I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Transplant Discussion => Topic started by: Hemodoc on July 04, 2008, 09:30:28 PM
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I applaud the Declaration of Istanbul calling for a prohibition to transplant tourism.
See post on RenalWeb and Dialysis at the Sharp End of the Needle.
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/07/sanity-returns.html
Happy 4th.
Peter
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When there is money paid to a donor for a kidney transplant, the donor gains because he and his family are rescued from desperate poverty in a third-world setting where poverty can mean poor health and even ultimately death. (The donor receives three years average wage in the Philippines for giving a kidney.) The recipient gains because his life expectancy and quality of life vastly improve. So it is a win-win situation. The only reason for opposing this is that the healthy major which has no understanding whatsoever of the desperate situation of dialysis patients, and absolutely no real interest in improving the shortage of organs for transplant -- has some vague, undefinable, inexpllicable aesthetic revulsion regarding the commercialization of body parts, which is quite ironic, since the US has long allowed the sale of blood for transfusion, although blood is of course, medically speaking, just as much an organ as is the kidney. I can't understand how the aesthetic revulsion of the majority about what an extremely vulnerable minority of desperately ill people has to do to save their lives should be permitted to excuse the continuing genocide of the majority against the minority of dialysis patients.
Australia at least has the right idea when it has recently held that since it is going to forbid payment for transplanted organs, it has a moral obligation to dying dialysis patients to increase the supply of organs for transplant by other means. But the rest of the world puts artificial and ultimately lethal hindrances in the way of patients getting transplants, by 1) refusing to enact presumed consent laws to harvest organs from all available cadaver donors as long as they have not registered their objection in advance; 2) treating the dead body as property belonging to the next of kin, who can override the donor's wishes to give a life-saving organ, even though the law does not allow them to override the donor's wishes with respect to the allocation of his financial estate; 3) failing to provide enough life support machines to hospitals so that organs can be harvested everywhere they become available; 4) resisting in some countries paired organ donation arrangements among couples who do not match their own spouses; 5) denying in some countries altruistic donation from non-related living donors. If you trap a vulnerable minority in a legal situation where you artificially limit the number of potentially life-saving organs for donation, and then close the door on the only route open to people to escape and save their lives, then you are committing genocide against that group according to the definition of genocide in the UN Convention on Genocide.
I am surprised to find that someone who calls himself a doctor would be in favor of genocide against the sick.
In both Israel and Iran the government supervises the payment of money from dialysis patients to living donors for the acquisition of kidneys for transplant. To be consistent, you should support world-wide against these countries for the 'immorality' of not murdering more of their dialysis patients.
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Dear Stauffenberg,
Sie sind ziemlich leidenschaftlich mit allen Ihre Antworten dennoch nicht immer genau. Zuerst I don' t-Anruf selbst ein Doktor, bin ich ein Doktor. Es ist meine Patienten, die mich einen Doktor anrufen.
Second, there have been studies done as I listed in my post on Bill Peckham's page showing the adverse health effects of renal donation to the majority of those that donated and much evidence that shows that it does not in the least change the status of their poverty. In fact, with the adverse health consequences well documented in several studies, many donors find themselves in a worse situation since they are no longer able to work at their prior level.
Further, genocide and lack of supply of organs are quite different entities. I am not sure where you get the reasoning for such a false comparison, but it is just that, a false comparison.
Lastly, I gave some very good links which RenalWeb first published, but it does not appear that you have read any of them by your response.
Back to the issues, the Declaration of Istanbul is a multi-national call to prohibition of the exploitation of the poor masses in the third world nations that are now being victimized by the rich from within their own nations and from other nations where organ supplies do not meet the demands. It is a breath of fresh air to behold, especially in lieu of the many recent editorials and articles calling for a system of payment which would only institutionalize the exploitation of these people and would be overseen by the corrupt governments that have allowed transplant tourism in their borders to start in the first place that is uniformly, expcept by you apparantly, called an appalling act of exploitation by every author I have ever read on this subject.
