Human Nature: Science, Technology, and Life.

Selling Organs in the Recession

Will the global recession push more people to sell their organs? Apparently, the answer is yes.

Here's the question as I posed it two months ago:

You don't normally think of selling your body's parts or products. But bad times can make you think hard. One reason you might not have thought of selling something from your body is that the idea felt unnatural or somehow made you uncomfortable. But for $5,000, with bills to pay and no other income prospects, you decide you can get over those feelings. ... The next question is whether money can persuade you to donate not just a body product, but a body part.

And here's an initial answer, courtesy of Agence France Presse:

The economic crisis has forced dozens of "desperate" people in Spain to put their organs up for sale on the Internet, a consumers association said Tuesday. The association, FACUA, told Spanish authorities it has detected "31 announcements of organ sales" on 13 Internet sites by Spaniards and Latin American immigrants. "These are offers of kidneys, lungs and bone marrow, by persons who say they are going through economic difficulties and asking for sums ranging from 15,000 to one million euros (19,000 to 1.3 million dollars)," FACUA said.

The trend is all too logical: As the recession takes away the external assets of more and more people, they'll be forced to sell what's left.

Surrogacy and the State

Is the global market in womb rentals out of control? Does it need regulation?

I wondered about that three weeks ago when I saw this Reuters story: "Poverty Makes Surrogates of Indian Women in Gujarat." The $4,000 to $8,000 paid to successful surrogates in India is "a huge sum of money in a country where many live on less than $2 a day," Rina Chandran reported. But compared with U.S. rates, it's cheap. That's why foreigners have begun

to flock to [Nayna] Patel's clinic, drawn by the lower costs, relaxed attitude toward surrogates and lack of legislation. A draft bill on surrogacy is pending before parliament, and meanwhile, hundreds of clinics have mushroomed across the country, with critics saying touts promoting this "reproductive tourism" care little for the health or rights of the surrogates. ... Patel has a list of nearly 200 [would-be surrogates] and is seeing more women walk in everyday because they are feeling the pinch of the slowdown.

And yet, Chandran noted, Patel "draws the line at gay couples."

Cheap reproductive labor for wealthy foreigners, but no gay parents allowed? For the usual incoherent combination of lefty reasons—not enough private discrimination in working conditions, too much private discrimination in family values—I felt the urge to support regulation of the industry.

Then, yesterday, Reuters published another investigation of overseas surrogacy conditions, this time in China. "With China's rising affluence, increasing numbers of infertile couples have been seeking surrogate mothers," James Pomfret reported. "Surrogacy agencies have been recruiting girls, often from poor villages, to have babies on behalf of prospective parents."

Should the government do something about this? Actually, authorities are already on the case:

In the southern Chinese city of Guangzhou, three young surrogate first-time mothers were discovered by authorities hiding in a communal flat. Soon afterwards, district family planning and security officers broke into the flat, bundled them into a van and drove them to a district hospital where they were manhandled into a maternity ward, the mothers recounted to Reuters. "I was crying 'I don't want to do this'," said a young woman called Xiao Hong, who was pregnant with four-month-old twins. "But they still dragged me in and injected my belly with a needle," the 20-year-old told Reuters. ... Another of the surrogates, who said she'd come from a village in Sichuan province, recounted how officers made her take pills then surgically removed her three-month-old fetus while she was unconscious.

This isn't the kind of policing liberals have in mind when they call for tighter regulation of the fertility industry. But the tricky thing about official intervention is that once the state gets its foot in the door, you don't necessarily get to dictate what it can and can't do.

Every time the global market in human body parts and rentals looks ugly enough to regulate, I'm reminded how much uglier things can get when the government steps in.

A Black Market in Children

If the government stopped you from bearing a child, would you buy one instead?

Before you say no, look at what's happening in China, as reported by Andrew Jacobs in the New York Times:

The Chinese government insists there are fewer than 2,500 cases of human trafficking each year, a figure that includes both women and children. But advocates for abducted children say there may be hundreds of thousands. Sun Haiyang, whose son disappeared in 2007, has collected a list of 2,000 children in and around Shenzhen who have disappeared in the past two years.

Where are all these kids going?

