Saturday, June 9, 2012

Check before you talk
Most of us tend to have fairly simple diagnoses of problems and similarly simple prescriptions for resolving those problems. But every now and then we get our nose rubbed in our own ignorance. We are reminded that simpleminded diagnoses and similarly simpleminded solutions are often destructive. Such simplemindedness is the common coin of political rhetoric, especially during political campaigns.
But politicians are not the only ones to oversimplify.
These reflections were occasioned by a recent debate about the morality of selling body parts. Should kidneys for transplants be assigned by lottery or should they be for sale in the open market? Michael Sandel of Harvard University opened the the debate by arguing that selling organs for transplants is morally reprehensible. Some things, Sandel believes, may and should be traded in a free market. Other things should not become commodities for sale, kidneys among them.
An economics professor in Montana, and visiting scholar at the American Enterprise Institute argued the conservative line against that. If kidneys could be bought and sold, then some people who were really short on cash might be willing to sell a kidney and thereby save the lives of people who now died because no transplant kidney is available for them. Once again the free market comes into play to save lives and make the world better.
But this pro and con selling kidneys argument ignores important facts and therefore is seriously oversimplified.
Here is one set of facts:
"Many people seem to think that donating a kidney is like giving a pint of blood. It is not.
- 4.4 kidney donors die each year in the US within 12 months of surgery.
- 20% experience complications, some of which are life-long and painful.
- 20-30% of living donors suffer from depression, anxiety, and PTSD.
More to the point, EVERY study from ALL countries with legal or illegal kidney sales has concluded that organ donation is highly detrimental to the person relinquishing the kidney. They experience more health problems, greater financial difficulties, increased psychosocial woes, and a general decreased quality of life. " (
Here is another interesting perspective on the kidney transplant debate:
Trichakis (a professor at MIT) and his colleagues decided to try to figure out how to balance fairness and efficiency in kidney transplants. They spent last summer building a sophisticated computer model that included thousands of variables and decades of data on organs and patients and medical outcomes.
At the end of the summer, they ran their model against the formula doctors currently use to allocate kidneys. Trichakis' model was just as fair as the current system— and enormously more efficient.
If you used their model to match patients and kidneys for one year, and you totalled up the extra life expectancy patients would gain, you'd get 5,000 extra years of life, according to their results.”
What do we learn? We should not argue about allowing people to donate kidneys before we are informed about the side effects of organ donation. Nor should we argue about the economic attractions of organ donation without having any understanding of what kind of difference kidney donation will actually make. Before we get into this free market vs. morality argument we had better find out whether there are more effective ways than organ donation of solving the problem of a shortage of kidneys for transplants.