May 5, 2001

3:15 PM

Pssst -- buddy, wanta buy a kidney? There is a regular trade from China of transplant organs taken from executed prisoners. People from the US have been travelling there and buying organs, then coming back to the US. Should we do anything about this, and if so what?
posted by Steven Den Beste (21 comments total)

I don't see how we can stand by and ignore this. (But note that this has nothing whatever to do with the issue of capital punishment in the US, since it's illegal to do such transplants here. So let's not get into that issue, please.)

My answer is this: any person who gets a transplant must be treated with cyclosporin or some equivalent drug for the rest of their life. Access to cyclosporin is not a right; it's a drug and fully regulated under federal law. And there is no other condition of which I'm aware for which such life-time treatment is required. Therefore, a person who gets a major transplant (i.e. a kidney) cannot hide.

It must be made law that anyone requesting and receiving continual treatment with cyclosporin or any other immune suppressant must prove that the transplanted organ they carry came from a legitimate source. If they cannot do so, they are not denied the drug but they are prosecuted and jailed for ten years. This should be a class-A felony, comparable in severity to manslaughter.

We do not have the ability to prevent China from doing this. But we can largely prevent anyone living in the US from participating in it, and we must do so.
posted by Steven Den Beste at 3:15 PM on May 5, 2001

As I think about this more, what I just proposed is unconstitutional because it represents "presumption of guilt". However, the law can be recast to make it legal, I think:

As long as a patient refuses to identify the source of the organ, treatment is limited to one year. If the source of the organ is revealed to be illegitimate, then treatment is permitted but prosecution takes place.

I think that is constitutional, but I'm still not sure. Any lawyers here care to comment?
posted by Steven Den Beste at 3:30 PM on May 5, 2001

So what you're suggesting is that if someone has become so fed up with waiting for a transplant here in the US -- most people wait for many years, after all, and many die before even hearing of a potential donor -- that they are willing to take a risk of buying Chinese organs of possibly unknown quality, because it is the only way they see of ever getting whatever organ they need...

...that the government should take advantage of the fact that they are now dependant on a drug that only they can supply, using that position to lock them into a cell that would be better used to hold a real criminal, rather than someone whose will to live became a little too strong for your tastes.

Not to mention that your "solution" would only serve to cause more people to, paraphrasing from the article, go for follow-up care at "a less elite institution" or stay "within secretive medical channels recommended by their brokers." You might reduce the practice a little, but more likely, you would force people who are probably getting sub-standard transplant operations to begin with to continue getting sub-standard care for the rest of their lives.

While I don't exactly agree with what the Chinese are doing here, I also don't think this is the right solution. I would much rather see an effort to increase the number of potential donors in the US. Unfortunately, organ donation is something that a lot of people feel funny about, and not much can be done to change that. We can't really force people to become donors either, though if we tried hard enough, I'm sure we could work out a deal with the military.
posted by CrayDrygu at 3:44 PM on May 5, 2001

I'm against the death penalty, but I don't see why a similar program doesn't go on in the US. Ie, the next time there's an execution in the US, the death of the prisoner would at least mean life for a few other people.

Regading organ notation: i think just changing the default to "YES" and allowing anyone to change this would make a big difference.
posted by Witold at 3:53 PM on May 5, 2001

I'm saying that an ethical person would rather die than to accept an organ from someone who has been executed. I'm saying precisely that a person who does this should be prosecuted.

Yes, I'm saying exactly that.

The danger here is that if executions become lucrative, then capital punishment will start to be imposed on people to make money rather than just in the name of punishment. Would you like to be tried in front of a judge who will be paid extra if you're sentenced to death? If there is a base of customers, then there will be unjust executions. We in the US have a moral obligation to diminish the potential customer base by any means available, and the only legal means of which I'm aware is control over immune supressants.

Among other things, doing this for a kidney is particularly reprehensible, because the kidney is the only major organ which can be transplanted from a live donor. Everyone is born with two, and can survive quite nicely with only one. Live donation of kidneys is now a well established procedure, and indeed is particularly well thought of because the kidney is removed from the donor only minutes before being transplanted into the recipient -- thus is particularly healthy.

