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It raises many difficult ethical issues
December 12, 2005 2:24 AM   Subscribe

'A cadaveric kidney comes from a dead person and in the majority of cases in China, the dead people are prisoners, which allows for us to know at least two weeks ahead when the kidney will be ready' Transplantsinternational.com is offering organs from executed Chinese prisoners for sale on it's website (offline at the moment) for £23,000 per kidney. They say the deceased's family receive a donation for the organs.

This is not a new phenomenon as it was brought to the attention of US Congress in 2001, however, now people seeking transplants know in advance that there is an organ ready for them. "Blood samples are taken from prisoners to ensure they will be the perfect match for their Western beneficiaries."

It raises all sort of ethical issues. Should someone accept an organ from an executed prisoner? What right does someone have to say it is immoral to take an organ acquired in this way? Then again China's human rights record is appalling, should desperate Westerners be taking of advantage of those in prison? Should it be made illegal in the West to become a transplant tourist in order to curb this trade?
posted by ClanvidHorse (49 comments total) 1 user marked this as a favorite

 
Sorry, should have put some of it as [more inside].
posted by ClanvidHorse at 2:31 AM on December 12, 2005


Fortunately it's not at the level of Larry Niven's "organ bank problem" yet. Personally, I don't think it "raises all sorts of ethical issues," it completely crosses them and a host of moral ones, too.
posted by Captaintripps at 3:51 AM on December 12, 2005


Captaintripps- on the one hand I think it is outrageous but then I think: what if it was me? What if it was a member of my family? If I thought that it may help me or a loved one live for longer would I attempt to rationalise it by saying things like 'well these people are going to die anyway?'. My initial reaction is one of horror but I am not so sure I would be so judgmental if I was in that position.

Corporations and individuals being engaged in it for profit is abhorrent on every level.
posted by ClanvidHorse at 4:03 AM on December 12, 2005


Human rights victimized. When reached for comment, the invisible hand replied: "it was only a love tap."

I'm afraid enough of not being effectively treated because of "organ harvesting." I shudder to think of being accused of Crimethink because profits from this industry have been going down a few points.
posted by GooseOnTheLoose at 4:17 AM on December 12, 2005


ClanvidHorse: Clearly this is well-within the realm of "you really have to be on the spot to know exactly what you'd do," but I know I couldn't live a mentally healthy life with the organs of a Chinese state convict in my body to sustain me. I would probably shun a friend who did. I have no idea if these people would have died anyway or if the reason they are dying now is a valid one. Organs don't just fall off a truck.

While referencing Golden and Silver Age science fiction writers is not always the smartest move towards a fully thought out way of dealing with ethical/moral issues, Niven truly hit it on the head with that one. Make capital convicts the source of life-sustaining organ transplants and eventually quite a few things become capital transgressions. In Niven's hyperbolic version, every legal transgression was a capital one.
posted by Captaintripps at 4:26 AM on December 12, 2005


should desperate Westerners be taking of advantage of those in prison?

Organ donation or no organ donation, the real crime is the state's capital punishment. What follows just makes it more shameful.

If I were one of those desperate Westerners (is that what a "desperado" is?), I think I might take the organ regardless of moral doubts if I figured the state was just going to kill the donor and sell his bits anyway. I might like to think I'd take the moral high ground and all, but if time ran out and the only liver available to me was a soon-to-be-executed prisoner's -- "OK, we're going to kill him tomorrow. Decide now. Do you want to use that liver or do you want us to throw it away?" -- I'm pretty sure I'd take it and try to make amends with his family later.

And making transplant tourism illegal where I live but permitting the trade to continue in China and elsewhere would just force me to live out of the country after the operation, because I wouldn't pass up a chance on a new liver if I needed that particular liver to live and I sure as hell wouldn't go home with my new liver only to have me and my new liver thrown in jail.

In any case, this stuff will not happen when we can grow replacement organs, and that can't be far away.
posted by pracowity at 4:41 AM on December 12, 2005


Donation from cadavers should be completely free and not involve any kind of cost to the donator. Absolutely no money or credit or donation of highly valuable goods should be involved as that would solitic a the creation of a demand and therefore the creation of a market.

