p, that’s just business as usual. If I sell him a bottle of water for £5,000, then I’m profiteering scum.

Thanks, Katherine, I thought it was a fairly cogent point myself.

Not to take away from your excellent point Ajay, which is indeed an excellent point, but my post was actually in response to John (Quiggin).

Doh!

I’ll take this opportunity to announce that none of my kidneys will ever go to John Quiggin.

On the topic at hand, ajay does indeed win the thread.

To accommodate Watson Ladd’s objections, they could implement the Swedish model for controlling prostitution: not illegal to sell, but illegal to purchase and to facilitate the purchase. Voila.

Why shouldn’t you be able to sell your heart – removal to take place after you die, of course?

Lots of people are not organ donors, but would become organ donors for a sufficient incentive.

J. Otto Pohl, as per John’s comment, you may now consider yourself disinvited from commenting on any of my posts in future. The good news, fwiw, is that this entitles you to stick an “Officially Oppressed by the Forces of Zionism” badge on the sidebar of your own blog (no larger than 120×180 pixels though, and don’t think that we won’t be checking).

43: ah, OK. That would make sense. But the payment would have to take place after death as well. No one’s going to give you much money now for an agreement to maybe deliver your heart in usable condition at some indefinite point in the future. What if you die of a heart attack? Or a shark attack?

Iran has a (heavily government controlled) market for live kidney donations. Iran has no shortage of kidneys for donation. Such paid markets can obviously work.

The Iranian market doesn’t work terribly well. http://www.guardian.co.uk/world/2012/may/27/iran-legal-trade-kidney

How close is surrogacy to organ donation depends heavily on how severe are the long-term consequences.
One important aspect where they are different is that surrogate women do know in advance what a pregnancy entails, while e.g. kidney donors may be poorly informed (see the link by ajay).

Re: surrogacy, I am reminded of the point elegantly made to my 1L contracts course by Mel Eisenberg, in taking us through the New Jersey surrogacy case (cannot remember the name of the case). The purchasers/aspirant adoptive parents argued that the surrogate should be held to the terms of the contract because, having previously given birth she had entered into the surrogacy contract in full knowledge of what she was getting into. The counter argument being that the surrogate had never before been pregnant with and given birth to *this* baby. There is a degree of intimacy in carrying a child to full term and giving birth that is unique and makes surrogacy to my mind different from organ donation.

Dairy, I will try not to pull a DataTutashkhia: thus, since I don’t know much about pregnancy (well, I *did* experience it, but for some reason my memory is fuzzy about it) I will take your judgement.
However, how do you think this should be translated in practice? Barring payments for surrogacy?

Manta1976: I am by no means ready to arrive at the conclusion that surrogacy for $$ should be banned. I do think, though, that regarding full term pregnancy and birth as merely matters of physical risk is too limited a frame. The natural progression of full term pregnancy and birth is to result in a new human being still acutely physically dependent – most typically on the mother and other closely related adults. I really don’t think most of us are _emotionally_ attached to our kidneys, even if we are physically dependent on them.

BTW – most of my memory of pregnancy relates to 8.25 months of unrelenting nausea and such an acute heightening of my sense of smell as to convert daily life into an (unpleasant) otherworldly experience, progressively augmented by extraordinarily painful sciatica. I find the resulting child fabulous, though, so clearly none of this got in the way of bonding.

In that case, I’d like to submit a polite requests for reconsideration of the ban, with full understanding of my position as a guest, and without seeking to assert imagined rights to publication.

Three for the price of one! Christian_h, you’re also no longer welcome in my comments threads – since your attack was directed at me personally, this is a purely personal ban.

As a general statement on all this, I’m very keen to change the tone of (what should be a) conversation arising from my posts. So, I’m not going to spell out any further rules, but I am going to remind commenters that you are guests – if you act, towards me or other commenters, in a way that would get you thrown out of a party at my house, or not invited back, you can expect the same thing here.

Oh, and I was going to add: going right on blithely commenting after you’ve been banned is exactly the kind of disrespect that suggests that a ban is warranted.

Belle, both kidneys filter the same blood and inevitably get damaged at the same rate by diabetes. In fact, there is no known disease that strikes one kidney down and spares the other. There is no redundancy in two kidneys.

Physical integrity is a red herring: if tonight a kidney was magically removed from your body, or you found out that you only ever had one kidney, how bad would your quality of life be? The removal of the pinkie toe is far more crippling.

People raising the specter of the poor being forced to sell organs to meet asset limits etc. are being disingenuous. US courts do not force people to work to pay off debts. We exclude the home from bankruptcy cases to protect the family of someone who is bankrupt. Why is it so hard to imagine excluding organs from the assets counted against these limits?

“In fact, there is no known disease that strikes one kidney down and spares the other. There is no redundancy in two kidneys.”

Eh? There’s a cancer of the kidneys isn’t there? One which does not strike both at the same time?

There is also physical damage: a kidney punch for example. OK, that second isn’t a disease but the first is.

“In fact, there is no known disease that strikes one kidney down and spares the other. There is no redundancy in two kidneys.”

Eh? There’s a cancer of the kidneys isn’t there? One which does not strike both at the same time?

Yes. My great-niece (when she was three years old) suffered one of the kinds of cancer that can do this. The affected kidney was removed.

Thank you, John.

May I too suggest that Dr. Pohl, who could be, at times, cranky and super-opinionated (and who isn’t?), is always a good sport, and a proven expert and activist in everything ethnic cleansing, which explains his frustration (though does not excuse the way he expressed it). And Christian_H, who doesn’t need my defense, is exactly the sort of person to whom Che Guevara addressed his famous “If you tremble at every injustice, you are a comrade of mine.”

