A U.S. Organ Trafficking Conviction

by Kieran Healy on July 12, 2012

Levy Izhak Rosenbaum gets 30 months (though he may end up being deported to Israel) for brokering kidney sales in New York, something which I don’t think has happened before in the United States:

He pleaded guilty in October to three counts of organ trafficking and one of conspiracy. … Three ailing people in New Jersey paid Rosenbaum a total of $410,000 to arrange the sale of kidneys from healthy donors, and an undercover FBI agent paid him $10,000. … Rosenbaum told a federal agent that he began brokering kidney sales around 1999, recruited Israelis to sell their organs and charged Americans as much as $160,000 a kidney. He told the agent that he had arranged “quite a lot” of transplants, according to a criminal complaint. … Before the judge imposed sentence, prosecutors presented testimony from a doctor and administrator from Albert Einstein Medical Center in Philadelphia. Rosenbaum organized about a dozen kidney transplants there from 1999 to 2002 and the hospital didn’t know the surgeries involved black-market kidneys, they said. … 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. The transplant surgery itself was financed by Cohen’s family insurance. A locksmith, Quick, 31, said he sold his kidney because he needed the cash and thought doing so was a good deed.

The role of the transplant center in Philly is an interesting one—I wonder where they thought the kidneys were coming from. Perhaps some story about relatives?

Both the legal and illegal sides of the transplant industry are embedded in the wider world of health care provision. As Bryan O’Sullivan remarks, the third paragraph of the article, setting up the story, inadvertently does quite a good job of describing US healthcare as a whole:

“It’s a kind of trading in human misery,” Thompson said of black-market kidney sales. Rosenbaum “charged a fee” for kidneys and “used a complicated web of transactions” to finance his business. “He corrupted himself,” the judge said.

“So as you can imagine it was quite difficult for us to build a case against him”, Thompson did not add.

{ 86 comments }

1

ajay 07.12.12 at 3:09 pm

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.

2

Barry 07.12.12 at 4:03 pm

Kieran, you thought that there wasn’t enough liberal vs. libertarian fights already going on here? :)

3

Data Tutashkhia 07.12.12 at 4:14 pm

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

4

jc 07.12.12 at 4:28 pm

i assume you’ve familiarized yourself with the virginia postrel arguments for a legalized market in human organs?

5

Kieran Healy 07.12.12 at 4:44 pm

Never heard of her.

6

Henry 07.12.12 at 4:48 pm

Nor she of you.

7

Aaron Swartz 07.12.12 at 5:01 pm

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

8

tomslee 07.12.12 at 5:32 pm

I think that must have been Keira Knealy.

9

Henry 07.12.12 at 5:38 pm

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.

10

peggy 07.12.12 at 6:04 pm

The surgeons at Albert Einstein are lucky that they didn’t get indicted. A dozen transplants in three years- did all the donors claim to be newly discovered Israeli cousins?

Lots of people must have realized what was going on, only the fixer failed to pay off the one who squealed to the feds.

11

Salem 07.12.12 at 7:47 pm

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.

12

merian 07.12.12 at 10:21 pm

There was a recent Philosophy Bites podcast on the ethics of selling organs with Tim Lewens, who’s a historian and philosopher of science (not, I note, an ethicist) at Cambridge University. I was a little underwhelmed with Lewen’s starting point, which consisted in stating that currently organ donors are required to be motivated by altruism. He then raised two potential arguments to support this altruism mandate. The first, regarding the quality of supply (a classist argument based on the presumed low-quality of organs on offer by poor people who are being incentivized to sell their organs) , he destroyed right away. The second, about the quantity of supply (because presumably in an organ market, current altruistic donors would be turned off donating), ended up mostly undecided. If followed a rather hand-wavey discussion of exploitation and a better one on incentives that would be compatible with altruism.

“Should we require, or not, that organ donations are motivated by altruism” sounds like the wrong question to me. Ultimately, we can’t legislate motivation. Also, I doubt the need for the primacy of altruism — altruism as a typical motivation could just as well be a side-effect of an ethically set-up scheme. Its cornerstones would have to include a scheme that distributes available organ by need and not by ability to pay. We could also have state-mandated protection from dismissal for organ donors who have to take some time off from work, compensation for lost earnings, insurance coverage in case of side effects, and a few possibly non-monetary perks to say thank-you for the physical suffering. None of these would be payment.