Such a market would not only encourage or justify partially death penalty ( an evident backward shame two allegedly advanced countries such as U.S.A and China should have abolished long ago) but also would spin off and create demand for donation between living beings.

Terrorists could force people to sell the organs they can spare to advance their causes or else die...and if not terrorist abject poverty or desperation are strong enough motivators.

If such demand was to be satisfied by living human beings or by a market of cadaver the money involved in the transaction would probably be distracted from research as human beings would be used as "spare parts" ..which would not motivate research into drugs and cures.
posted by elpapacito at 4:50 AM on December 12, 2005


Corporations and individuals being engaged in it for profit is abhorrent on every level.

If you live in the US, then you must be aware that corporations such as HCA and Humana profit from organ donation every day. The medical personnel involved are generally well-paid as well. In fact, the only two people in the entire process who don't make any money are the recipeient, who pays for the whole thing, and the donor, who makes the whole thing possible. I understand and tend to agree with the position that organ donation should be free, but somehow the current situation doesn't seem entirely right.
posted by TedW at 5:00 AM on December 12, 2005


I live in the UK. Although there are private medical corporations here, the vast majority of this type of work is within the universal health service, the NHS. Obviously the surgeons, etc are well-paid but no one is looking at a profit margin when they carry such work out.

Except maybe the Government ministers -lobbied by rapacious corps- who want to turn into some kind of highly profitable private health care system.
posted by ClanvidHorse at 5:09 AM on December 12, 2005


Paging Dr. Epstein. Dr. Epstein to the operating room, please.
posted by felix betachat at 5:34 AM on December 12, 2005


i think we should execute the people who take these organs...

and then, take their organs and...
posted by 3.2.3 at 5:37 AM on December 12, 2005


TedW is right. There is nothing in human conduct which is NOT the market. The only thing that refusing payment to prospective donor families accomplishes is to cause them to misprice their decision -- how many people who refuse to donate on the basis of sentiment about burying someone intact would do so the alternative was $50,000 or $100,000?
posted by MattD at 5:38 AM on December 12, 2005


mattd: dude you realize you're speaking like a religious fanatic ?

There is nothing in human conduct which is NOT the market

Now prove it and while you're at it prove existence of God.

how many people who refuse to donate on the basis of sentiment about burying someone intact would do so the alternative was $50,000 or $100,000?

Then why not $ 1Million ? After all you either pay or die, look who has got the power to decide price ? Market my ass, I'm the market.

But I'll be reasonable and ask for all the money you can pay me and all the debit free assets..and I'll the auction to the highest bidder. And you'd better hurry up or the organ will spoil and you'll die.

And if I so wish I'll be unreasonable because nobody meets my reserve price and let the organ spoil..after all it's my relative/parent asset and you have no business deciding on its allocation and use.
posted by elpapacito at 5:53 AM on December 12, 2005


There is a related debate going on in the stem cell research community; some are asking why it is unethical for researchers to pay egg donors for eggs donated for research, when infertile couples routinely pay donors to undergo the exact same procedure. New Scientist article here.
posted by TedW at 6:04 AM on December 12, 2005


has anyone been watching Curb Your Enthusiasm lately?
posted by avocet at 6:39 AM on December 12, 2005


The "ethical issues" raised here are not difficult at all; or, at least, they shouldn't be for anyone with an ounce of respect for human life.

Rich people are harvesting organs from the poor. Laughably, they comfort themselves by imagining that the poor have free choice in this matter. However, the choices of a Brazilian barrio dweller or a Moldovan peasant are seldom made in a free or informed manner -- the statistics quoted in this article show that the vast majority of donors experience declining health after the operation; over the course of a few years, the one-time infusion of cash they receive from the donation is far outstripped by their lost wage-earner potential, particularly since most donors rely on the fruits of their physical labor.

I'm in favor of a free market in most situations. This is not one of them, because it will inevitably result in the commodification of human life, the rape of human dignity, and the exploitation of the poor in the most degrading and awful manner possible.
posted by xthlc at 6:40 AM on December 12, 2005


This reminds me a lot of the early days of dissection when the only cadavers available for such horrors were the recently executed... or, the recently murdered.