[M]ost of the boys are purchased domestically by families desperate for a male heir, parents of abducted children and some law enforcement officials who have investigated the matter say. The demand is especially strong in rural areas of south China, where a tradition of favoring boys over girls and the country's strict family planning policies have turned the sale of stolen children into a thriving business.

The family-planning policy fines most couples who bear more than one child:

[I]n many rural areas, including Anxi County, a resident whose first child is a daughter is allowed to have a second. Having a third child, however, can mean steep fines as high as $5,800 and other penalties that include the loss of a breadwinner's job. A boy, by contrast, can often be bought for half that amount, and authorities may turn a blind eye if the child does not need to be registered as a new birth in the locale. In some cases, local officials may even encourage people desperate for a son to buy one. After their 3-month-old son died, Zhou Xiuqin said, the village family planning official went to her home and tried to comfort her and her husband, who was compelled to have a vasectomy after the birth of the boy, their second child. "He said, ‘Don't cry, stop crying, you can always buy another one,' " Ms. Zhou recalled.

And that's just what the couple did. They bought a 5-year-old boy for $3,500.

This is what happens when you block legal access to what people desperately want: You create a black market. That's true of drugs, abortions, and even children. The black-market problem doesn't settle any of these policy questions. But before deciding on the policy, you had better take it into account.

Some Chinese parents are trying to defeat the human traffickers by catching kidnappers on surveillance video. Other activists are "agitating for the establishment of a DNA database for children." One activist tells Jacobs, "If the government can launch satellites and catch spies, they can figure out how to find stolen children."

Can a totalitarian regime of cameras, DNA databases, and forced vasectomies stop a black market in children? I don't know. But it sure can start one.

Organ Rewards in Singapore

Two days ago, I mentioned Frances Kissling's proposal to reward organ donors by offering them "comprehensive long-term health insurance" as well as "life and disability insurance." Kissling framed the offer not as an incentive but as "the basic safety net that a just and giving society should provide people who offer to risk their own lives to save the lives of others."

She's not alone. Singapore has just "passed a law allowing cash payments to organ donors," according to Agence France Presse. "Previously, it was illegal for a living donor to be financially compensated." But now "an organ recipient can voluntarily pay the donor if he wishes to help cover expenses like hospital and surgery fees."

And how did proponents of the legislation present it? "This is a bill about fairness, being fair to donors who do suffer financial consequences as a result of their act of donation," Singapore's health minister told parliament during the debate. "I know the controversial nature of paying donors. But we also realize that it is unfair to allow genuine donors to bear all the financial consequences of their altruistic acts."

Coverage of transplant-related medical expenses is already legal in the United States. But it'll be interesting to see whether the message from Singapore—fairness to altruists—becomes an effective argument, here and elsewhere, for more extensive compensation.

Organ Rewards

If financial incentives for donating a kidney are wrong, what about financial rewards?

Frances Kissling offers that idea in a beautiful piece at Salon. She writes:

Appropriate concern for the international organ trafficking problem ... has so distorted the concept of altruism and eroded the principle of mutual respect that potential kidney donors are denied the basic safety net that a just and giving society should provide people who offer to risk their own lives to save the lives of others. ... [W]e financially abandon the donor almost immediately after we take their kidney. There is no provision for comprehensive long-term health insurance for donors, or for life and disability insurance. Opponents of any form of compensation or benefit to donors beyond costs directly attributable to the transplant itself fight efforts to provide these benefits.

What worries compensation opponents is that such benefits, framed as incentives to increase the organ supply, will economically coerce poor people to surrender body parts. But what if we don't frame the benefits as incentives? What if we present them, in Kissling's words, as what "a just and giving society should provide [to] people who offer to risk their own lives to save the lives of others"? And could we make this difference real, not just a matter of spin, by designing the reward system without regard to its effect on the organ supply?

Kissling argues that we should

treat potential donors with the same generous spirit with which they have offered their kidneys. No donor should spend a single dollar in the process of giving an organ. And donors should have the safety net they need to stay healthy, to support their family if they cannot work and life insurance should they die. ... One member of Congress who gets it is Arlen Specter, who is circulating the Organ Trafficking Prohibition Act of 2009. The bill increases the penalties for really buying and selling organs, but makes clear that state and federal government can provide the kind of benefits donors deserve without going to jail. Anyone disagree?

Well? Do you?