As for paying for organs, more than a nebulous exploitation argument (which I’m sure we could refine now that CT has all this experience with discussing workplace exploitation), I’d think that the effect on social cohesion might be rather devastating if selling one’s bodyparts became the expected behavior of poor people, or people who hit insolvency. Im sure there’s a suitable dystopia available in the SciFi literature. Leaving out this aspect was my main beef with the podcast.

Of course the ethics of selling one’s organs is different from, though a prerequisite for the consideration of, the ethics of brokering organs for profit, the ethics of making organs available only to people who pay, or indeed the ethics of running any part of the health care system for profit (that is, beyond assuring the livelihood of practitioners and whatever support staff is indispensable for keeping the system running).

13

faustusnotes 07.12.12 at 11:25 pm

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.

14

Josh G. 07.12.12 at 11:59 pm

I think the objectionability of allowing organ sales has a lot to do with the characteristics of the society in which it happens.
If they allowed organ sales in, say, Sweden or Finland, I wouldn’t be too concerned. Those societies have decent social safety nets, good solidarity, and reasonably low Gini coefficients, and their citizens are unlikely to face choices such as “donate your kidney or starve on the streets.”
But in America, where what little social safety net exists is in tatters, and one of the two major political parties openly hates the poor? The chances for exploitation are far too great. If we allow this, how long before Southern states start forcibly taking organs from convicted criminals? How long before donating kidneys, blood, etc. is a requirement for anyone on food stamps or Medicaid?
Smash the Republicans first, and then we can talk about allowing organ sales.

15

dsquared 07.13.12 at 12:11 am

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.

16

John Quiggin 07.13.12 at 12:58 am

As an aside, last week I heard economist Al Roth give a fascinating talk on the problem of matching kidney donors to recipients. A large proportion of living donors are family members of the intended recipient (and living donors are increasingly important), but they are not always compatible, and this can produce long chains of exchanges.

17

Kieran 07.13.12 at 1:30 am

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.

18

Maggie 07.13.12 at 2:45 am

“if a life is worth saving, it’s worth saving at a profit”

Not if introducing profit motive into the system leads to fewer lives ultimately being saved. As is inarguably the case in the current U.S. healthcare system at large. And it’s only too easy to imagine what would happen to death rates among a population of the poor who were exposed to the hazards of major surgery absent access to health care generally (follow up would be provided, sure, but with profit in the picture would it be sufficiently generous? wouldn’t it perversely get less and less generous the worse and more extended one’s condition becomes, as already happens in the rest of the profit-based system? and will people who’ve never been doctored for their own sake stand up as well to surgery? and under a profit system would the checks against operating on weak candidates be as strong?) and who would face their own incidence of kidney disease or trauma without a spare and without being able to buy another to make up for it.

None but the richest of the rich (and most kidney patients aren’t) can afford to offer prices that would motivate any but the utterly desperate and/or ridiculously innumerate and shortsighted. Even the “proles” know that $25K is next to nothing these days, will hardly get you into a half-decent pickup truck. You’d have to look outside the developed world to find significant numbers of reasonably-healthy people desperate enough to be motivated by such small sums. Which of course opens another whole can of worms.

For a dystopian sci-fi take on a different but closely related set of possibilities, see of course the recent movie “Repo Men.”

19

Watson Ladd 07.13.12 at 4:31 am

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.

20

Harold 07.13.12 at 4:46 am

All major surgery carries significant risk.

21

Watson Ladd 07.13.12 at 5:42 am

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?

22

bad Jim 07.13.12 at 6:05 am

I’ve heard from someone working in a major hospital that tissue matching has become a minor consideration because the drugs now in use are sufficient to suppress rejection. It could be that this is false in general, or true only for certain organs; it could even be the case that the survival rate for organ recipients is so poor that it doesn’t matter. I have no expertise, and only pass this along because my informant is not a complete idiot (some parts are missing) and has no reason to lie to me, and because it seems plausible to the extent that even recipients of matching organs require immunosuppressive treatment forever after.

23

merian 07.13.12 at 6:39 am

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.

24

Barista 07.13.12 at 6:40 am

I happen to only have one kidney. I found out by accident, and I have been slightly unnerved by the variable quality of my urinary processes ever since. It does make a difference.

25

J. Otto Pohl 07.13.12 at 6:50 am

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.

26

Data Tutashkhia 07.13.12 at 7:16 am

Otto, it’s perfectly alright to criticize despicable traitors who committed yerida.

27

Belle Waring 07.13.12 at 7:22 am

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.

28

ajay 07.13.12 at 8:24 am

14 is a good point. Kidneys will become the new mobile phones – as in “how can they say they’re really poor when they can afford to have X”.