I fully understand the desperation of someone who needs an organ. But I don't subscribe to the idea that one may do anything, anything whatever, in order to live. Sometimes an ethical person will accept their fate and die.

I have an organ-donation tag on my drivers license and the signed/witnessed card in my wallet. I have donated more than four gallons of blood. I fully agree that we should work to increase the amount of organ donation. But none of that has anything to do with this specific issue.

We can't stand by and ignore an evil of mountainous proportions just because it's being done by desperate people. And let's be clear on something: I consider these people to be "real criminals", because I consider them morally to be guilty of "conspiracy to commit murder". By making someone else's death commercially valuable, they increase the chance that someone else will die. This is, to my mind, no different than hiring a hit man.
posted by Steven Den Beste at 4:03 PM on May 5, 2001

What happens when said outlaw returns to U.S. and sees a doctor. Wont he ask "Hey Bob where did ya get that nifty kidney" Unless a law is in place, Bob gets to keep his new lease on life. The doctor may refuse to treat the patient on ethical grounds.
posted by clavdivs at 7:03 PM on May 5, 2001

"I'm saying that an ethical person would rather die than to accept an organ from someone who has been executed."

I don't agree. Personally, I'd add an extra word in there:

"An ethical person would rather die than accept an organ from someone who has been wrongfully executed." Or maybe, "who has been executed so their organs could be used."

"But I don't subscribe to the idea that one may do anything, anything whatever, in order to live."

Neither do I.

"We in the US have a moral obligation to diminish the potential customer base by any means available, and the only legal means of which I'm aware is control over immune supressants."

Let me quote this again:

"Not to mention that your "solution" would only serve to cause more people to, paraphrasing from the article, go for follow-up care at "a less elite institution" or stay "within secretive medical channels recommended by their brokers.""

There will always be doctors willing to hand out these drugs regardless of whether the people have a perscription for them, and chances are that if someone's willing to pay $10k for a kidney from China, they'll be able to find such a doctor fairly easily as well.

Not to mention that, while it's probably legally okay, any doctor who gives a damn about the hippocratic oath would be pretty angry about having this death sentence placed upon anyone who's still desperate enough to have an illegal transplant done.

Having said all that, I remind you that I agree something should be done. I don't think the government should use its control over cyclosporin to do it.

And no, I can't think of another way right now.

Oh, and witold:

"i think just changing the default to "YES" and allowing anyone to change this would make a big difference."

That'll never go through. Have you seen how angry some people get about email lists that default to yes? No way are they going to be any quieter about doing the same things to their internal organs.
posted by CrayDrygu at 8:21 PM on May 5, 2001

If the death penalty is OK then harvesting the organs for transplant should likewise be OK. This, of course, doesn't even begin to address the slippery slope that society heads down when considering this. Larry Niven and other science fiction authors looked at the dark side of this where traffic violations incurred the death penalty so that everyone else could live longer. Given the shortage of transplant organs in the states, it doesn't surprise me that some other nations relatively young "criminals" would become fodder for the West's immortality machine.
posted by shagoth at 8:24 PM on May 5, 2001

Cray, the foundation of our legal system is the fact that it is disinterested. Juries are chosen by interviewing each individual juror, and dismissing any which has preknowledge of the case, or who knows any of the participants, or who has a stake in the outcome. If a judge has any kind of connection to the case, he will recuse himself.

It is important that the participants in a trial, criminal or civil, believe that the case will be decided only on its merits, uninfluenced by external factors. Without this, the system falls apart and citizens submit to it only because of the threat of force.

If capital punishment is used to create a pool of organs which can be used to help citizens, then every citizen instantly has a vested interest in executions, and it's no longer possible to be certain that they're making their decision solely on the basis of the merits of the case itself.

And, as Niven has indeed pointed out, when executions benefit the citizens there is pressure on legislators to use the death penalty more often, for less serious crimes. Some of the people in China who have been executed recently were convicted of corruption. Surely taking bribes should not be a capital offense!

