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Organs and Payment: cui bono?

20 Oct, 11 | by Iain Brassington

Dipping in and out of the Nuffield Council on Bioethics’ recent report on organ donation (available in various forms from this page), I’ve been struck by a couple of things.

One is that the Council is painfully keen to maintain its distance from the idea that organs – especially those from live donors – could be sold.  The report makes clear that not every form of payment for donation implies this kind of commodification, and is correct to do so.  But, all the same, it’s pretty clear in its insistence that sale would be a Bad Thing.  And, of course, this just invites fairly conventional arguments about whether, and why, sale of organs really would be so bad after all.  One of the worries nodded towards here is the commodification objection – but it seems plain to me that it’s one thing for you to treat me or my body as a mere commodity, but quite another for me to treat my own body as such.  And there’s also a difference – at least on the face of it – between being treated as a commodity and being treated merely as a commodity.

(On this note, I cringed at the way that Kant is mangled on p 120 of the full report.  But that’s possibly just me and my soft spot for the Prussian weirdo.)

So far, so conventional.  What really caught my attention – partly because it caught the attention of headline-writers in the news media – was the proposal that payment might be offered to defray the funeral costs of people whose organs could be used. Part of me wonders whether there’d be a sliding scale here – maybe you’d get the flowers bought for just one kidney, rising to a level at which, if every transplantable organ was used, you’d get the full Viking ship burial, or maybe the London Community Gospel Choir to perform Verdi’s Dies Irae.

But a more serious part of me wonders why the funerary costs should be defrayed, especially given the insistence that organs are not commodities.  After all, protest as much as you like, but such a scheme seems to me to cast organs as being a part of the deceased’s estate: a source of wealth that is heritable.  It’s slightly strange that, if someone is going to benefit from the use of organs for transplant, it would not be the donor, but the donor’s heirs.  What, precisely, have they done?  Why should their inheritance be safeguarded, in howsoever small a way, by their relatives’ willingness to have their organs recycled?

Well, I suppose that one is to disincentivise the veto that can be exercised by next of kin.  But that assumes that the veto is legitimate to begin with, and that it’s appropriate to try to sway people with money.  But if it’s OK to sway people with money, then why not offer it to the person whose lungs you want to transplant in the first place?

Meanwhile, I ought to note the response from The Daily Mash.  It’s quite superb.

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  • Lindsay

    “Well, I suppose that one is to disincentivise the veto that can be
    exercised by next of kin.  But that assumes that the veto is legitimate
    to begin with…”

    I just don't see why the presumed aim (disincentivising the family veto) assumes that the veto is legitimate to begin with, Iain. Consider an analogy. In order to reduce the production of narcotics like heroin or cocaine in certain parts of the world, anti-drugs programmes pay farmers over the odds to grow alternative crops like coffee. Does this assume that growing drugs is legitimate (or even that it isn't)? To my mind it only assumes that (a) the exercise of a veto by families is undersirable and (b) that a payment of treasure is seen as a either a more effective or less costly (including in political terms) way of reducing that exercise than alternative instruments such as information, use of authority or organisation.

    Or am I missing something?

  • http://www.law.manchester.ac.uk/aboutus/staff/iain_brassington Iain Brassington

    Yeah – that's a good point.  Though the family does get a de facto veto on a lot of organ harvesting decisions, so there is a slight difference in this sort of case.  We don't give cannabis producers the opportunity to grow their plants at the same time as trying to encourage them not to.

    I also wonder whether offering payment (or payment in kind) to the family might be a disincentive; there'll be some families that would not think twice about donating, but who might, if there's money on offer, begin to think differently about the process, and decide that the incentive isn't great enough after all.

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