The New Paper
23 July 2008
What price Altruism?
Should there be financial compensation for organ trading?
By Low Ching Ling
IT is an issue that has divided patients, their families, doctors, lawmakers, ethicists and just about anyone who feels strongly about it.
Supporters of legalising organ trading say it is a no-brainer: Why not do it if it can save more lives?
Please, get real, no one is going to give a stranger his or her kidney for free, they argue.
Critics decry organ trading as unethical. They insist donors should do it out of the goodness of their heart.
Which way should Singapore go?
But does it always have to be narrowed to a zero-sum game - either pure altruism or financial reward?
Perhaps not, Health Minister Khaw Boon Wan revealed in Parliament yesterday. He said he would sometimes get requests from charities and religious bodies who want to offer 'some compensation, in kind and in cash' to organ donors and their families to 'acknowledge their altruistic act'.
But the organisations would worry that their gestures might be seen as organ trading.
Mr Khaw said: 'My view is that we should encourage third parties, especially those from the charity and religious sector, to help promote altruistic organ donations, and that we should consider how they can be allowed to provide some financial compensation to the donors and their families after the transplants have taken place.'
Yes, push altruistic organ donations to their 'maximum potential', and let living-related kidney donations and those done under the Human Organ Transplant Act to still be the 'predominant sources' of kidney transplants.
But don't rule out organ trading, Mr Khaw added.
'If altruistic organ donations cannot fully meet the demand, we should continue to search for good complementary solutions,' he said.
'We should not reject any idea just because it is radical or controversial.'
Can legalising organ trading be the answer to our kidney donation woes?
Mr Khaw said: 'By forcing ourselves to think about unconventional approaches, we may be able to find an acceptable way to allow a meaningful compensation for some living-unrelated kidney donors, without breaching ethical principles and hurting the sensitivities of others.'
And perhaps it is time we get real, he said. After all, there are desperate patients out there who want to live, and also desperately poor people willing to exchange a kidney for a better life. 'This is the reality and the human dilemma confronted by many in such desperate situations,' Mr Khaw said.
'Criminalising organ trading does not eliminate it. But it merely breeds a black market with the middle man creaming off the bulk of the compensation which the grateful patient is willing to offer the donor.'
WHAT PRICE ALTRUISM?
So, will putting a price on altruism work in Singapore?
It may still take some time before the Government reaches a decision. For now, the Health Ministry will push to amend some other existing laws on organ transplants.
First, by removing the age limit of 60 years old on cadaveric donors.
Mr Khaw said: 'Many countries, including Spain, do not set such an age limit. The suitability of the organ depends on its condition, rather than the age of the donor.'
Second, by allowing pair-matched donations here.
This means that if patient A's donor does not match A and patient B's donor does not match B, they can switch donors if there is a match that way. A live donor registry will be set up to facilitate this.
With the two initiatives, Singapore can aim to raise its kidney sufficiency level from 50 to 70 per cent in the medium term.
What about those who have broken the law?
Mr Khaw said: 'Even as we take action against those involved in illicit organ trading and unscrupulously exploiting the desperate and the vulnerable, we will take a sympathetic approach to the plight of the exploited donors and the basic instinct of kidney failure patients to try to live.'
---------------------------------
The New Paper
23 July 2008
Want fairness? Let kidney bank handle it
By Ng Wan Ching
THROWING money at donors is not the solution to the kidney shortage facing kidney failure patients here. If it is, then those who need money the most will be the first to give. And those who have the most money will be the first to get.
That situation, as so many have pointed out, will exploit the poorest among us and it will favour the richest. The amount of money given, directly or indirectly, to the donor, will influence who might donate a kidney.
At $20,000 to $50,000 a kidney, perhaps the lowest earning segment of society will feel compelled to give.
For up to $300,000, perhaps the next higher segment of society will feel the push.
For up to $500,000, perhaps even well-heeled professionals might be induced to donate.
The amount has to be carefully calibrated so as to be meaningful and yet not glaringly so that it becomes a rare consumer item.
Idealistic as this sounds, there should still be room for altruism, albeit not so pure. (None of this prevents those who want to give for nothing in return.)
So how can the sums paid to donors be regulated?
The money could come from a common pool managed by a governing body rather than individuals paying for their donor organ in a free market. On top of managing the money, the governing body overseeing the kidney bank will have to come up with policies that address various issues.
Such as, what will happen to their family members if they happen to need a kidney in the future? Once someone has given up one of their kidneys, they won't be able to help their loved ones in their time of need.
One solution is to put kidney donors' family members at the top of the transplant list if they do need a transplant. And while money might encourage more people to give, there will still be those who baulk because of health considerations.
Many US hospitals say donation does not increase a donor's risk for kidney failure or put him at more risk for future health complications.
But the 'what if's' linger.
Studies have been done to show that donors are at no more increased risk of heart attacks. Further study is needed to determine whether the apparent increase in the risk of high blood pressure is truly an effect of living kidney donation.