Defaulting on a Surrogate Pregnancy

What if you delivered the money to a broker, and the broker lost, stole, or squandered it? You did your part, but the surrogate is no longer being paid. And she has every legal right to end the pregnancy.

That's the scenario unfolding in California.

More here.

Creativity and Body Parts

Drawn by payments of up to $10,000, an increasing number of women are offering to sell their eggs at U.S. fertility clinics as a way to make money amid the financial crisis. ... The Center for Egg Options in Illinois has seen a 40 percent increase in egg donor inquiries since the start of 2008. New York City's Northeast Assisted Fertility Group said interest had doubled and the Colorado Center for Reproductive Medicine said it had received 10 percent more inquiries.

One clinic's egg donation manager explains that the bad economy "encourages women to find creative ways to make money." It's an interesting use of the word creative. In this case, two kinds of creativity seem to be involved. One is the invention of egg donation in the first place. Selling eggs was impossible until doctors learned how to extract, preserve, fertilize, and transfer them for successful implantation. These breakthroughs made eggs transferrable and commercially valuable.

The second kind of creativity goes hand in hand with the first. You don't normally think of selling your body's parts or products. But bad times can make you think hard. One reason you might not have thought of selling something from your body is that the idea felt unnatural or somehow made you uncomfortable. But for $5,000, with bills to pay and no other income prospects, you decide you can get over those feelings.

Economics clearly drives the donation market. Two years ago, Reuters notes, a study found that the average payment to an egg donor in the United States was $4,216. But the average sperm donor in New York City gets only $60 per deposit. And sperm banks, unlike egg donation programs, are reporting no recent increase in donations. The money's not good enough.

The next question is whether money can persuade you to donate not just a body product, but a body part. In principle, half the world's kidneys are expendable. People are already buying and selling them on the global market, regardless of laws. Some reformers are proposing to replace this black market with a regulated system of incentives ranging from $15,000 to $40,000. If $5,000 is enough to make people think creatively about donating their eggs, $15,000 might well be enough to do the same for kidneys.

Octuplets and Opportunism

Under a Georgia bill, if you're 39, your doctor is forbidden to fertilize more than two of your eggs per treatment cycle. Take all the hormones you can stand, make all the eggs you want, but you get two shots at creating a viable embryo, and that's it.

How does this restriction "protect the mother" and "reduce the risk of complications" for her? It doesn't. ... So why limit the number of embryos created per cycle? Because the bill's chief purpose isn't really to help women. It's to establish legal rights for embryos.

More here.

Seven Ways To Sell Your Body

As economies around the world continue to shrink, how many people will start thinking about selling their bodies?

Two years ago, the global market in human flesh looked like a humanitarian issue. It was a problem for those poor people in developing countries, not for us. But global capitalism doesn't care what color your skin is, as long as you've got some to sell and you need the cash. And, increasingly, people need the cash.

The idea starts with superficial rentals. Last month, according to the New York Times,

FeelUnique.com, an online beauty products store, paid 10 men and women to apply temporary tattoos with the company's Web address on their eyelids and then wink at strangers. Chosen randomly from more than 6,000 who applied online, participants were paid 100 pounds (about $149) to wink at people 1,000 times, or 10 pence a wink, an allusion to pay-per-view Web advertising.

Harmless, right? So let's move around to the back of the head. Thirty people have hired themselves out to Air New Zealand as "cranial billboards," the Times reports. "For shaving their noggins and displaying the ad copy for two weeks in November, they received either a round-trip ticket to New Zealand (worth about $1,200) or $777 in cash."

A bit tacky, but who are we to judge? They need the money. And if people are willing to wear temporary tattoos for pay, why not permanent ones?

Since 2005, Dunlop Tires has hired tattoo artists to work at its booth at the annual Specialty Equipment Market Association show in Las Vegas, geared to motorists who modify cars. Volunteers who agree to be permanently tattooed—either with Dunlop's logo or its trademarked tire tread—while onlookers gawk receive a set of tires worth $500 to $1,000, said Jim Davis, a Dunlop spokesman. About 200 people have been tattooed so far.

If it's OK to sell permanent advertising on your skin, it's hard to see why we outlaw temporary prostitution, especially in view of current financial pressures:

Signs of the economic free fall have cropped up in many of Nevada's 25 or so legal brothels. The Mustang Ranch, for example, has a steady stream of customers, but the number of women vying for work has soared.