29

Plucky Underdog 07.13.12 at 9:22 am

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.

30

John Quiggin 07.13.12 at 9:25 am

I’ll take this opportunity to say that J Otto Pohl and Data Tutashkhia are permanently banned from commenting on any post of which I am the author.

31

ajay 07.13.12 at 9:39 am

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.

32

Katherine 07.13.12 at 9:40 am

Oh thank fuck for that.

33

ajay 07.13.12 at 9:44 am

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

34

Data Tutashkhia 07.13.12 at 9:52 am

What, because of this particular joke, @26? It wasn’t nasty, and a bunch of people were making jokes in this thread right from the beginning. Not fair.

35

Katherine 07.13.12 at 10:31 am

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).

36

ajay 07.13.12 at 10:35 am

35: it was a purported misunderstanding intended for humorous effect, your honour.

37

Katherine 07.13.12 at 11:03 am

Doh!

38

Katherine 07.13.12 at 11:11 am

On a slight aside (and do say if this is off topic) – there is an international market in human organ useage that isn’t illegal, and that’s international paid surrogacy.

It is illegal in most (if not all) developed countries to pay a woman to act as a surrogate, so there are a number of rich, western wannabe-parents who go to India and pay young women there to act as surrogates for what is, to them, oodles of cash.

It’s not organ harvesting in the sense of permanent removal and transfer of a uterus, but it is renting, if you like, a human body part by the rich from the poor, with potentially serious health consequences, so it is in many ways similar.

And there’s a definite domestic vs international double standard that doesn’t exist when it comes to organ sales.

39

christian_h 07.13.12 at 11:53 am

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.

40

rea 07.13.12 at 12:42 pm

If we accept the principle that organs are assets that can be bought and sold, what’s to stop your creditors from seizing them and having them sold by the sheriff to pay your debts?

And if we allow the sale of one kidney, why stop there? Why not allow the sale of two? Or a heart?

41

Data Tutashkhia 07.13.12 at 1:11 pm

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.

42

ajay 07.13.12 at 1:13 pm

And if we allow the sale of one kidney, why stop there? Why not allow the sale of two? Or a heart?

Selling your own heart would count as assisted suicide and would be illegal in most countries – at least for the surgeons involved.

43

Salem 07.13.12 at 1:38 pm

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.

44

Tim Worstall 07.13.12 at 1:47 pm

The obligatory Iran comment: 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.

Whether we ought to set up such a system rather depends on the relative values on places upon various things. For example, is stopping people from dying on dialysis worth having filthy lucre involved?

45

Henry 07.13.12 at 2:01 pm

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).

46

MPAVictoria 07.13.12 at 2:16 pm

“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).”

Damn it man! Who is going to tell us about Ghana now!?

47

ajay 07.13.12 at 2:35 pm

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

48

ajay 07.13.12 at 2:38 pm

38 is an interesting point. Somehow surrogacy always seems to fall into the same cognitive bracket as, say, egg donation, sperm donation and IVF, but as you point out there’s a good case for putting it closer to organ donation.

49

Manta1976 07.13.12 at 3:00 pm

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).

50

ajay 07.13.12 at 3:21 pm

49: Well, I was meaning it’s conceptually similar rather than similar in effect (which I think is what Katherine was getting at), but that is a good point as well.

51

Dairy Queen 07.13.12 at 4:01 pm

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.

52

praisegod barebones 07.13.12 at 4:01 pm

Not to threadjack, but if anyone wants to actually look at some actual CT threads on Israel, the archives for May and June 2010 would be a better place to look than J. Otto’s memory.

53

Manta1976 07.13.12 at 4:26 pm

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?

54

Wonks Anonymous 07.13.12 at 6:25 pm

ajay@47, I didn’t see anything about a reduction in the total number of lives saved, as Maggie@18 suggested. Here was a summary given in the piece:
Making a judgment about whether the 20-year-old system as a whole has been successful was complicated, [Dr Benjamin Hippen, a transplant nephrologist with the Carolinas medical centre in North Carolina] said. “The majority of those selling kidneys in Iran are disproportionately poor, and information about the long-term outcomes for sellers is quite limited. Too, it is increasingly clear that there are many different systems, rather than a single unified system in Iran.

“That said, Iran appears to have successfully addressed the shortage of organs, incentives for organs have not substantially attenuated the growth and development of organ procurement from deceased donors, and reported outcomes for recipients have been favourable.”
That sounds a lot more like “some bright signs, but too early to tell” than “not very well” to me.