Since we've moved beyond that now, I can only hope that the same will follow for organ donation. Then again, with the privatized health care system in the US, kidneys going to the highest bidder can't be too far off... after all, how on earth are you going to afford a kidney transplant without health insurance? And how are you going to get health insurance without being independently wealthy? I'm sure "I need a kidney" counts as a "pre-existing condition."
posted by grapefruitmoon at 6:44 AM on December 12, 2005


Damn. I feel dirty just reading about this.
posted by chunking express at 7:55 AM on December 12, 2005


When did they stop this practice in the US, the 70's? That was about the same time they stopped using cadavers from mental institution "inmates" as well, no?
posted by Pollomacho at 7:58 AM on December 12, 2005


Should someone accept an organ from an executed prisoner? What right does someone have to say it is immoral to take an organ acquired in this way? Then again China's human rights record is appalling, should desperate Westerners be taking of advantage of those in prison? Should it be made illegal in the West to become a transplant tourist in order to curb this trade?

How many pages, and when is it due?
posted by mendel at 8:10 AM on December 12, 2005


Devil's Advocate here. If organs were bought and sold on an open market, the profit motive would bring more organs to the market, and save more lives. The most cost effective source of new organs would probably not be death row inmates or third world innocents, but first world people who die accidental deaths. If you knew that checking the organ donor box on your license could mean a cool $50-100,000 for your bereaved family, you'd be more likely to do it. Think of it as free life insurance for the working classes. And since, as several commenters have pointed out, we are already buying and selling organs behind the scenes in this country, why not give the families of the the deceased a cut? It sounds like a win-win-win deal.

Corporations and individuals being engaged in it for profit is abhorrent on every level.

Says who? Profit is how things get done in our society. The trick is making sure the profit motives encourage the right kinds of behavior. Getting organs into the bodies of folks in need seems a worthy goal.
posted by LarryC at 8:14 AM on December 12, 2005


we should clearly harvest organs from third world sweatshop workers -- guess they don't really need them, being all poor and shit.

but we should harvest them when the shift is over -- we don't want to slow down Abercrombie & Fitch's production line
posted by matteo at 8:19 AM on December 12, 2005


It's all very well moralising on MeFi, but if I was dying and I had the money, I might buy an organ. Transplants are extremely rare, and not I'm about to judge somebody for trying to survive at any cost. Let's face it: the poor doner's going to die anyway, so they may as well make some money from it to support their family. It's horrifying to think that the cause and effect of execution and donation may one day reverse, but that's hardly the buyer's problem.

I hate to state the obvious, but the only real villain here is the Chinese government (with perhaps some complicity from western democracies). They use the death penalty, they fail to tackle widespread poverty, and they allow organ sales to health tourists instead of channeling them at no cost to deserving residents.
posted by londonmark at 8:36 AM on December 12, 2005


You know, to be honest I don't have a problem with organs being bought or sold, I would like it if prisoners were not exicuted. However, if a person consents to have their organs sold I think people should be able to do it.

I mean really, why not? Doctors make money, hospitals make money, tons of people make money off organ transplants, why not the donor?

If it were up to me, there would be a way to sell 'organ rights' So you could sell a heart-right and that would give them the right to harvest your heart if you died. It would be the value of your heart times the probability it could be recovered.
posted by delmoi at 8:40 AM on December 12, 2005


You know, I bet in 20-50 years we'll be able to grow replacement organs in vats or whatever, and a few decades after that we'll look back at this practice as some kind of bizarre medieval Barbary, equivalent to bloodletting and leeches and stuff.

you know, in the second half of the 20th century and early 21st people used to physically remove organs from dead people and put them in sick people to make them better?

Do way that's discusting!
posted by delmoi at 8:47 AM on December 12, 2005


er, that should be "No way" not "Do way". (wtf?)
posted by delmoi at 8:48 AM on December 12, 2005


Says who? Profit is how things get done in our society. The trick is making sure the profit motives encourage the right kinds of behavior. Getting organs into the bodies of folks in need seems a worthy goal.
posted by LarryC at 11:14 AM EST on December 12 [!]