I favor absolutely no renal transplant donor system that violates the dead donor rule for cadaveric transplants and that violates principles of equity and justice for living donors by placing undue temptations upon the poor to "donate" their kidneys when in fact, the poverty that they face turns the act of donation into that of a form of coercion.
In any case, the Declaration of Istanbul has the moral power of right in opposing a system of financial and cultural transplant colonialism. It has my full support as a physician and as a CKD-5 patient.
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The flaw in your reasoning is that you are balancing against the real moral good of saving lives of renal patients and lifting donors out of lethal poverty the unsubstantiated, purely intuitive notion that there must be some intangible evil in commercializing human body parts, whether you can point to anyone who loses by the transaction or not. But the fact is, our society accepts commercialization of the human body all the time, either in its temporal or spatial dimension. Temporally, a human's existence through time is commercialized, since he can be hired to do work for another person. Spatially, a human's existence in three dimensions is commercialized, since he can legally sell his blood for transfusion or his hair for wig-making, etc. So the line of commercializing humans in their two basic forms of physical existence, time and space, has long since been crossed. This line has historically evolved over time. In the middle ages it was considered disgraceful to allow money payments for libel, since this implied that a person's reputation was a commodity to be bought by the libeller. In the early 19th century it was thought immoral to allow sales of life insurance, since human life was something sacred which could not be treated as a commodity. The general trend of modern morality has been to focus on real benefits to people, not on imaginary, intuitive sacredness. Otherwise we are back to sacrificing human lives to the Sun God as the Ancient Aztecs did, because we imagine the Sun is a sacred thing for which human interests have to be surrended, just as you now imagine that the human body is a sacred thing which cannot be freely used to benefit its owner and the person in need of a new organ.
The UN Genocide Convention analogy is clear. The UN Convention, Article II (c) defines genocide as "Deliberately inflicting on the [vulnerable minority] group conditions of life calculated to bring about its physical destruction in whole or in part." By trapping dialysis patients in a medical and legal system which unnecessarily and artificially denies them transplants in the numbers needed or as quickly as needed, society imposes on them conditions of life which destroys them in whole or in part. Denying financial inducements for organ donation is just one part of this lethal, genocidal trap.
Payment to the donors for a kidney in the Philippines is $4700, which is quite high in a country with a third world living standard and a 25% unemployment rate (Matthew Wagner, "Kidney Transplant Candidates" Jerusalem Post, 5 May, 2008. If that does not change their financial fate, that is not the fault of the person paying for the donation, since the average family income in the Philippines is only $ 3500 a year. By law, a contract can be set aside by a court as exploitative if one person has to make the contract to save his life, but the other is just making the contract to make money (Post v. Jones). So in the case of a dying dialysis patient buying a transplant, it is the dialysis patient, not the donor, who is the exploited one in terms of the law's moral principles.
It is simply not true that the medical and ethical community is unanimous in opposing organ donation. Dr. Benjamin Hippen, a North Carolina transplant nephrologist, the Australian nephrologist Dr. Gavin Carney, and the American Institute scholar Dr. Sally Satel have all endorsed the buying of kidneys from live donors.
It is also simply not true donating a spare kidney is medically detrimental. See Ingela Fehrman-Ekholm, et al, "No Evidence of Accelerated Loss of Kidney Function in Living Kidney Donors" TRANSPLANTATION, vol. 72, no. 3 (2001) 444-449, and I. Fehrman-Ekholm, et al, "Kidney Donors Live Longer" TRANSPLANTATION, vol. 64, no. 7 (19997) 976-978.
You should be very sure of your facts and your reasoning before you support laws and programs that kill people.
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Spatially, a human's existence in three dimensions is commercialized, since he can legally sell his blood for transfusion or his hair for wig-making, etc.
The flaw in your reasoning is comparing the commercialization of blood and hair (both of which the body replaces) with the commercialization of obtaining live kidneys (that do not grow back and require invasive surgery).