Should women who resort to this line of work in other states continue to be arrested? Do you have some other employment opportunity to offer them?

And if extra cash to women who need it is a good thing, what about the increasing use of undeveloped countries as testing grounds for drugs not yet approved in the West? According to an article in the New England Journal Medicine, "Pharmaceutical and device companies can realize substantial cost savings by conducting trials in developing countries, so they are increasingly moving phase 2 and phase 3 trials to places such as India and South America." In these countries,

There may be a relative lack of understanding of both the investigational nature of therapeutic products and the use of placebo groups. In some places, financial compensation for research participation may exceed participants' annual wages, and participation in a clinical trial may provide the only access to care for persons with the condition under study. Standards of health care in developing countries may also allow ethically problematic study designs or trials that would not be allowed in wealthier countries. In one study, only 56% of the 670 researchers surveyed in developing countries reported that their research had been reviewed by a local institutional review board or health ministry. In another study, 90% of published clinical trials conducted in China in 2004 did not report ethical review of the protocol and only 18% adequately discussed informed consent.

So, the standards overseas are lower, and the people recruited to test the drugs have fewer choices. But isn't that how capitalism works? Aren't these people getting value in exchange for supplying their bodies at lower cost? As Ezekiel Emanuel, chairman of bioethics at the National Institutes of Health Clinical Center, puts it: "More places outside the United States are participating in research—is that a bad thing?"

And what about the sale of human eggs, sperm, and surrogacy? Driven by the recession, women are lining up to sell their eggs and rent out their wombs. It's fully legal. Do you want to stop them or their clients? Do you think you can?

If it's OK to sell your eggs and skin—and to rent out your body for pregnancy or drug testing—why not let people sell expendable organs? Thanks to the progress and spread of transplant technology, every healthy person with two good kidneys or a splittable liver now has a fungible asset. Earlier this month, for instance, the Asahi Shimbun reported:

Amid the serious shortage of available organs in Japan, a nonprofit organization admitted to helping 17 Japanese receive transplants in China even after Beijing banned such operations for foreigners in 2007. A deputy chief of the NPO [said] the group paid doctors in China, in addition to treatment costs, for the kidney and liver transplants there. ... Cases have already emerged of Japanese traveling to Southeast Asia for new organs.

I'm not saying all of these practices are acceptable or unacceptable. Some are more worrisome than others. But they're all happening, and they're all being driven by money. And as the recession takes away the external assets of more and more people, we're going to face increasingly difficult questions about letting them sell what's left.

A Kidney Stimulus Package

The other day, I was reading about a new procedure in which a kidney was extracted for transplant through the donor's vagina. And it got me thinking: If kidney donors deserve special surgical benefits—which is what doctors argued in this case—then what other benefits should they be offered? How about free medical care? How about cash?

The Johns Hopkins doctors who performed last week's vaginal kidney delivery describe several special benefits. "An organ donor, in particular, is most deserving of a scar-free, minimally invasive and pain-free procedure," says one Hopkins surgeon. The natural-orifice procedure supplies these benefits. According to Dr. Robert Montgomery, head of the Hopkins transplant division, "Removing the kidney through a natural opening should hasten the patient's recovery and provide a better cosmetic result."

The doctors see these benefits not just as a special reward but as an inducement. "This approach could have a tremendous impact on people's willingness to donate," argues Montgomery. The shorter recovery time "greatly reduces the inconvenience of donating and we're hoping that will encourage more people to donate."

I've written before about the horrors of the international black market in organs from living donors. Federal law goes further, banning the provision of any "valuable consideration" in exchange for an organ. But the law adds that this term doesn't apply to "the expenses of travel, housing, and lost wages incurred by the donor."

So it's OK to compensate donors for lost income opportunities. And it's OK to make sure that they, of all people, get the most pain-free procedure with the best "cosmetic result." What else?

Sally Satel, a friend of mine and a frequent Slate contributor, points out that other countries have taken further steps. In When Altruism Isn't Enough: The Case for Compensating Kidney Donors, she reports that last year, "the Dutch health minister directed health insurers to reduce annual fees by 10 percent for registered organ donors."

