Your Body, Yourself, and Your Sellable Parts

There is a Libertarian argument that the body is a commodity and hey, why not sell a kidney? You do some good and can get access to things that poor people don’t normally deserve, like a college education for their kids.

No surgery, not even a tonsillectomy, is risk-free, as this tragic story shows…

(CNN) — When Manuel Reyna developed a deadly kidney disease, his sister, Florinda Gotcher, didn’t hesitate to give him one of her kidneys. When she found out they were a match, she cried.

“She was so happy,” remembers Gotcher’s daughter, Melinda Williams. “She was overwhelmed that she was able to save her brother’s life.”

Williams said her mother didn’t worry about the risks of surgery. Statistically, kidney donor surgery is considered to be very safe: in 2010, the year before Gotcher’s surgery, 6,276 people donated a kidney, and none of them died within 30 days of the surgery.

Her laparoscopic surgery went well, but about 30 minutes afterwards in the recovery room, she took a mysterious turn for the worse.

Someone raised a question that sent me on a search– what happens to the altruistic kidney donor if they find themselves uninsured and suffering ominous symptoms in the remaining kidney? The answer is disturbing.

There is a large support system for insured people with kidney disease who need a transplant. But for donors who fall out of the social safety net there’s not much out there. The system is set up for people in dire need of transplant or dialysis, but not for prevention of disease in people still healthy. Medicare disability is available for people with end-stage renal disease. The reason that this particular condition is covered is an intersection of science and politics going back a generation…

In the 1960s, in addition to dialysis, kidney transplantation was emerging as a treatment for chronic renal failure. The two therapies interacted in both complementary and competitive ways, each following its own developmental pathway. Though initially greeted with skepticism by many in the medical establishment, these therapies had demonstrated their clinical effectiveness by the mid-1960s.

Clyde Shields, the First Patient with Chronic Kidney Disease to Undergo Dialysis, University of Washington, 1960.

Both lifesaving treatments were costly — beyond the means of most individuals — and not covered by insurance. In Seattle, in response to financial limitations, access to dialysis was restricted through explicit rationing carried out by an anonymous lay committee — an approach that was laid bare for the American public in a Life magazine article in November 1962. Elsewhere, decisions limiting access to dialysis were tacitly incorporated into traditional medical decision making. Dialysis highlighted the tragic choices that had to be made when fundamental societal values encountered problems of scarcity.

Dialysis and transplantation have saved many lives. The lack of investment in prevention, however, has left a huge gap. Diabetes is epidemic, putting thousands on a downward slide to kidney failure. Diabetes can come on gradually, and do a lot of damage before it is diagnosed. The hard-working uninsured American, who is maxed-out on work and family responsibilities is the person who won’t get the inexpensive care to stay healthy. But when they reach end-stage renal failure– Medicare is there.

The funding supports a network of doctors and treatment centers. This is a huge benefit to their patients. Not all kidney disease is preventable, and saving lives is a public good. Universal health care would extend that good to people still healthy and reduce the need for expensive, high-tech treatments like dialysis and transplantation. Keeping a good blood sugar and your own kidneys in working order way beats a transplant.

You would think that a person who donated a kidney would be somehow recognized by a grateful society and not denied medical care. That seems like common decency. But that is not how the free market works. Not only is there no program that guarantees coverage for a donor, they may not even be able to buy insurance. If the Affordable Care Act is struck down by the Supreme Court, insurance companies will once again be able to deny coverage to people with ‘pre-existing conditions’, such having one kidney.

I don’t see a conspiracy here, I see unintended consequences. The system reimburses care for people with end-stage renal disease. These people are deserving, known to their doctors. Every life is precious.

But there are people out there in the community. Maybe they are sweeping the floor, or entering the bills, or caring for patients in the dialysis center. They are on the slide to being a patient there. This can be prevented. Do we have the moral imagination to see public health as a public good? I believe we do, and if the people lead on real health reform, nothing can stop us.

Lauren, at The Fat Lady Sings, has a funny and frightening post about the process of becoming a live kidney donor…

“I don’t even know if I’m a potential donor,” I answered. “I still have to do a kidney scan. If I’m not a donor, there’s no conversation to have. And anyway, I’m only trying to donate one.”

“Why are you being so stubborn about this?” asked Richard. “Most people wouldn’t even think about it.”

I pursed my lips. “Because River needs a kidney,” I said. “I sent the kids to Hebrew school for years so they could learn Torah. Saving a life is the most important mitzvah. What’s the point of talking about all this stuff if you don’t practice it?

“And I’m getting pissed off at hate-mongers and religious hypocrites. Giving somebody a kidney seems like a good way to tell them to go to hell. It makes our blogging community stronger.”

“I’d feel more comfortable with a gift of flowers,” answered Richard. “I understand your reasoning but you mean a lot to us, too. We don’t want anything to happen to you.”

Lauren’s post, incidentally, shows a lot of what is wrong with our health care ‘system’.

Someone close to me was contemplating being a live donor to a co-worker who was very sick. I am greatly relieved that he didn’t. Friends, sign that donor card on your driver’s license. You won’t need them in heaven.

Conditional Freedom

Gladys Scott wanted to donate a kidney to her sister Jamie who has been on dialysis and not doing well. The two sisters have been in prison for 16 years for their part in a robbery.

Having worked with patients whose kidneys failed due to inadequate treatment for their diabetes, I wonder if Jamie’s life-threatening illness could have been prevented with low-tech, basic care. Scratch that– I’m certain that she would not be on dialysis if her diabetes had been treated properly.

Barbour said in a statement. “The Mississippi Department of Corrections believes the sisters no longer pose a threat to society. Their incarceration is no longer necessary for public safety or rehabilitation, and Jamie Scott’s medical condition creates a substantial cost to the State of Mississippi.”