The long-term monitoring of donors' health calls for more research.
---------------------------------
The New Paper
23 July 2008
Allow organ trading, says Noble Prize laureate
Attitudes towards compensating kidney donors are changing. Health Minister Khaw Boon Wan spoke about a recent article by Dr Gary Becker, of the Hoover Institution, who won the 1992 Nobel Prize in Economics.
In an article titled 'Should the purchase and sale of organs for transplant surgery be permitted?', Dr Becker used economic principles to argue for organ trading. Here are some excerpts.
AN ECONOMIST'S PERSPECTIVE
'To an economist, the major reason for the imbalance between demand and supply of organs is that the US and practically all other countries forbid the purchase and sale of organs.'
WON'T REDUCE NUMBER OF DONORS
'Some critics simply dismiss organ markets as immoral 'commodification' of body parts. More thoughtful critics suggest that allowing organs to be bought and sold might actually reduce the total number of organs available for transplants because they claim it would sufficiently lower the number of organs donated from altruistic motives to dominate the increase due to those sold commercially.
'That scenario, however, is extremely unlikely since presently only a small fraction of potentially useable organs are available for transplants.'
LIMITS TO OPT-OUT SYSTEM
'A PhD thesis in progress by Sebastien Gay at Chicago shows that opt-out systems may yield somewhat more organs for transplants than the opt-in systems used by the US and many other nations, but they do not eliminate the long queues for transplants.'
CHARITY NOT ENOUGH
'If altruism were sufficiently powerful, the supply of organs would be large enough to satisfy demand, and there would be no need to change the present system.'
EQUILIBRIUM PRICE
'In a paper on the potential of markets for live organ donations, Julio Elias of the University of Buffalo and I estimate that the going price for live transplants would be about US$15,000 ($20,280) for kidneys and about US$35,000 for livers.'
Current costs for transplants in the US are in the range of US$100,000 for kidney and US$175,000 for liver.
POOR NOT EXPLOITED
'... why would poor donors be better off if this option (of selling their organs) was taken away from them?
'... Many of the organs used for liver or kidney transplants are still likely to be supplied by relatives. In addition, many middle class persons would be willing to have their organs sold after they died if the proceeds went to children, parents, and other relatives.'
DETERRING IMPULSIVE SELLERS LOOKING FOR SHORT-TERM GAIN
'(We can have) a month or longer cooling-off waiting period between the time someone agrees to supply an organ and the time it can be used.
'They would be allowed to change their mind during the interim.'
23 July 2008
What price Altruism?
Should there be financial compensation for organ trading?
By Low Ching Ling
IT is an issue that has divided patients, their families, doctors, lawmakers, ethicists and just about anyone who feels strongly about it.
Supporters of legalising organ trading say it is a no-brainer: Why not do it if it can save more lives?
Please, get real, no one is going to give a stranger his or her kidney for free, they argue.
Critics decry organ trading as unethical. They insist donors should do it out of the goodness of their heart.
Which way should Singapore go?
But does it always have to be narrowed to a zero-sum game - either pure altruism or financial reward?
Perhaps not, Health Minister Khaw Boon Wan revealed in Parliament yesterday. He said he would sometimes get requests from charities and religious bodies who want to offer 'some compensation, in kind and in cash' to organ donors and their families to 'acknowledge their altruistic act'.
But the organisations would worry that their gestures might be seen as organ trading.
Mr Khaw said: 'My view is that we should encourage third parties, especially those from the charity and religious sector, to help promote altruistic organ donations, and that we should consider how they can be allowed to provide some financial compensation to the donors and their families after the transplants have taken place.'
Yes, push altruistic organ donations to their 'maximum potential', and let living-related kidney donations and those done under the Human Organ Transplant Act to still be the 'predominant sources' of kidney transplants.
But don't rule out organ trading, Mr Khaw added.
'If altruistic organ donations cannot fully meet the demand, we should continue to search for good complementary solutions,' he said.
'We should not reject any idea just because it is radical or controversial.'
Can legalising organ trading be the answer to our kidney donation woes?
Mr Khaw said: 'By forcing ourselves to think about unconventional approaches, we may be able to find an acceptable way to allow a meaningful compensation for some living-unrelated kidney donors, without breaching ethical principles and hurting the sensitivities of others.'
And perhaps it is time we get real, he said. After all, there are desperate patients out there who want to live, and also desperately poor people willing to exchange a kidney for a better life. 'This is the reality and the human dilemma confronted by many in such desperate situations,' Mr Khaw said.
'Criminalising organ trading does not eliminate it. But it merely breeds a black market with the middle man creaming off the bulk of the compensation which the grateful patient is willing to offer the donor.'
WHAT PRICE ALTRUISM?
So, will putting a price on altruism work in Singapore?
It may still take some time before the Government reaches a decision. For now, the Health Ministry will push to amend some other existing laws on organ transplants.
First, by removing the age limit of 60 years old on cadaveric donors.