I never got the impression that CT was “Zionist”, just that for the most part they’d rather not deal with the issue.

55

Dairy Queen 07.13.12 at 6:40 pm

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.

56

dsquared 07.13.12 at 6:48 pm

J Otto Pohl and Data, it’s looking increasingly like you’re banned from the whole damn site.

57

Data Tutashkhia 07.13.12 at 7:24 pm

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.

58

Data Tutashkhia 07.13.12 at 7:40 pm

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.

You hate DataTutashkhia so much that you’d rather take an anonymous commenter at his/her word? Fair enough. However, at the trial described in 51 you’re (most likely) going to be presented with testimonies of two real, equally convincing women, saying the opposite things. What are you going to do? One way or another, you’ll have to form your own judgement, based (mostly) on your own intuition, that is based on your own experience.

59

John Quiggin 07.13.12 at 9:00 pm

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.

60

JanieM 07.13.12 at 9:30 pm

I’ve been biting my metaphorical tongue about this for weeks, but three cheers for a Data-Tut-free CT. It’s not my blog, but when 1/7 of the comments on a (recent) thread are by one commenter, and a whole bunch more are in reply to that commenter’s intentionally-provoking inanities, a rebalancing is very welcome. So — thanks!

61

JanieM 07.13.12 at 9:33 pm

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.

62

Data Tutashkhia 07.13.12 at 10:01 pm

Hi JanieM,
if you read that thread again, you’ll find that, as a good, polite boy, I only spoke when spoken to. Nor have I commented in John Quiggin’s threads after he announced his permanent ban, as you seem to imply. So, what exactly is the nature of my misconduct? That you perceive my comments as “intentionally provoking inanities”? I can assure you that they certainly weren’t intentionally provoking, and how exactly do you distinguish “provoking inanities” from those “diverse opinions” everybody thinks they desire?

63

Watson Ladd 07.14.12 at 5:43 am

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?

64

merian 07.14.12 at 6:28 am

@Watson Ladd, #63, “imagine you’d ever had one kidney” doesn’t convince me at all. Being widowed or divorced is quite different from never having married in the first place; losing a house you own is different from always having rented; losing your job is different from not yet having entered the labor market (even at the same age); and being kicked out of college is not the same as not having gone to university at all. To use a metaphor from thermodynamics, those states are path-dependent. And I’m sure you’d find a lot of writing about the impact of, say, mastectomy even on women who don’t NEED that breast for anything in particular.

65

Tim Worstall 07.14.12 at 9:47 am

“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.

66

John Quiggin 07.14.12 at 10:32 am

@Data My suggestion would be to go away and think for a while (at least a week) about why you got such a negative reaction here. If you think you can do better and decide you would like to come back, ask nicely, and promise no more than one comment per thread per day.

67

JanieM 07.14.12 at 11:50 am

“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.

68

JanieM 07.14.12 at 11:53 am

Format fail. 2nd para. should also have been italicized, as it was Tim Worstall’s response to the quote in the first par.

69

Data Tutashkhia 07.14.12 at 12:06 pm

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.

70

Maggie 07.14.12 at 6:38 pm

I am not a doctor but it doesn’t seem right to say that since (some) diseases of the kidney strike both at once it is therefore no detriment to only have one. If your kidney function is to be diminished by disease, surely it matters how much function you have to start off with. That a *healthy* person can do fine with one kidney is irrelevant. Also consider that a person poor enough to take money for a body part is unlikely to have adequate access to health care and therefore is more at risk from illness and will be in no position to buy a replacement should they need it. Not to mention the ugliness of creating a class of people, even healthy ones, whose only encounter with the health care system is when they are brought in to be mined for benefit of the more fortunate.

I find the enthusiasm for turning the bodies of the poor into natural resources very suspicious, especially in a time when scientists tell us that the possibility of lab-grown organs is coming into sight. Why not agitate for increased research funding to hasten the day, leaving aside this whole ugly quandary? I believe the ugliness itself is a motivating factor; for people who supposedly believe in self-ownership they are awfully eager to set the precedent that the poor man’s body is inalienably his own. And the ruse of special concern for kidney patients, such that their plight uniquely justifies such an attack on social cohesion, is insultingly transparent. Anybody who was really concerned about kidney patients, and so sure that second kidneys are superfluous, would donate their own (Postrel’s example is conspicuous in its uniqueness). No, 99% of them are only interested in kidney disease for the opportunity it presents to argue for the further degradation of the poor.

71

Maggie 07.14.12 at 6:45 pm

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.