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Which people are killed when transplant tourism exploits poor and impoverished people? Those very same people that you feel benefit so much from a one to two year lump sum.
Once again, your reference to me supporting genocide is a completely false analogy. I am a CKD-5 patient who could benefit from a kidney from the Philippines. In my case, my wife is Filipino and it would not take much to find someone in her own extended family willing to give me a kidney actually for no payment, but I have declined. I have been to the Philippines twice already. Since you are fixated on the PI when my article was on India, lets talk about a couple of things.
First, for $4,700, could a man who donated his kidney buy a house for his family? Probably not since the average cost of a home in my wife's town is about 20,000 US dollars. Further, there is no health coverage except for a small minority, so just as in India where the majority of renal donors suffer health decline, the earning potential over their remaining life will actually be lessened thereby completely eliminating any potential financial advantage over a one or two year period.
Further, the cultural aspects of the Philippines is much different that in most of the western countries. In the Philippines, any financial advantage is usually followed by a complete cessation of work while they have money in their pockets. It is also cultural difficult in the Philippines to teach the importance of saving for future needs. Money in hand is quickly spent. Trust me, it has taken me 15 years to change my wife's outlook on finances. Further, the Philippines is a place of large and extended families with great needs so the 4,700 dollars you noted would likely be gone very quickly helping other members of their family in need. I speak of his cultural aspect from direct observation of my own in laws and from extensive conversations from a missionary with over 20 years in country in the Philippines.
So, you are once again completely in error on the great financial advantage of 4,700 US dollars that is not even enough to buy an average house which would not even be considered a house usable to most deep inner city ghetto dwellers in the US who all live in relative mansions compared to the average working class family home in the Philippines.
Further, as I have already noted in my first post, there are well documented harmful effects on the health of the majority of transplant tourism donors. Since most of the transplant tourists come from nations where we have access not only to standard dialysis but to quotidian dialysis which has an equal survival benefit as transplant, then your argument begins to unravel even more. Your continued accusations of me supporting genocide are completely ridiculous especially when the alternative daily dialysis in the western countries will give you an equal life sustaining chance as transplant. Thus, I continue to strongly support daily dialysis here in America where it is greatly underutilized and I oppose all forms of unethical transplant behaviors to include most especially transplant tourism. No, my friend your reference to my support of the Declaration of Istanbul as being tantamount to genocide are completely ludicrous and unsupported by the facts.
Nevertheless, it is unlikely that I will change your views on this or many other issues, so, I once again invoke my right to simply agree to disagree. I suspect you shall not even agree to disagree and will continue to make an issue out of a nonissue. So be it, I have stated my views and will move on to other discussions.
I once again stand up and applaud the Declaration of Istanbul and the courageous call for complete abolition of exploitive transplant tourism. I further applaud RenalWeb for running the post on this issue in the first place and that is where it came to my attention.
The human body parts of the poor are not to be used as body parts for the rich unless we are going to fall into the demise of a dark system where there is no value to human life, only those that have will have and those that do not have will serve those that do. I find that a morally reprehensible system of human existence and will gladly stand against such outrageous moral in-servitude whenever I have a chance to voice for a better and more humane conclusion of difficult issues. Whether my voice will lend any balance to the final outcomes is another matter of debate, yet, I have heard a saying of which I do not know the proper person to attribute it, but to simply say, that all that we need for evil to multiply is for good people to do nothing. I thus stand in opposition to both genocide as properly defined and transplant tourism.
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Zach: Your argument simply assumes the point it needs to prove, which is: What is the ethically significant difference between selling a body part which can be replaced and selling one which cannot? As long as it is a spare part, such as the extra kidney is, it should make absolutely no ethical difference.
HD: If you had bothered to read the two extremely-well researched medical journal articles I recommended to you from 'Transplantation,' you would know that there is no renal decline or negative health consequence to donors of renal transplants. Somehow you assume that physical reality will cooperate with your philosophically untutored moral intutions about what is right or wrong and thus make paid donation harmful, but the fact is that it is not.
