To what extent do we truly own ourselves?
In a recent ruling, the Ninth Circuit Court of Appeals decided that most bone marrow donors can be compensated—exempting them from a law banning organ sales, the National Organ Transplant Act of 1984.
However, the ruling only applied to a newer technique for obtaining marrow, which collects cells from the donor’s blood. These cells are later grown into marrow in the lab. Essentially, the court decided that the procedure didn’t resemble true organ donation enough to subject it to a compensation ban. The older form of bone marrow extraction requires harvesting marrow from inside a bone; donors undergoing this procedure are still banned from compensation.
The arrangment proposed by the plaintiffs indirectly pays donors $3,000 in one of three ways, by providing either a scholarship, a housing allowance, or a gift to charity in the donor’s name.
One of the plaintiffs in the case, Kumud Majumder, lost his 11-year-old son Arya to leukemia last year. In an AP interview after the ruling, he praised the decision, claiming it would encourage more marrow donation. In his view, “compensation will save the lives of patients, improve the lives of donors, drive down the costs of treatment and improve the quality of life of cancer patients as they battle to survive.”
But should we go further?
According to the government’s Organ Procurement and Transplantation Network (OPTA), over 100,000 people are currently waiting for organ transplants. Presumably, a system where prospective donors could be paid, or have money sent to charity, would help at least some of those potential transplant recipients live fuller, healthier lives.
One country that does have a legal system of compensation, at least in the case of kidney donors, is Iran. In the Iranian system, people who give a kidney are entitled to a direct payment from the government, an additional payment from the recipient (or a charity, if the recipient is impoverished), and limited health insurance coverage. And in Iran, the waiting list for kidney transplants has been trimmed to zero.
This, of course, leads to some rocky ethical ground. Critics have claimed, and this has proven true in Iran, that most people choosing to donate a kidney are poor. Thus, they fear that in such a system, the “choice” is essentially a forced one. The donors’ poverty has led them to put their own bodies on the market, an ultimately demeaning and shameful decision. It also, obviously, doesn’t lead to any long-term advancement—there’s no career in getting a kidney removed from you.
A system of payment like that in Iran would put particularly difficult choices on young people, especially given the current trying economic circumstances. A 2001 survey of Iranian kidney donors revealed that their average age was only 31, and 83% of those who donated indicated that their motive was mostly or entirely financial. Three-quarters of the donors were ultimately unsatisfied with their decision. One particular angry respondent made it a generational issue: “Why should we young be victimized for the generally old recipients who have passed most of their life? What about us?”
Yet some people make this decision anyway in countries where it is prohibited. Without the legal protections offered by an open system, they place themselves in the care of violent criminals. One Belarusian man who went this route was locked in a hotel room in Ecuador for his month, had his family threatened—and ultimately received $10,000 for the ordeal.
The idea of organ markets is laden with stacks of baggage a mile high. It’s truly the stuff of urban legends, as well as an almost certainly terrible movie from 2010. But given the sheer number of people currently suffering—and dying—on transplant lists, there must be a better way to care for them than we have at present. The Iranian experience shows that Millennials would likely be the target donors in any market system. Therefore, we’ll be the ones responsible for making such a system respect the dignity of donors, while of course helping save the lives of recipients. Perhaps the Ninth Circuit ruling will be the first step in making this system reality.
What do you think of compensation for organ donation?