Organ Peddling

E-mail debates of newsworthy topics.
June 10 1998 3:30 AM

Organ Peddling

VIEW ALL ENTRIES

       As you might expect from a surgical resident like me, squeamishness--ethical or otherwise--has nothing to do with my opposition to your proposal for a legal market for the sale of organs. Far from it being a "brave" cause hindered only by a couple of "practical difficulties," I think it is fundamentally flawed. Indeed, it lays bare serious inadequacies in a no-holds-barred libertarian worldview.
       Your e-mail briefly mentions the issue of selling organs from cadavers. That raises many altogether different problems (like who owns them and who decides and how you get this kind of market to actually function in the real world) that I won't take up here. The idea of living people selling off some of their organs has enough troubles for one conversation.
       You start your rebuttal by saying we should permit people to sell their organs because it could save lives. But we should be clear that, even if lives would be saved, such sales would be horrifying--and should be kept illegal--if irrational thinking or exploitation are likely driving sellers' decisions. If people signing a sales contract for their kidney are making a big, dumb mistake or being unjustly taken advantage of, then it would not be "better that we have 200 people alive with one kidney each than 100 people alive with two kidneys." My argument is that, given how unlikely it is that hawking one's organs will be in one's self-interest, mistakes and exploitation will likely rule the day. Given how serious and irrevocable the decision is, organ-selling should remain banned.
       What person could possibly have reason to accept the substantial health risks and disfigurement of selling their organs? You dismiss the two people in my article who took out ads offering to sell a kidney. One wanted to buy a boat. The other needed an unaffordable operation. They were "odd" examples, you said, for they were oldish (although a transplant surgeon would not necessarily think so) and perhaps infirm. Instead you suggest a good example is a young family man who desperately needs funds for an operation on his child. But he's a reason for enacting universal health insurance, not for dropping the ban on organ-selling. Your chosen example is a classic case of exploiting a desperate situation, like charging a man dying of thirst $1,000 for a glass of water. If our wealthy society has many people in such a state of deprivation that it would be rational for them to sell their organs, society is what needs to be fixed.
       As dubious as I am, however, let's suppose that we could somehow screen exploitation out. There would still be some people left trying to sell their organs. Perhaps a few have lives that would be so enriched by the payment they get that the risks are worthwhile. But many, like a lot of gamblers, will be enticed to do it by a weakness for money or a mistaken estimate of the risks involved. Indeed, given what we know about the rationality of people, it is a safe bet that organ markets would be dominated by folks with faulty reasons for selling their organs.
       Professor Epstein, you approach this issue and others in your book with a presumption that people nearly always act rationally, and then you conclude that people should be allowed to engage in virtually any transaction. But everything that I've seen in my modest experience watching how patients actually make vital decisions about their lives--like whether to undergo a risky surgery or not--indicates that decision-making is usually far from rational. That's just the way people are.
       You avoid grappling with my argument by saying the problem is merely "confusion," which can be fixed with your prescription for more information, but it's not. Our reasoning process has fundamental flaws. For three decades, neuropsychology research has shown that our decisions are heavily influenced by irrelevant factors--such as the order in which options are laid out, the way they are framed, and who presents them. The brain is particularly dreadful at weighing probabilities and risks. We do not carry around statistical programs in our heads. Instead, we deal with probabilities using mental shortcuts that often fail us. Anecdotes are more powerful than data. Immediate gains and losses loom larger than distant ones, regardless of size. In my essay, I cite still other examples.
       The upshot is that, no matter what is done, humans will reliably and frequently make irrational choices. That is no less the case when weighing the losses of having an eye or kidney removed against the gain of a bunch of cash. Where a decision is this open to exploitation and irrational thinking, has consequences this serious and irrevocable, and is so unlikely to be in a person's self-interest, we ban it. It is no different than prohibiting, as we do, people from donating three-quarters of their blood at one sitting or entering into a heavyweight boxing match when they are unfit.
       I wonder if you recognize these concerns to some extent. You write in your book that you agree with laws preventing living people from donating their heart or enslaving themselves. Why? After all, it's conceivable that people may rationally wish to do such things. A parent, for example, may rationally wish to give up his or her heart and life to a child. Nonetheless, I stick with the ban because of the large likelihood that exploitation or a nonrational factor is driving a decision of such terrible consequences. Why do you?

This dialogue grows out of Gawande's article "Organ Meat," which appeared recently in Slate.

Click to purchaseMortal Perilfrom Amazon.com.

TODAY IN SLATE

Doublex

Crying Rape

False rape accusations exist, and they are a serious problem.

Scotland Is Just the Beginning. Expect More Political Earthquakes in Europe.

No, New York Times, Shonda Rhimes Is Not an “Angry Black Woman” 

Brow Beat
Sept. 19 2014 1:39 PM Shonda Rhimes Is Not an “Angry Black Woman,” New York Times. Neither Are Her Characters.

The Music Industry Is Ignoring Some of the Best Black Women Singing R&B

How Will You Carry Around Your Huge New iPhone? Apple Pants!

Medical Examiner

The Most Terrifying Thing About Ebola 

The disease threatens humanity by preying on humanity.

Television

The Other Huxtable Effect

Thirty years ago, The Cosby Show gave us one of TV’s great feminists.

There’s a Way to Keep Ex-Cons Out of Prison That Pays for Itself. Why Don’t More States Use It?

Why Men Can Never Remember Anything

The XX Factor
Sept. 19 2014 1:11 PM Why Men Can Never Remember Anything
Behold
Sept. 19 2014 11:33 AM An Up-Close Look at the U.S.–Mexico Border
  News & Politics
Foreigners
Sept. 19 2014 1:56 PM Scotland’s Attack on the Status Quo Expect more political earthquakes across Europe.
  Business
Moneybox
Sept. 19 2014 3:24 PM Why Innovators Hate MBAs
  Life
Inside Higher Ed
Sept. 19 2014 1:34 PM Empty Seats, Fewer Donors? College football isn’t attracting the audience it used to.
  Double X
The XX Factor
Sept. 19 2014 4:58 PM Steubenville Gets the Lifetime Treatment (And a Cheerleader Erupts Into Flames)
  Slate Plus
Slate Picks
Sept. 19 2014 12:00 PM What Happened at Slate This Week? The Slatest editor tells us to read well-informed skepticism, media criticism, and more.
  Arts
Brow Beat
Sept. 19 2014 4:48 PM You Should Be Listening to Sbtrkt
  Technology
Future Tense
Sept. 19 2014 12:38 PM Forward, March! Nine leading climate scientists urge you to attend the People’s Climate March.
  Health & Science
Medical Examiner
Sept. 19 2014 12:13 PM The Most Terrifying Thing About Ebola  The disease threatens humanity by preying on humanity.
  Sports
Sports Nut
Sept. 18 2014 11:42 AM Grandmaster Clash One of the most amazing feats in chess history just happened, and no one noticed.