Sounds good, right? If you do a good deed for your fellows, don't you deserve a reward? You're supplying a medical benefit to the community. Doesn't the community owe you, at a minimum, a discount on your health insurance?

And why stop at 10 percent? Satel notes that Saudi Arabia's Cabinet recently "passed a law to compensate unrelated living donors with lifelong medical care."

Still onboard? Let's keep going. Satel proposes to amend the definition of "valuable consideration" in U.S. law so that states can offer "incentives" for organs. The incentives, she explains,

could take many forms, perhaps as simple as an offer of lifelong Medicare coverage or a credit on the federal income tax. States could, perhaps, implement their own creative incentive ideas, such as the utilization of tuition vouchers, state income tax credit, loan forgiveness, or contributions to retirement accounts.

After all, lifelong medical care, which we've already agreed is appropriate, is a quantifiable benefit. What if the reward you really need isn't medical? What if you need a college education or a professional degree? What if you're struggling with your student loans or your mortgage? Can't we do something for you?

Don't worry. We're not talking about cash. Under most of the proposals outlined by various authors in Satel's book, benefits would be "in-kind," with "a months-long cooling-off period prior to surgery" so that nobody rushes to donate out of financial desperation. The value of the incentives might range from $15,000 to $40,000. And according to surgeon David Cronin and economist Julio Elias, there would be one further payoff:

A smoothly functioning pilot period of in-kind rewards might, however, allow the public to adjust to the very idea of compensation so that actual payment became more socially acceptable over time ...

That's a good bet. Satel opposes cash payments, and a bill awaiting introduction in Congress, the Organ Donor Clarification and Anti-Trafficking Law of 2009, would reassert the ban on cash transactions (in fact, it would increase penalties for them) even as it legalized state-provided in-kind incentives. The question is whether such legal distinctions would hold firm in the face of the increasing social acceptability of compensation.

So here's the dilemma: If we maintain the ban on "valuable consideration," Americans with sufficient wealth will keep going abroad to buy organs from living donors on the black market. Those without sufficient wealth will wait for freely donated organs, and some will die waiting. On the other hand, if we relax the ban, we might get used to the idea of compensation and end up buying and selling organs legally.

Which is worse?

Your Money or Your Wife

Can you get paid for donating an organ?

In practice, you can. All over the world, people are being paid for their kidneys. But what about the United States? Under U.S. law, can you demand compensation for such a gift?

Richard Batista of Long Island, N.Y., thinks he can. He's suing his ex-wife for $1.5 million, citing, among other things, the kidney he gave her eight years ago. He says she rewarded his life-saving generosity by having an affair, divorcing him, and keeping their children away from him.

Newsday implies the case will go nowhere:

Medical ethicists agreed that the case is a nonstarter. Arthur Caplan of the University of Pennsylvania's Center for Bioethics said the likelihood of Batista getting either his kidney or cash was "somewhere between impossible and completely impossible." Robert Veatch, a medical ethicist at Georgetown University's Kennedy Institute of Ethics, noted that "it's illegal for an organ to be exchanged for anything of value."

I'm not so sure. Batista can't take his kidney back, but that's not what he's after. He wants his ex-wife to let him visit their kids, on pain of compensating him for what he gave her. And what he gave her, according to his attorney, wasn't just an organ but a livelihood. According to Newsday, the attorney says the $1.5 million demand "reflects damages, including how much money she made as a result of being able to continue working and not having to go on dialysis." So the dollar figure isn't based on the price of an organ (which would be considerably cheaper, based on the going rate of kidneys abroad); it's based on the income one spouse accrued thanks to the other's sacrifice. And sacrifices between spouses are treated differently, under the law, from sacrifices between strangers or friends. There's a tradition and expectation of common benefit. You and your spouse become one flesh—in this case, literally.

I'm sure some of you clever lawyers can figure out how to position this claim as an extension of those divorce cases where the wife gets compensated for devoting herself to her husband's executive career. "It's not the organ itself we're asking you to value. It's the financial benefit the defendant gained thanks to the risk, the pain, and the extensive, invasive medical procedures this good man, this loving husband, endured. Yes, it was a gift of love—but no less a gift of love than the other sacrifices so many spouses make for each other's careers. Let it be acknowledged in the same way."

I'm tearing up already. Will it work? I wouldn't bet a kidney on it. But it's worth a try.