Mr Khaw said: 'Many countries, including Spain, do not set such an age limit. The suitability of the organ depends on its condition, rather than the age of the donor.'
Second, by allowing pair-matched donations here.
This means that if patient A's donor does not match A and patient B's donor does not match B, they can switch donors if there is a match that way. A live donor registry will be set up to facilitate this.
With the two initiatives, Singapore can aim to raise its kidney sufficiency level from 50 to 70 per cent in the medium term.
What about those who have broken the law?
Mr Khaw said: 'Even as we take action against those involved in illicit organ trading and unscrupulously exploiting the desperate and the vulnerable, we will take a sympathetic approach to the plight of the exploited donors and the basic instinct of kidney failure patients to try to live.'
---------------------------------
The New Paper
23 July 2008
Want fairness? Let kidney bank handle it
By Ng Wan Ching
THROWING money at donors is not the solution to the kidney shortage facing kidney failure patients here. If it is, then those who need money the most will be the first to give. And those who have the most money will be the first to get.
That situation, as so many have pointed out, will exploit the poorest among us and it will favour the richest. The amount of money given, directly or indirectly, to the donor, will influence who might donate a kidney.
At $20,000 to $50,000 a kidney, perhaps the lowest earning segment of society will feel compelled to give.
For up to $300,000, perhaps the next higher segment of society will feel the push.
For up to $500,000, perhaps even well-heeled professionals might be induced to donate.
The amount has to be carefully calibrated so as to be meaningful and yet not glaringly so that it becomes a rare consumer item.
Idealistic as this sounds, there should still be room for altruism, albeit not so pure. (None of this prevents those who want to give for nothing in return.)
So how can the sums paid to donors be regulated?
The money could come from a common pool managed by a governing body rather than individuals paying for their donor organ in a free market. On top of managing the money, the governing body overseeing the kidney bank will have to come up with policies that address various issues.
Such as, what will happen to their family members if they happen to need a kidney in the future? Once someone has given up one of their kidneys, they won't be able to help their loved ones in their time of need.
One solution is to put kidney donors' family members at the top of the transplant list if they do need a transplant. And while money might encourage more people to give, there will still be those who baulk because of health considerations.
Many US hospitals say donation does not increase a donor's risk for kidney failure or put him at more risk for future health complications.
But the 'what if's' linger.
Studies have been done to show that donors are at no more increased risk of heart attacks. Further study is needed to determine whether the apparent increase in the risk of high blood pressure is truly an effect of living kidney donation.
The long-term monitoring of donors' health calls for more research.
---------------------------------
The New Paper
23 July 2008
Allow organ trading, says Noble Prize laureate
Attitudes towards compensating kidney donors are changing. Health Minister Khaw Boon Wan spoke about a recent article by Dr Gary Becker, of the Hoover Institution, who won the 1992 Nobel Prize in Economics.
In an article titled 'Should the purchase and sale of organs for transplant surgery be permitted?', Dr Becker used economic principles to argue for organ trading. Here are some excerpts.
AN ECONOMIST'S PERSPECTIVE
'To an economist, the major reason for the imbalance between demand and supply of organs is that the US and practically all other countries forbid the purchase and sale of organs.'
WON'T REDUCE NUMBER OF DONORS
'Some critics simply dismiss organ markets as immoral 'commodification' of body parts. More thoughtful critics suggest that allowing organs to be bought and sold might actually reduce the total number of organs available for transplants because they claim it would sufficiently lower the number of organs donated from altruistic motives to dominate the increase due to those sold commercially.
'That scenario, however, is extremely unlikely since presently only a small fraction of potentially useable organs are available for transplants.'
LIMITS TO OPT-OUT SYSTEM
'A PhD thesis in progress by Sebastien Gay at Chicago shows that opt-out systems may yield somewhat more organs for transplants than the opt-in systems used by the US and many other nations, but they do not eliminate the long queues for transplants.'
CHARITY NOT ENOUGH
'If altruism were sufficiently powerful, the supply of organs would be large enough to satisfy demand, and there would be no need to change the present system.'
EQUILIBRIUM PRICE
'In a paper on the potential of markets for live organ donations, Julio Elias of the University of Buffalo and I estimate that the going price for live transplants would be about US$15,000 ($20,280) for kidneys and about US$35,000 for livers.'
Current costs for transplants in the US are in the range of US$100,000 for kidney and US$175,000 for liver.
POOR NOT EXPLOITED
'... why would poor donors be better off if this option (of selling their organs) was taken away from them?
'... Many of the organs used for liver or kidney transplants are still likely to be supplied by relatives. In addition, many middle class persons would be willing to have their organs sold after they died if the proceeds went to children, parents, and other relatives.'
DETERRING IMPULSIVE SELLERS LOOKING FOR SHORT-TERM GAIN
'(We can have) a month or longer cooling-off waiting period between the time someone agrees to supply an organ and the time it can be used.
'They would be allowed to change their mind during the interim.'
Posts
No comments:
Post a Comment