Thursday, July 31, 2003

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.


Public Debate in Seattle

Tomorrow (Friday) I will participate in a public debate at the University of Washington in Seattle. The official topic of the debate will be: "RESOLVED: The Seattle City Council's Monopolistic Policies are in the Public Interest." The actual focus of the debate will be a truly inane law (uh-oh, am I poisoning the well?) passed by the Seattle City Council that effectively gives two big firms a monopoly in construction waste hauling. Naturally, I'll be on the opposition side. Each side will consist of one student and one professional. I'll be partnered with Andrew Bailey, a Biola student, and our opponents will be Michael Howard, a UW student, and Rod McCarvel, a Seattle attorney.

Here are the details, if any readers happen to live in the area and feel like attending:
UW Seattle campus, Thompson Hall Room 101, Friday 1 August 2003, 6:00 - 7:00 pm.
A splendid time is guaranteed for all.


Wednesday, July 30, 2003

Organ for a Livin’

I read this article about the evils of human organ sales in yesterday’s L. A. Times. I would refute the arguments – if I could find any. Unfortunately, the author just plays on morbid fears and hyperbole, with nary a trace of analysis. Ironically, the most persuasive part of the piece is a quotation that the author presents as self-evidently wrong:

Avraham, a retired lawyer in Jerusalem, explained why he went through considerable expense and danger to travel to Eastern Europe to purchase a kidney from a rural worker rather than wait in line for a cadaver organ in Israel: "Why should I have to wait years for a kidney from someone who was in a car accident, pinned under the car for many hours, then in miserable condition in the intensive care unit for days and only then, after all that trauma, have that same organ put inside me? That organ is not going to be any good! Or, even worse, I could get the organ of an elderly person, or an alcoholic, or a person who died of a stroke. It's far better to get a kidney from a healthy person who can also benefit from the money I can afford to pay."
And that’s bad because…?


Tuesday, July 29, 2003


Last night, I saw some jackass Congressman denouncing the terrorism threat-bet concept as “just plain immoral,” and Hillary Clinton called it a “futures market in death.” Now, I’m not entirely sold on the notion of ideas futures as an efficient means of assessing risks, for reasons I’ll explain below. But to condemn the program out of hand just because it sounds morbid is truly stupid. The question should be a factual one: would these betting markets in fact provide the authorities with better information about likely terrorist events without making such events more likely? If the answer is yes, then I think it would be immoral not to use them.

And it’s quite obvious that the Congressmen who’ve been criticizing the idea really don’t understand it at all. The most common charge is that it would allow terrorists to profit from their planned terrorist acts, because they could engage in a kind of insider trading. As Barbara Boxer puts it, “terrorists knowing they were planning an attack could have bet on the attack and collected a lot of money.” Hmm, let’s see how this would work. Suppose Ahmed the Terrorist is planning to blow up the Seattle Space Needle. So he does months of planning, all in secret so he won’t get caught. And then he gets the brilliant notion of making money at the same time, so he logs onto the DARPA website and buys a whole bunch of shares of “Seattle Space Needle gets blown up.” The price suddenly jumps, and the authorities immediately focus their attention on potential threats to the Space Needle, making it much more likely that Ahmed’s plot will be foiled. That’s exactly how the system is supposed to work.

The problem, as I see it, is that some terrorists won’t be as stupid as Ahmed. Instead, they will spend money with the deliberate purpose of driving up the price on other events -- ones that they have no plan to make happen -- with the intent of drawing attention away from their real plans. Or if they were really foresighted, they could start buying shares for the events they intend to make occur months in advance, and then deliberately dump their shares a little while before the plan goes into effect so that the price goes down. Or they could just buy and sell randomly, in order to create noise in the data. Would they lose money doing this? Yes, but terrorists have shown a great willingness to spend money in order to hurt people.

In short, the terrorism threat-bet plan might not work, but the critics’ criticisms are exactly backward. The problem is not that terrorists would be enabled to make money on their own criminal acts, because the very act of trying to make money on your terrorist plans is exactly what would thwart them. The problem is precisely the opposite: that terrorists might deliberately lose money in order to foil the system.


Monday, July 28, 2003

Gay High

Somehow this strikes me as a bad idea. I’m all in favor of shielding gay students from physical and psychological abuse, of course, and maybe that alone is enough to justify the creation of a new gays-only school. But it’s a pretty damning indictment of the NYC public schools’ disciplinary system if they have to segregate people in order to protect them against violence.

In addition, the existence of a school for gays will bolster the bigoted belief that gays are so different from the rest of us that they need to be quarantined. And it makes it even more likely that young people in their crucial bigotry-forming years won’t be exposed to any real live gay people. I realize transferring will be voluntary, but that won’t challenge the impression that is created in the minds of students. The option will soon become an expectation on the part of bigoted students. “Why don’t you go to Gay High, queer!” will be the new taunt of choice.

Furthermore (and here’s where I might hack some people off), I think it’s unwise for kids to categorize their sexuality at such a young age. High school students are bubbling cauldrons of hormones, fears, anxieties, and sudden impulses. They may not really know what their actual orientation is until years later. Yes, I’m sure that lots of gay people realize their orientation with great certitude early in life (many have told me so). But there have to be many others who do not; I’m betting that women are overrepresented in this category. In the narrow environment of a single-orientation school, students with second thoughts may feel trapped by rash decisions made early on. Worse yet, they might even feel pressure to conform, since a choice to go straight means having to switch schools.

On the upside, I can’t wait to hear what the school’s mascot is.