Eggonomics

Looking for some extra income to make ends meet during the recession? Try selling eggs. Not chicken eggs. Your eggs.

Melinda Beck has the story in today's Wall Street Journal:

Here's another sign of the tough economic times: Some clinics are reporting a surge in the number of women applying to donate eggs or serve as surrogate mothers for infertile couples.
"Whenever the employment rate is down, we get more calls," says Robin von Halle, president of Alternative Reproductive Resources, an agency in Chicago where inquiries from would-be egg donors are up 30% in recent weeks—to about 60 calls a day. "We're even getting men offering up their wives. It's pretty scary." James Liu, a reproductive endocrinologist at University Hospitals, Case Medical Center, in Cleveland, says there is no waiting now for egg donors since his roster has swelled from the usual 4 to 17. Andrew Vorzimer, an attorney who represents prospective parents in Los Angeles, says the usual six-month wait for a surrogate in California has vanished as well. "Many of these women have college loans to pay off or they want to help buy a house or provide for their own kids' education," says Mr. Vorzimer, who is also CEO of Egg Donation Inc., a recruiting agency.

So the good news is, you have an exploitable asset in your ovaries. The bad news is, you have to compete with all the other young women—and apparently their husbands—who have realized the same thing. Did I mention the daily hormone shots? The prohibition on intercourse? The needle extraction?

Still, it's a better deal than lots of people in the developing world are getting. They're selling kidneys; you're only selling eggs. And you can make a lot more money than they can. Beck lays out the numbers:

The going rate for a surrogate is about $25,000. Egg donors generally receive $3,000 to $8,000. But a few agencies advertise that they'll pay much more for specific characteristics. One ad running in campus newspapers promises $25,000 for a donor who is "100% Jewish with ... High SAT Scores... Attractive, at Healthy Body Weight and Free of Genetic Diseases." ... "Now that we have more donors, it's become a buyer's market," Ms. von Halle says. "Some people are looking for a 6-foot Swedish volleyball player with 39 ACTs, and they'll take their time." ... Darlene Pinkerton, executive director of A Perfect Match in San Diego, which offers up to $50,000 for egg donors with high SATs ... [has] seen a doubling of inquiries recently. The American Society for Reproductive Medicine considers compensation above $10,000 to be inappropriate; Ms. Pinkerton argues that the offer brings in donors who might not otherwise be interested.

In other words, the egg market is working like any other market. A Perfect Match is offering big bucks for exactly the same reason the ASRM opposes this practice—because money can persuade people to do things they otherwise wouldn't do. Actually, the 50 grand supplies only half the persuasion. The other half comes from the recession. You need money; you're running out of options; here's a way to get it.

But ordinary eggs won't get you the 50 grand. For that, you'll need the SAT scores, and the face, and maybe a bit more height. You'll need to be tested for the wrong genes—and maybe for the right ones, now that we can project athletic potential from specific variants.

Do you find this scrutiny degrading? Does the whole tiered pricing system offend you? Then go look in the mirror. Catering to buyers' tastes is part of selling. I know it's a lousy economy out there. But if you don't want others treating your eggs as a commodity, don't treat them that way yourself.

The One-Child Warranty, Continued

Last week I wrote about the warranty on children killed by the recent earthquake in China. I referred to an exemption to the country's one-child policy, allowing parents who lost their kids to replace them. At one point, I asked, "Why should the warranty apply only to this earthquake? What about the floods of 1991 and 1998? What about the drought of 1988? How many couples lost their only kids in those calamities? Where's their compensation?"

Many of you wrote in to correct me, noting that the replacement allowance is a general rule under the one-child policy. I wasn't satisfied with these assertions, so I went to the Chinese government's Web site for clarification. After some digging around, the only direct nationwide statement I could find was in the "Population and Family Planning Law of the People's Republic of China," adopted in 2001. Here's the basic language (Article 18):

The State maintains its current policy for reproduction, encouraging late marriage and childbearing and advocating one child per couple. Where the requirements specified by laws and regulations are met, plans for a second child, if requested, may be made. Specific measures in this regard shall be formulated by the people's congress or its standing committee of a province, autonomous region, or municipality directly under the Central Government.

