Organ Nine to Five, What a Way to Make a Living

My sister Ellen, who is a pre-med student, had some interesting points to make about my post below on organ selling. She agreed to let me post them here, and I’ll intersperse my own reactions.

I haven't read the article you're talking about -- I clicked on the link but I couldn't read it because I don't have a subscription -- but I bet that what the [author] finds wrong with organ selling isn't exactly a problem with organ selling per se. If [her] arguments are on what [s]he says are moral grounds, [s]he is probably mad that people are so poor that they have to sell their organs. Whether or not that's actually the profile of people that sell their organs, [s]he probably thinks it's disgraceful that some person out there isn't getting helped by society or something enough that he doesn't find himself so strapped for money that he has to risk his health [by] giving up organs to make a buck. I don't know if I agree or disagree with that. The problem there isn't with organ selling but with other conditions that would cause someone to consider organ selling.

I think Ellen is totally correct about the sentiments behind the op-ed. And it’s indeed horrible that some people are so poor that they’d sell their organs to get ahead. But -- and this is the key point -- you don’t make those people any better off by taking options away. Preventing organ sales does nothing to improve the condition of poor people in underdeveloped countries; it just shuts down one of the possible exit routes.

Anyway, the quote [s]he used didn't support an argument against organ sales, like you said, but the guy [s]he quoted (hypothetical?) wasn't completely on the mark either. People with cirrhosis or other things wrong with their organs aren't allowed to be organ donors. Among the many tests that have to be done before the organ is transplanted, checking it for overall good health is one of them. The people who have shitty organs are the ones getting the transplants, not donating them. Stress on the body can cause damage to organs over the long term, but the things he was referring to (like car wrecks) wouldn't affect the organs too much. The reason people go into shock after a trauma is to save the vital organs, or rather, keep those organs from becoming damaged/deprived if they weren't already at the expense of everything else (b.p., temp, etc.). So the organs will nearly always come out fine. If the case is that the organs are themselves damaged in the trauma, they aren't used for transplants. Abraham or whatever his name is would probably get organs about the same in health and functions whether he got it from a gunshot victim as a voluntary seller.

Good points. However, it's not as though the organs from car wrecks and gunshot victims are going unused. There is a shortage of organs, so people take what they can get. Avraham’s medical knowledge may be deficient, but his choice to buy organs from healthy people just assures that more organs from accidental donors will be available for others.

The one thing different [between accident donors and healthy donors] is something that is actually an argument for selling, which is that type-matching might be easier with selling, because someone might offer more money if someone that matches him steps up to sell, whereas the other way has no dependence on blood type or anything like that.

That’s a new argument in favor of organ selling that I’d never heard before. Cool.

Oh yeah, I'm willing to bet that if this [author] is opposed to organ selling for the reason I said, [s]he also doesn't like egg-selling either, although not as strongly as [s]he dislikes organ-selling. [Sh]e may not even like sperm donation, but a lot of people all of a sudden change their views on that one because sperm are so easy to get while egg-harvesting can be a painful process and eggs, unlike sperm, aren't seen as "a dime a dozen." Or a dime a million. Whatever.

Great point. I don’t know if the author of that article actually opposes sperm- and egg-selling, but to be consistent she should, because some poor people do it for the money.

ADDENDUM: Ellen emailed me again (after I told her I might blog this) to make a small correction:

I don't know why I said "shock" when I referred to the body's response to trauma. Shock can be caused by trauma or by other things (septicemia, anaphylaxis...), but shock actually leads to the organ's failure. However, doctors do do all they can do to prevent this, and the organs are the last thing to go, so even someone that entered early stages of shock could probably still donate at a later date. I do know though, that the body will try to save its vital organs at the expense of things peripheral. I don't even remember if there's a term for it, but I know it happens. Think hypothermia -- people end up with frostbite because their blood was shunted to their heart/lungs/brain/etc. Provided someone doesn't end up with a [positive-feedback] shock response, the chance of sustaining noticeable organ damage because of a trauma not specifically related to that organ isn't terribly high -- not enough to worry that their organs aren't healthy enough to be transplanted. If they actually get medical attention. Still, I know I am right about the kinds of people that they let donate. People who have self-inflicted damage, people who have abormal organs, people who died because the organ in question failed...most of the people that Abraham was worried about.

I don’t think this changes any of the discussion above, but I thought I’d post it for the sake of medical correctness. Thanks to Ellen for all the useful comments.