What will Jamie Scott do for medical care? Sixteen years of her life gone and no safety net.

Having read some details of the legal case, I wonder why they were given such a long sentence.

Here’s a link to a site called Free the Scott Sisters.

Here’s Bob Herbert– on the ethics of requiring an organ donation as a condition of release.

As Bob Herbert notes– Gladys had long wanted to donate a kidney to her sister, but was ignored. Making a ‘condition’ of what she was going to do out of family love throws a moral dilemma into the situation unnecessarily.

I hope this story won’t disappear after the sisters are released. I want to know what happens to them, and wish them better health in 2011.

I have to go to work now, but I want to re-run a story from 2007, about commodification of the body—

Desperately Selling a Kidney

It was a strange experience reading Sally Satel’s essay, Desperately Seeking a Kidney in last Sunday’s New York Times. The writer, a resident scholar at the conservative think tank, American Enterprise Institute, needed a kidney transplant. She offers her personal narrative, and then some proposals for inducing the poor to sell their bodies in a free market.

Ms. Satel begins with her experience as a woman suddenly faced with a life-threatening illness…

Three days a week, for four debilitating hours at a time, I would be tethered to a blood-cleansing machine. Even simple things like traveling to see friends or to give talks would be limited. This would very likely continue for at least five years until my name crawled to the top of the national list of people waiting for kidneys from the newly deceased. On average, 12 names, the death toll from the ever-growing organ shortage, would be scratched off the list each day.

She is a psychiatrist, working in a methadone clinic, and she knew from her medical training what dialysis involves. She dreaded it so much that she chose not to wait on the transplant list, opting instead to search for a live donor. She writes honestly and unsparingly of her failed negotiations with two friends, then with a man she met online. Finally she received an offer from an acquaintance, Virginia Postrel, a fellow conservative writer, and the transplant was successful.

While Ms. Satel calls the gift she received, ‘altruism’ she has a different definition when applied to people outside her circle.

We must be bold and experiment with offering prospective donors other incentives for giving, not necessarily payment but material reward of some kind– perhaps something as simple as offering donors lifelong Medicare coverage. Or maybe Congress should grant waivers so that states can implement their own creative ways of giving something to donors: tax credits, tuition vouchers or a contribution to a giver’s retirement account.

This is the kinder, gentler version. She is not ignorant of how desperate things can get for the poor in this world…

I flirted with the idea of becoming a ‘transplant tourist’ in Turkey or the Philippines, where I could buy a kidney. Or going to China, where I would have to face the frightful knowledge that my kidney would probably come from an executed prisoner. Grim choices, but I was afraid I could die on dialysis if I didn’t do something to save myself.

In all of this long essay Ms. Satel never wonders what would have happened if she were poor and uninsured. She seems to live in a bubble where the only problem is a lack of donated organs. And she downplays, almost callously, the risk to the donor.

The operation is done by laparoscope, leaving only a modest three-inch scar. She would have been out of the hospital after two or three nights. Most important, the chance of death is tiny–2 in every 10,000 transplants– and the long-term health risks are generally negligible.

This kind of reasoning explains a lot about why conservatives can be persuaded that whatever works for them is just peachy. There is a reason nature gave us two kidneys, a woman with chronic renal failure should be able to figure that out. If you lose one, as did my aunt, to a tumor, or my friend, to a motorcycle accident, you have a spare. And I’m not so casual about the long-term health risks — we haven’t been doing these transplants for all that long. Not to mention the risk of post-surgical infection as antibiotic resistant germs increase. Myself, I would gladly take this risk for love, but god grant I never have to for money.

But back to the kinder, gentler. The mother who sells a kidney so her son can go to college ( no pressure, Sonny), or the eighteen year old who needs cash and feels invincible. Or the man who needs insurance and can’t get accepted on an affordable plan. David Holcberg, of the Ayn Rand Institute puts it a little more frankly. This was printed on the Journal’s editorial page —

A person may reasonably decide, after considering all the relevant facts (including the pain, risk and inconvenience of surgery), that selling an organ is actually in his own best interest. A father, for example, may decide that one of his kidneys is worth selling to pay for the best medical treatment available for his child…

Opponents of a free market in organs argue as well that it would benefit only those who could afford to pay–not necessarily those in most desperate need. This objection should also be rejected. Need does not give anyone the right to damage the lives of other people, by prohibiting a seller from getting the best price for his organ, or a buyer from purchasing an organ to further his life. Those who can afford to buy organs would benefit at no one’s expense but their own. Those unable to pay would still be able to rely on charity, as they do today. And a free market would enhance the ability of charitable organizations to procure organs for them.

Just think, all those deadbeats sitting in the waiting room at Hasbro with their sick kids, they could be persuaded to put out if they want ‘the best medical treatment for their sick child’.

But don’t consider giving free medical care to needy children, or scholarships to hardworking poor students. That would be immoral.

We are really on the edge of a class disparity that is not only about money but blood. We already pay lip service to ‘serving our country’ while dangling cash and scholarships in front of the kids at Central and Hope High. The recruiters know where to go.

No matter how well written, and no matter how much natural sympathy one feels for anyone who goes through a dangerous illness, Sally Satel’s essay is horrible. In countries where desperate people sell their kidneys, you can be sure there will be many who die prematurely when their remaining kidney gives out, and there will be no help for them. I wonder where in the Libertarian scheme of things you put the person who sold a kidney, and now needs one. Do you chalk it up to ‘bad choices’ ? We will be going down a very dark road if we give up the principle of taking care of our own, rich or poor, and instead let the rich use the poor for spare parts.

For another, less temperate, take on this, check out Daily Kos. And yes, I’ve signed a donor card, but they’re not getting them until I’m dead.