And here's the sole reference to damaged children (Article 27):

Where the only child of a couple is disabled or killed in accidents, and the couple decides not to have or adopt another child, the local people's government shall provide the couple with necessary assistance.

So, the general policy is vague. Implicitly, at least, you can decide to have another child if yours is killed or even disabled, as long as the tragedy was an accident.

Slate's Lucy Morrow Caldwell contacted several China experts who helped us with the original "Explainer" on this topic. We couldn't find records of the policy being waived in previous disasters, but Vanessa Fong of Harvard and Wang Feng of the University of California confirmed that the policy has traditionally permitted a second child if the first is killed or disabled. Cindy Sun of Fudan University directed us to a May 28 statement from the National Population and Family Planning Commission of China. The statement includes a clause that an acquaintance of mine translates as follows:

To the families whose children were injured or killed in the earthquake, the benefit of additional birth should be given, according to the number, sex, and injury of the children who survived the disaster.

In other words, precise numerical replacement, with different values for boys and girls, since many rural parents are allowed to have a second child if the first is a girl.

We also found a link to the earthquake policy issued by the Family Planning Commission in Chengdu, the capital of Sichuan Province, which bore the brunt of the disaster. A second acquaintance paraphrases its main points this way:

1) A "green light" for parents whose only child was injured, disabled, or killed.
2) The government will proactively work with these parents if they wish to have another child. This includes registering them and providing reproductive services.

Here's his translation of the policy's fine print on injury or disability:

Medical identification shall be conducted on injured/disabled children of single-child families. If the child is certified to have second-degree or above injury or disability, the parents shall be assisted to apply for bearing a second child.

A third acquaintance translates the fine print somewhat differently:

For those whose only child was disabled in the earthquake, local Birth-Control Agencies shall record the cases and compare them to the "Medical Disability Standards for Children from One-Child Family." For those qualified, the local agencies shall help them file the applications for the birth of a second child. The Birth-Control Council of Chengdu city will perform medical assessment and approval process promptly.

One final note: Article 11 of Sichuan's family-planning regulations stipulates that couples may have a second child if "the first child has non-genetic defects and is unable to grow up to be a normal laborer."

So, here's the full policy, as far as I can piece it together from the available documents: You can replace your child (in the numerical sense) in the event of death or disability, as long as the cause was an accident. Extent of replacement depends on the number and sex of the children you lost. Replacement for disability requires medical certification that the damage is second-degree, as measured by official standards. Replacement is also available for disabling defects, but not if they're genetic, presumably because in that case the replacement might be similarly defective.

Got that? To me, it sounds a lot like the piece of paper that came with my PC monitor. So, there's your warranty. Let's hope you never have to use it.

The One-Child Warranty

A lot of people in China are angry. The earthquake that struck there two weeks ago has destroyed their entire stock of the country's most strictly rationed item: children.

Here's the background from the New York Times:

Thousands of parents have openly challenged the government over why so many schools collapsed during the earthquake. An estimated 10,000 students are believed to have died. The anguish of parents and grandparents has been compounded by the one-child policy, which was introduced in 1979 to control population growth.

Imagine being one of these parents. The government has restricted you to one child, and now that child is dead. You've lost your whole family in one stroke.

But wait: The government has come up with a solution. You can replace your defunct child with a new one. The Associated Press explains the offer:

Chinese officials said Monday that the country's one-child policy exempts families with a child killed, severely injured or disabled in the country's devastating earthquake. Those families can obtain a certificate to have another child, the Chengdu Population and Family Planning Committee in the capital of hard-hit Sichuan province said. ... Chinese couples who have more than one child are commonly punished by fines. The announcement says that if a child born illegally was killed in the quake, the parents will no longer have to pay fines for that child-but the previously paid fines won't be refunded. If the couple's legally born child is killed and the couple is left with an illegally born child under the age of 18, that child can be registered as the legal child-an important move that gives the child previously denied rights including free nine years of compulsory education.

Got that? If your child is broken, you can apply for a certificate to get a replacement child. Or you can substitute a used child and transfer the license from your previous child, with all the attendant financial rights. However, there will be no refunds.

It reads like a warranty or a software agreement. Except we're not talking about consumer electronics. We're talking about children. This is what happens when you ration people like commodities.