When organ donation becomes the outcome of an execution, then every execution implicitly becomes "for the purpose of organ donation". How can this be avoided? How can juries not be aware that if they order the death of this scum, that four or five people's lives might be saved? Or that those four or five people will die if they "only" order life imprisonment? How can they avoid having this color their decision?

It also takes us to a place I don't want us to go: deciding when it's OK to sacrifice any life, no matter how venal, to save the life of another, no matter how noble. I don't want us beginning to decide "One of these people must die, which should it be?" I shudder to think of the results on our culture if that becomes commonplace, and where else it might lead us.

I'm not against the death penalty, but for me it's punishment and only punishment. I don't like the implications for our society if executions result in a substantial benefit to it.
posted by Steven Den Beste at 9:05 PM on May 5, 2001

And there is no other condition of which I'm aware for which such life-time treatment is required.

Diabetes, some mental conditions, and that's just off the top of my head... oh, and some could argue AIDS.
posted by kindall at 9:26 PM on May 5, 2001

Here's Abbot's package insert; they list Rheumatoid arthritis and Psoriasis as approved conditions for treatment.

I think that could still be dealt with; the point is that a person who's gotten what I want to have made an "illegal" transplant could still be detected and tracked through requirements for drug treatments.

What would you suggest instead?
posted by Steven Den Beste at 9:43 PM on May 5, 2001

I don't have much to add to thread but I had to respond to something CrayDrygu wrote.
I don't agree. Personally, I'd add an extra word in there:
"An ethical person would rather die than accept an organ from someone who has been wrongfully executed."
We are talking about China here, right? You want make an ethical choice based on a decision by the PRC? I'm aware that this story is most likely part of a propaganda wave aimed at China but that doesn't make it any less true.
posted by rdr at 10:44 PM on May 5, 2001

Never mind the latent evil in convicted criminals' appendages
posted by owillis at 10:47 PM on May 5, 2001

Aaron, it turns out that doctor/patient privilege includes the ability to conceal commission of a felony -- like cocaine abuse, for instance.

In fact, a doctor can't be compelled to reveal anything, and in general the only time a doctor will reveal anything voluntarily is if they think it's necessary in order to prevent a new serious crime being committed. Thus while a doctor might say "I think this patient is going to get an illegal transplant" they won't ever say "this patient has already gotten an illegal transplant" and they cannot be compelled to say so, so far as I know. That was why I suggested that tracking the use if immunosuppressants was a way of finding such people.

Also, the people who have been getting these transplants in China have been living in the US, taking trips to China specifically for this purpose, and then coming back here afterwards. That's not quite the same.
posted by Steven Den Beste at 11:27 PM on May 5, 2001

[Steven] wrote: "...tracking the use if immunosuppressants was a way of finding such people."
Does this mean the next step is tracking the use of AZT to find out who has AIDS (to find illegal drug use or (in some countries) illegal homosexual activity). Or tracking the use of chemotherapeutics to find out who has cancer (useful information for insurance companies). Okay, I admit it's a little bit farfetched, but tracking medications to find a felony is in my opinion unethical. I think it creates a black market for cyclosporine. In stead of buying a kidney, people would buy a kidney and a twenty-years supply of cyclosporine in China.

The real issue is: 'how do we shorten the waiting list for transplants?' This is not the way.
posted by nonharmful at 1:11 AM on May 6, 2001

"We are talking about China here, right?"

No, I'm talking about the idea in general.
posted by CrayDrygu at 12:47 PM on May 6, 2001

Clone organs...
posted by thirteen at 5:13 PM on May 6, 2001

Far more practical than organ cloning would be to figure out how to make animal-to-human transplantation work. And indeed someone is working on that now.

That still doesn't answer the question of what we should do about someone who participates in conspiracy to commit murder in order to get an organ from a human.
posted by Steven Den Beste at 6:04 PM on May 6, 2001

The problem with using these Chinese organs is 60 minutes after they're implanted you want another one....
posted by darren at 11:42 AM on May 7, 2001

I think it is an issue we cannot control and we can not prosecute in this country for foreign crimes. This is an issue that emphasises the need for a real international coalition not the weak UN or the puppet free-trade agreements.
posted by wsfinkel at 5:01 PM on May 7, 2001