LarryC, given the US is privatizing its prison systems at an unprecedented rate, the issue of making it even more profitable to incarcerate people — and the dubious nature of the laws we've enacted to fight the War on Drugs, the War on Terror, the War on the Poor, etc. so as to increase the prison population to its highest levels ever — raises serious ethical questions.
posted by Rothko at 9:13 AM on December 12, 2005


While empathy with those who are in need of organs is one of several useful perspectives in thinking about this, I'm surprised at the number of people in this thread who are willing to leave it at that. i.e. "I would do it if I were in their shoes." It seems to me that we are in deep trouble if the analysis of difficult ethical questions boils down to, "what would I do if it benefits me?"

The risks of creating a market in human organs from countries like China are awfully high. How in the world can we verify where these organs are really coming from? While markets can be very effective mechanisms for distributing scarce resources, in this case they create a strong incentive to put to people to death for their organs, with or without the help of China's underdeveloped and corrupt legal system.
posted by dougny at 9:15 AM on December 12, 2005


So I guess this means that abortions reduce the number of organ donating criminals right? I guess we should ban abortions to provide more criminals, to provide more organs, to make rich people healthy to make more babies.
posted by blue_beetle at 10:18 AM on December 12, 2005


As long as the United States doesn't condemn execution, I don't see why they should condemn this practice.
posted by iamck at 10:21 AM on December 12, 2005


dougny: It seems to me that we are in deep trouble if the analysis of difficult ethical questions boils down to, "what would I do if it benefits me?"


Dougny I think it is very difficult to look at anything objectively once it is a matter that has immediate implications for the person concerned. What I do know is that people who may hold high ethical standards in the abstract tend to change their tune when they are faced with situations that put them under pressure. I dont think that makes them bad or weak people. It is easier to hold a moral view when you don't have to deal with the realities of a situation.

Not that I am saying you shouldn't have ideals or anything...
posted by ClanvidHorse at 10:24 AM on December 12, 2005


LarryC: If you knew that checking the organ donor box on your license could mean a cool $50-100,000 for your bereaved family, you'd be more likely to do it.

I don't know if it works that way for everyone. If it were me, for example, I'd be less likely to. It'd be nice to help my family and all, but I couldn't justify supporting a horrifying system that made people bid on their own lives. I don't think I'd want to help the person who won that bidding war survive.

With the current system, the idea of helping a person at random (and on the basis of their survivability) has enough merit that I'm happy to do it for free.
posted by Mitrovarr at 10:50 AM on December 12, 2005


LarryC, If you let corporations take the profits, you'll just have corporations finding exploitive methods for signing people up.. and people won't sign as they will fear the corperation murdering them. Its very hard to create a systme where realitives got all the money:
1) people frequently kill their relaitives for money.
2) doctors would charge fees for working with expensive materials. Might increase cost of operations acrost the board too.
3) insurance would run everyone's rates sky high, or bulk at paying.
4) people who are perfect matches will be skipped over for less suitable, but richer, matches, i.e. more waisted organs.
5) people who need organs sooner will be skipped over too.
You might hope for organ markets too pure money into organ cloning, but given the total cock-ups patents often make of scientific research goals, you may do more harm than good here too.

Why stop at money? Why not allow all sorts of restrictions on your organ doner card? Say, no old people, no foreigners, no blacks, no gays, Christians only, etc.
posted by jeffburdges at 11:10 AM on December 12, 2005


The advertising possiblities alone are enormous, and the transaction fees will be a nice source of profit. If a realtor can get six percent, certainly a parts broker can get more.

Paging through the future, I see:
_________________________________
We Sell Only Interro-Certified(TM) Kidneys

Our Chairman wishes us to inform you that our highly professional interrogation staff have been carefully trained to avoid any interrogation method that could cause risk of damage to the carefully tagged organs and body parts for which your advance purchase order has been approved.

In addition, our Chairman wishes us to advise you that for all organs and body parts currently on offer, the pre-sale suspects are held in comfortable surroundings and have not been interrogated in any way that risks damage or loss of resale value of any parts listed on our website as available.

Please check often as this information is updated frequently.

Our Chairman wishes you to believe that any admission of guilt leading to the availability of organs or body parts you have purchased will have been obtained without any damage to those organs or body parts of the suspect that you are purchasing.