A few years ago, I lambasted the one-child policy as a forced-abortion machine. Then, a couple of weeks ago, I was talking with a friend about global warming, and it occurred to me that the single most effective thing anybody has done to slow that process over the last 30 years is probably the one-child policy. I still think it's a colossal offense against human rights. And in the present context, it's a case study in the regulation of human beings as a kind of property. If you lose your quota through no fault of your own, you can get a coupon to refill it. Half of me is grateful to the Chinese government for giving these bereft couples a second chance. The other half is revolted that the government controls such things.

If you're going to replace children like broken toasters, one per customer, then you'd better standardize the warranty. When I looked for the earthquake exemption report on Xinhua, the state news agency, I couldn't find it. Then I realized why. It was granted by the authorities in Chengdu. It's a local exemption. The last thing the national government wants is to broadcast it in other provinces, where people are still being held to the one-child policy.

Sorry, but that won't do. Why should the warranty apply only to this earthquake? What about the floods of 1991 and 1998? What about the drought of 1988? How many couples lost their only kids in those calamities? Where's their compensation?

Forget it. You can't replace children like toasters. You shouldn't ration them like toasters, either.

The Bio-artificial Industry

How do you feel about mass-producing and selling human tissue in machine form? I hope you like the idea. Because it's on the way.

A few days ago, the University of Michigan trumpeted a study validating the efficacy of its "bioartificial kidneys." In a clinical trial involving people with acute renal injury and failure, the kidney boosters cut the usual death rate (compared to patients using conventional "continuous renal replacement therapy") from two in three patients to one in three.

Pretty amazing. But just what is a "bioartificial" kidney? Here's U-M's description:

The bioartificial kidney includes a cartridge that filters the blood as in traditional kidney dialysis. That cartridge is connected to a renal tubule assist device [RAD], which is made of hollow fibers lined with a type of kidney cell called renal proximal tubule cells. These cells are intended to reclaim vital electrolytes, salt, glucose and water, as well as control production of immune system molecules called cytokines, which the body needs to fight infection. Conventional kidney dialysis machines remove these important components of blood plasma, along with toxic waste products, and cannot provide the immune regulation function of living cells. Initial testing in animals ... found the cells in the RAD perform the metabolic and hormonal functions lost in acute renal failure.

This is the point I've made in recent posts about biological pacemakers and limb regeneration. Prosthetics are nice, but flesh is better. That's why the U.S. Army is now funding tissue regeneration. Instead of trying to reengineer everything in biology, we're learning to borrow, cultivate, and replicate it. Let Mother Nature do the work: She already knows how to filter toxins while keeping what your body needs and regulating your systems.

David Humes, the professor behind the U-M study, is also the scientific founder of the company that's preparing to commercialize the RAD. He envisions the new paradigm this way:

[T]he nature of our new approach -- using living cells as therapeutic agents -- argues for the feasibility of developing whole classes of new cell-based and tissue engineered therapies. The ability to harness vital processes of cells, to target their living molecular machinery on restoring critical substances which have become disordered by disease, has vast implications for the future of medicine. The apparently successful use of living cells in this way validates our approach and should encourage others to investigate cell therapies for a range of disorders.

Technologically, this is a sensible and powerful idea. It will save lives. But as an inflection point in our thinking about human flesh, it's, well, pretty RAD. What we're getting into is not just the commercialization but the mass-production of body parts. It's a bit like PETA's campaign to commercialize lab-grown meat -- except that in this case, the meat will be human.

Where do we get the cells in the cartridge from? According to the American Society of Nephrology, they're "grown from donor kidneys." So we're starting with somebody's donated organ. Instead of transplanting it to one person, we're growing cells from it, which can then be farmed out to multiple patients. We're not just distributing the cells; we're incorporating them into what U-M calls a "living cell cartridge." It's bio -- it's artificial -- it's bio-artificial.

Like lab-grown meat, the living tissue in the cartridge may run into spoilage problems. U-M notes that its researchers are still working on the "challenges of mass producing, storing and shipping a living-cell device." But the goal, according to the nephrology society, is definitely "mass production." And the next step will be to repackage it as a "wearable kidney that performs natural functions unachievable through man-made technology alone." Real flesh, grown from somebody else, mass-produced, packaged into a cartridge, and worn on your body. Good luck sorting the bio from the artificial.