72

JanieM 07.14.12 at 7:04 pm

What Maggie said.

To clarify, my mention of cancer that strikes only one kidney was not meant in support of allowing a market in kidneys. It was in support of the concept of not making sh!t up.

73

Voitokas 07.15.12 at 2:46 pm

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.

74

tomslee 07.15.12 at 3:03 pm

Voitokas – Interesting, but can you help me to judge whether I should trust these assertions? Perhaps your qualifications or sources? Otherwise it’s “some anonymous man/woman on the Internet said…”.

75

Voitokas 07.15.12 at 3:54 pm

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.

76

Voitokas 07.15.12 at 3:57 pm

Alas – I think I misused the html tag for the hyperlinks…
CDC MMWR = http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5608a2.htm
Emedicine = http://emedicine.medscape.com/article/238798-overview#showall

77

Watson Ladd 07.15.12 at 4:22 pm

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.

78

Maggie 07.15.12 at 11:25 pm

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

Well that depends on how you define “able” doesn’t it. At present, there’s nothing pressuring poor Americans to sell their organs. It’s off the table. Once it’s put on the table, poor people’s ability to resist it will be diminished from its present near-absolute level. But in order to understand that you have to understand that practical constraints and pressures are as determinative of levels of freedom as formal, legal ones, if not more so (in fact legal constraints are really only a species of practical constraint: the risk of punishment). You also have to have imaginative empathy for how extreme need can impel, even diminishing free will. A person desperate enough to accept the prices that would prevail in an open market (prices in Iran are extremely low) is someone who has been pushed to the point where every realistically possible option is an offer they can’t refuse. Opening up exploitative possibilities increases their vulnerability to exploitation. 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. In the case of organ-selling in particular the legal and practical possibilities run mostly in parallel because of the level of social cooperation required to execute a transplant; the number of people involved makes it hard to get away with (which is why the doctors and institution from the OP should also be investigated). So while you won’t be legally mandating kidney donation you will definitely be giving the most vulnerable segment of society a powerful push in that direction. You may argue that it is paternalistic to spare them dilemmas; I believe it is coercive and hard-hearted not to.

79

Barry Freed 07.15.12 at 11:34 pm

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

80

peggy 07.16.12 at 2:41 am

Agree with Maggie. Remember how poor and desperate people are in the US. Student loans last forever and can’t be discharged in bankruptcy. Traffic tickets result in jail terms.

81

Salient 07.16.12 at 5:43 am

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.”

82

GiT 07.16.12 at 6:39 am

This would seem to be the relevant BHL response to the question of signalling expectations would seem to be Vallier’s post “Libertarianism, the Workplace and the Reconciling Power of the Social-Moral Order”.

The BHL question would likely be why is it necessary to use the law, rather than conventions, as a means of signalling humane norms?

If the question is one of the ‘signal’ the state gives off, then leading by doing might be a better means of sending a signal than leading by ordering. So, if public employment sets certain workplace norms against which the private sector is compared (and forced to adhere to when contracting with the government), then the state sets norms without using legal powers (of course, it uses its own bureaucratic and self-regulating powers to self-police).

83

praymont 07.16.12 at 8:08 am

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.

84

Salient 07.16.12 at 5:04 pm

The BHL question would likely be why is it necessary to use the law, rather than conventions, as a means of signalling humane norms?

[1] Because there’s no mechanism to change conventions with, but there is a mechanism to change law with.

[2] Because we’re focused on the situations where conventions have already failed us. In cases where there are conventions to follow humane norms, and they are widely followed, we have no reason to think about or discuss them.

[3] Because conventions reflect the status quo at the present moment, and offer no hope for improving justice.

[3a] “Change the conventions, not the law” is the mantra of people who don’t especially care if change happens (for example, see Dr. MLK Jr’s assessment of ‘white moderates’ in Letter from a Birmingham Jail).

[3b] We don’t take suggestions on how to effect change from people who aren’t especially interested in change actually happening

85

Harold 07.16.12 at 5:34 pm

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?

86

js. 07.17.12 at 4:57 am

“Change the conventions, not the law” is the mantra of people who don’t especially care if change happens (for example, see Dr. MLK Jr’s assessment of ‘white moderates’ in Letter from a Birmingham Jail).

This is so so true. And, while I haven’t mentioned it elsewhere, it’s what sort of annoys me about people going on about “culture!” and such (as has happened a bunch in the Libertarian threads, of course).

Also, any and all mentions of “Letter from a Birmingham Jail” need to be noted and seconded—a simple fact, I think.

Comments on this entry are closed.