Note that there is a deadline up until which you may add to (but not reduce) the list of organs or body parts you are purchasing in this transaction, from those currently listed as on offer. Speculative purchase for resale is supported by our Special Transactions program.

Furthermore, our Chairman advises you that for certain less common blood and immune groups, it is wise to pre-order well in advance of need. Completion of pre-purchase is required to implement our Selective Enforcement(TM) program. Using the extensive medical records database kept by our government to locate a potential suspect who has un-committed available organs and body parts, Selective Enforcement(TM) focuses attention on the likely suspect in order to establish a basis on which to acquire the parts you have pre-purchased in a timely way.

Our Chairman wishes you to understand that Guaranteed Timely Delivery is always available on a cost-plus basis.

Thank you for considering InterroCertified(TM) Organs and Parts, a wholly owned subsidiary of General Globalized, Inc.
posted by hank at 11:39 AM on December 12, 2005


Rothko, I'm with you on the evils of the prison-industrial complex. But I am not sure it is relevant here.

Jeffburdges, I don't expect the relatives to get all the money, or even most of it, but to have a stake in getting organs into the bodies of those who need them. Would people kill their young'uns for the organ money? Not inconceivable, but life insurance exists right now and hasn't led to a murder epidemic. Obviously, we will still need some kind of ethics board overseeing the process. (Didn't some hospital in California just get nailed for giving an organ to a rich guy who jumped ahead in the line?) But a marketplace for organs doesn't seem any less moral than the current system.
posted by LarryC at 12:16 PM on December 12, 2005


Let's face it: the poor doner's going to die anyway

Well let's face it, he would live longer if he didn't live in capitalist USA or communist China. But given that everybody including you is going to die anyway, why waste an organ with you ? Who cares if you pay and who the fuck cares about my family getting a cut ! Non disfunctional families wouldn't accept the notion let alone the money.

I mean really, why not? Doctors make money, hospitals make money, tons of people make money off organ transplants, why not the donor?

This is some piece of pernicious logic. By analogy if the government makes money from cigarette taxation, the tobacconists from selling tobacco, the farmers from raising tobacco then why shouldn't tobacco the plant make some money ?

You see the human being is tobacco in this analogy because it's the final resource, the exploited source. While we could argue that making money out of lung cancer is bad, nobody is going to cry for the exploitation of the "poor" tobacco plant. Why ?

Because we're human beings not plants, we should use nature resources judiciously but not even Buddists repent from "killing"
plants to live.

Also if the donor was to get money from his sale, the price of a transplant would certainly not decrease...but even if we factor in increase "supply" I would be the one advocating vociferously and ferociously to all donors that they can ask ANY amount of money and they can blackmail for 10 100 1000 times what they would very happy with , because death is a potent motivator to pay any sum !

I would also cry on top of my lungs that no matter how much money you have, having one less kindey or piece of liver or whatever isn't worth any money in the world...those who need one badly know very well they're priceless.
posted by elpapacito at 12:24 PM on December 12, 2005


Not inconceivable, but life insurance exists right now and hasn't led to a murder epidemic.

Could it also be that life insurances exclude murder ? Or that insurers would rather die then pay you the money they own you ? Oh wait it's the other way around..would rather make you die !
posted by elpapacito at 12:26 PM on December 12, 2005


LarryC, You only addressed my first complaint of the least exploitive system. It will get exploitive fast once anyone with power, i.e. anyone besides the family or doctor, starts making money off it. The SEC is exactly the sort of government ethics board your talking about, i.e. a miserable failure. Our current system of letting doctors make these decissions based on medical knowedge works quite well.
posted by jeffburdges at 1:07 PM on December 12, 2005


Some of the short-sightedness in this thread reminds me of the episode of the Twilight Zone where a family is given a little button to push. When pressed, someone they "don't even know" will die and the family will get a million dollars.

Arguments ensue, but eventually they press the button. A man shows up to drop off the money and collect the button. The man assures them that the button will now be given to someone they "don't even know." Zing!

If you allow organ selling, you generate a market that will encourage harvesting.

If you imagine that you are not a member of the organ pool because you're middle-class, you're assuming the wealthy won't preferentially choose to buy well-fed, healthy organs for transplants.

In a world where white, newborn orphans get adopted first, that's just naive.