We all have (objectively) good qualities that sometimes manifest in an unpleasant way, but we can be more sensitive to each other in these situations, more forgiving. Yes, Sir. Yes, we can.

I meant “….that the poor man’s body is NOT inalienably his own,” of course. And BTW I know that the libertarian concept of “ownership” is tightly bound up with the right to sell the thing owned, the problems with which are a whole other discussion. Nonetheless, the insistence on “self-ownership” seems futile or even perverse if it turns out to diminish people’s ability to actually keep the the thing supposedly owned.

To provide some medical perspective, between 10% and 16% (US numbers) of adults have chronic kidney disease, which provides some estimate of how many donors might expect that later in life. The main causes, diabetic and hypertensive kidney disease, can be halted but not reversed.

As renal function decreases, having one vs two kidneys does make a difference. Nephron (the little systems that do the filtering) mass directly affects how quickly one can clear waste from the blood. Halving your nephron mass by donating a kidney still leaves you just in the normal range of function if you are young and healthy, but nobody stays young and healthy (and, for more perspective, a healthy 70-year-old only has half the renal function of a healthy 30-year-old). As renal function decreases with the progression of disease, it will usually decrease more quickly in a person with only one kidney. Someone with decreased renal function is at increased risk for adverse medication effects and cardiovascular complications. People with chronic kidney disease generally progress to end-stage renal disease. This means dialysis, i.e. waiting for a transplant, and has a prevalence of around 0.2% (1 in 500 people, or 1 in every 64 people with chronic kidney disease). This would be reached at an earlier age by a person starting off with half of a normal nephron mass. End-stage renal disease has a 5-year mortality rate of around 70%. Also, regarding previous comments, there are things that can damage one kidney: embolic disease, renal artery thrombosis or stenosis, tumour, and accident all come to mind. Not to say that people should not donate a kidney or be frightened if they are born with only one kidney or have to have one removed – just that the risks of donation should not be minimised.

I don’t know about economists, but I think that one reason that many doctors are wary of paid organ donation is the possibility of exploitation. Even well-educated patients receiving the most well-intentioned and communicative of care often undergo procedures without really understanding the risks and benefits. Once there is money in it for someone to convince someone else to give up an organ, people will be taken advantage of.

Oh, sorry – I am a final-year medical student. The numbers are mostly from NHANES (National Health and Nutrition Examination Survey) 1999-2004 data collected by the CDC in the U.S. and published in 2007 in JAMA and CDC MMWR . Etiology and prognosis etc. can be double-checked at
emedicine, a pretty reliable and up-to-date resource with free sign-up. If you are on a university network and have access, UpToDate and DynaMed are also excellent.

My assertion that patients often undergo procedures without really understanding the risks and benefits is admittedly only from personal experience on clinical rotations. I have had discussions with professors, residents, and surgical attendings about the nature and value of informed consent, and their experiences seemed mostly to parallel my own. I don’t have any solution to the problem of informed consent, especially in the complicated case of kidney donation (short- and long-term risks that are difficult to sort out and calculate), but I am sure that creating a space in the process for profit-seekers would only complicate the problem.

Maggie: Everyone wants clone generated organs. The technical issues remaining to be solved in the case of the kidneys are immense: so far we’ve only got tracheas into living patients. Transplants have significant costs: rejection, immunosurpression, etc. Kidneys have very nontrivial plumbing, and so far we depend on taking donated organs and killing the cells in them to leave behind a matrix for the production of new organs.

Furthermore no one is talking about mandatory kidney donation. People will be just as able to keep their kidneys as now.

As people have pointed out, we can look at Iran where kidney sales are legal and see how it is working, rather then BS.

More importantly Watson, would the proceeds on a sold kidney be taxed as capital gains or ordinary income?

Laws against kidney-selling, selling oneself into slavery, prostitution, baby-selling etc. function (among other things) to spare the poor certain dilemmas and to signal to them that certain solutions, even if tempting or even practically irresistible, are at least not socially expected of them.

…sometimes you read a sentence so perfectly well-written and incisive and concise that you feel compelled to quote it, because it deserves to be seen in italics. … yeah. … Also, this idea generalizes beyond the social experience of the poor. Signalling to people that certain sacrifices are not socially expected of them is important even in cases where everyone has universal basic income, e.g. a law restricting bathroom break policies functions as a signal that you, whether desperately poor or just struggling to be a good single parent who provides her kids with new toys, are not socially expected to forgo bathroom breaks in order to work for a telemarketing firm. Reading this comment clarified what I’m finding most disturbing about proposals to reduce employee’s means of redress of grievances to threat of exit. Even if on some technical level it functions adequately, people shouldn’t have to feel like it’s reasonable for anyone to expect that of them. “If you don’t like it, leave” is a very worker-hostile signal for a state to adopt, even if it’s mitigated by “If you don’t like it, leave; we’ll help you.”

A couple of studies suggest that the recipients of purchased kidneys don’t fare as well as recipients of altruistically donated kidneys: http://www.ncbi.nlm.nih.gov/pubmed/17102761 and http://www.ncbi.nlm.nih.gov/pubmed/18922987

Granted, their sample sizes are small, but it does show that more research is needed.

I can’t help wondering if Watson has sold his own kidney, since he thinks it is such an easy and relatively safe way to make a little extra cash. Would he advise his wife and children to do this for pin or mad money?