Nov 2, 2008

Money for a Kidney and a Life

A few months ago, I wrote several posts about the possible legalisation of human organ trading. Here's one of my posts.

My view was that it was feasible to legalise such activities. I felt that the organ donors should be entitled to receive payment. I also felt that the payment amount should be fixed by law (and not allowed to operate as a free market), and could be periodically reviewed and revised.

The Singapore government has now announced that it will proceed substantially on those lines.

ST Nov 1, 2008
Kidney law to change
By Salma Khalik

FROM early next year, the law will be changed to allow compensation for live kidney donors.

The amount should not be so large that it's seen as inducement, said Health Minister Khaw Boon Wan when he announced it yesterday.

Both the World Health Organisation and countries like the United States say it is ethical to compensate donors, so they do not suffer for their act of altruism.

Mr Khaw said the amount of compensation is not 'hard wired' into legislations of countries such as the US, Britain and Australia that allow it. Singapore will follow suit.

He hinted that the sum will be at least five figures, and possibly six. The actual amount of just compensation will be left to a committee, which will be set up to look into this.

In the recent organ trading case involving former retail magnate Tang Wee sung, the indonesian donor was to have received $23,700 for his kidney, from the $300,000 Mr Tang paid the agent.

That case sparked a debate on whether it is ethical to pay someone for an organ. Yesterday, Mr Khaw repeated that it is not ethical to do so.

But he added, 'The ethical community, including the World Health Organisation, has clarified that it is ethical to compensate, so long as the compensation amount is not so big as to induce.'

Khaw says that it is not ethical to "pay" someone for an organ. However, he also says that it's ethical to "compensate" someone for an organ ... so long as the amount is "not so big as to induce".

So he tries to change the packaging, but the substance is still the same. "Pay", "compensate", whatever you call it, it's still money. Whether the amount is big enough or not big enough, to "induce", well, those are all highly subjective considerations.

To me, the biggest consideration is the need to save human lives.


geriatric_eunuch said...

"Whether the amount is big enough or not big enough, to "induce", well, those are all highly subjective considerations."

Indeed. When you're trying to survive on US$1 a day, $1000 IS an inducement and a 5-6 figure sum a veritable fortune beyond your wildest dreams. Let's call a spade a spade and not be mealy-mouthed about this — it's organ trading given a more ethical spin. The buyers will inevitably be the relatively affluent and the sellers the poor and disadvantaged. Who ever said life was fair?

I don't envy Khaw or his counterparts their rock-and-hard-place dilemma: permit only altruistic donations and watch the illegal trade go underground with all the abuse that implies, or legalise the practice knowing full well that it will become the thin end of the wedge leading eventually to full-blown trade in human body parts. Hopefully Singapore has no plans to be a lucrative hub for this business, for business is what it will unavoidably evolve into.

I'm reminded of a chilling science fiction short story (whose title I can't recall) I read a long time ago. Set in a none-too-distant future when body parts have become acceptable currency, gambling dens arise where punters without ready cash can opt to wager their organs on the turn of a card. Losers are conducted swiftly to the on-site surgery to make good their debts. For all their fine clothing and bonhomie, the clientèle all display signs of not having had Lady Luck on their side at some point, missing the odd eye, ear, and limb and showing the aftermath of expert surgery.

Terrifying thought. Let's pray it'll never happen.

Mercia said...

I quite like this idea, and it seems like a great way for the government to increase tax revenue by legalising the organ finding trade.

I'm also pondering how big is the market exactly for the services of such agents, and possibly the new role governments and NGOs can help in regulating this trade and allowing for money to flow from the rich to the poor.

Fox said...

I speculate that the government will only allow kidney trading between Singaporeans.

Apart from saving lives, nother consideration is that the economic burden on society (the individual undergoing dialysis and the public) is reduced. Dialysis is very expensive and kidney transplants are almost always cheaper in the long run.

The said...

/// So he tries to change the packaging, but the substance is still the same. "Pay", "compensate", whatever you call it, it's still money. ///

Sounds like Clinton's distinction between smoking pot, but not inhaling.

Question is - are kidneys to be treated as assets/properties or goods? Is there going to be a property tax or GST?

SR said...

If people are allowed to buy organs off poor people, they will become irresponsible in taking care of their own body.

At least that's my theory.

And poor people may sell away their organs out of financial desperation only to regret it later on.

Woof Woof said...

Q: who pays for the "compensation"? Is it the recepient?

Q: Does this mean if I can't afford to "compensate" the donor, I won't be able to get transplants in future? Will there still be a free-for-transplant queue?

Mr Wang Says So said...

"Will there still be a free-for-transplant queue?"

Sure. From the usual current source ... you wait for accident victims etc.

SR said...

So those who are richer will get easier access to renewable organs compared to the poorer people.

Which comes back to my point that such a scheme would simply motivate poorer people to be willing to give up their organs for cash, where previously they were unwilling to do so.

Mr Wang Says So said...

"So those who are richer will get easier access to renewable organs compared to the poorer people."

Yup. The same goes for healthcare in general.

However, the whole idea of legislatively fixing the price of organs is to reduce that problem.

The Void Deck said...

I think everyone is forgetting that the whole idea of this organ trading philosophy is to save lives, as Mr Wang said. If everyone can agree to that point, then regulation can therefore address the hows, legalities and practices on ethical organ trading.

The Void Deck said...

Oh, "ethical organ trading" need not be oxymoronic.

SR said...

I wonder if there has there been any unbiased and comprehensive study to examine the effects (if any) of living with only 1 kidney versus living with 2.