If people are allowed to shop for organs, you're putting yourself in the store display window right beside the third-world labourer. And you're pretty tempting - you don't have HIV, you probably haven't been exposed to poisons your whole life, you probably haven't suffered malnutrition or parasitic infection. You're organs are probably in very good shape compared to 90% of the planet. Furthermore, there's someone out there who:
1. Doesn't care who you are.
2. Has the money to buy your organs.
posted by Crosius at 2:44 PM on December 12, 2005


corsius the twilight zone example, I like it
posted by elpapacito at 2:53 PM on December 12, 2005


Elpapacito: So payments for donated organs should also exclude murder. And as for what happens to the price, surely a greater supply of organs will quickly reduce the price per organ. (Especially if we list them on Ebay.)

Jeff: Whenever I google the topic, I find article after article about people dying while awaiting transplants. I don't think the current system is working all that well.
posted by LarryC at 3:01 PM on December 12, 2005


larryc : (Especially if we list them on Ebay)

Among the list of larryc signature most trolling quotes, $ 19.95 time limited offer hurry up call now !
posted by elpapacito at 4:02 PM on December 12, 2005


So, I guess the only way to have organ donation is if the donor and his/her family get nothing but a warm fuzzy feeling for having done a noble deed.

I guess we're safe, in that there are so few people who value that very highly.

Or something.

But yeah, harvesting from executed prisoners is just begging for abuse of the system.
posted by darkstar at 4:26 PM on December 12, 2005


China has a comparitave advantage in producing kidneys since they're not weighed down with silly ethics and laws. The US has a comparitave advantage in producing dollars (and sick people). It's a win-win.
posted by jewzilla at 7:09 PM on December 12, 2005


I know diddly about biology, but don't transplants have to be from someone genetically similar for the best chance of avoiding rejection? And if so, won't that alone minimize the risk of outsourcing organ "production?"

(Elpapacito: I thought with the Ebay remark I was being witty and making fun of a clear weakness in my argument, but if it came across as trolling I apologize.)
posted by LarryC at 9:27 PM on December 12, 2005


LarryC, Our only real solution is to regrow human organs in animals, use stem cells to repair our own, etc.

A short term solution is to make organ donation mandatory when local police identify a death as accedental, but only if police are confident the death was accidental. If the local police have questions about the death, the recipients should be restricted to people in both (a) the same socio-economic status and (b) matching certain randomized criteria. Anyone whose medical records had ever been compromised should carry a "restricted donation card" which imposes some random constraints upon the assignment of their organs. Local police should periodically examine the lists of transplant candidates, recipients, doners, etc. for suspicious trends.

I see no reason to pay for dead people's organs at all---they are dead after all. However, measures should be taken to make targeted killing unprofitable.

(For religious reason, you'd also need to have an "opt out" card which prevents your organs from being used, but also prevents you from receiving organ donations.)
posted by jeffburdges at 7:19 AM on December 13, 2005


LarryC- Ideally, the transplants with the best chance of succeeding are from an identical twin. But after that, blood type is most important, and then certain antigens in the blood. While on average, a family member might be slightly more likely to provide a more compatible kidney, many times the better match will come from a perfect stranger. Even then, the difference in success rates between the best match and the worst match with the same blood type isn't all that much.

One way to boost organ donation would be to allow adults to get cadaver organs only if they've previously signed up as donors themselves.

Meanwhile, a convict is trying to donate a kidney to someone on the outside.
posted by spira at 9:04 AM on December 13, 2005


Thanks, Spira.
posted by LarryC at 5:39 PM on December 13, 2005


ClanvidHorse: Dougny I think it is very difficult to look at anything objectively once it is a matter that has immediate implications for the person concerned. What I do know is that people who may hold high ethical standards in the abstract tend to change their tune when they are faced with situations that put them under pressure. I dont think that makes them bad or weak people.

ClanvidHorse, I agree with you. That's why policies should be made taking into account the point of view of those who are likely to benefit as well as those who might be harmed. And I think that those who might be harmed in this case are Chinese citizens who could have an unfortunate and unwarranted run-in with the law if there is money in it for local officials.
posted by dougny at 3:43 PM on December 14, 2005


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