Some organizations offering transplants in the Philippines not only pay the donor almost two year's average salary for that country but also provide lifetime health insurance. Mitch Michaelson's service is one such institution.
There is still considerable debate in the nephrology community about the extent of the medical benefits of everyday home hemodialysis, so you cannot assume at this stage of the data that the life expectancy of those patients will equal that of transplant recipients. Daily home hemodialysis is simply too new and the numbers using it are still too small to make a reliable statistical inference regarding life expectancy. In any case, your point fails because of the extreme shortage of opportunities for home hemodialysis, so the vast majority of patients will continue to face a much higher death rate and shorter life expectancy without a transplant.
If the extreme poverty in the Philippines induces paid donors there not to save their payment and invest it wisely, then that is not the fault of the paid donation system. To try to make that point you would prove too much, since that would be an argument against contributing any money for any purpose to the poor of the Philippines.
Since you know so much about the Philippines, you should also know that cadaver-source renal transplants are simply not performed there, and that all locals who receive a kidney transplant BUY it, just as foreigners do, from other Filipinos. Do you think locals as well should be denied access to any possibility of a transplant ever because Filipino culture finds purchasing kidneys an ethically appropriate usage?
You assume without argument that paid organ donation violates the values of human life, but if you measure human value positivistically, as what real people feel and experience, then paid organ donation increases human value, since both the donor and the recipient get what they want from the exchange and there is a net increase in human life arising from the situation between the two after the donation as opposed to that existing before. The flaw of your analysis is that you assume that human life is some sacredness of the human body in itself, and that human life, health, and happiness have to be sacrificed to preserve sacrosanct the untouchability of the body. But humanness is not primarily the human body, but what can be done with it to support real human needs. Whatever promotes human happiness, well-being, and productivity also promotes human dignity, but you would destroy all of that just to keep the body intact, in a kind of idolatry of the human body over real human needs. That's not very Christian, it seems to me.
You seem to think that a renal patient is somehow a 'rich' person exploiting the 'poor' donor. But if you think of the comparative situation of the two people involved in the bargain, the donor is infinitely more wealthy than the purchaser, since the donor is strong and healthy, however poor he may be in money, while the purchaser is deathly ill, suffering from an incurable, catastrophic illness, with a minimal life expectancy. Just ask, who would you rather be, a poor healthy person in the Philippines or a 40-year-old billionaire on dialysis with the 8 year life expectancy of a diabetic renal patient?
The first moral duty of the doctor is to be the patient's strongest support and advocate. And yet throughout this debate you take the side of the majority of unthinking healthy people who know nothing about the horrors of renal failure and dialysis, who generally suffer from extreme prejudice against the sick, and who make ethical decisions on the basis of uninformed intuition. You endorse the lethal politicies the healthy majority imposes on the most vulnerable and discriminated-against minority in the world, the sick, the minority your profession should commit you to defend and protect. I sincerely hope I never have to rely on a doctor for treatment whose understanding of his primary and overriding commitment to helpling the sick is as defective as yours is.
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My dear Stauffenberg,
It never ceases to amaze me how easily it is to cast aspersions without points of fact and declare that as evidence of an argument. Your facts are quite faulty, but that does not seem to matter to you.
Once again, I stand by the Declaration of Istanbul as a courageous advance in the argument over ethical renal donor regulation. You are in a position completely of your own that not even those that wish to implement payment of renal donation agree with. I know of no other person who has publicly stood for the continued transplant tourism that you alone do stand for. All others involved in this debate uniformly condemn its practice.
As with most outliers in debates, their points of view are almost always discarded early. I would highly recommend all do so in this debate and continue with more profitable use of your time learning of the technical points of organ donation and the ethical dilemmas posed by recent trends and recent proposals.
Arguing with those that simply oppose all sanity is not a wise use of their time.
Thus, Stauffenberg, I will simply dismiss your inaccurate portrayal of my views and your uncalled for insults against me since even those in favour of payment for renal transplant donation have summarily dismissed transplant tourism as a morally reprehensible practice. You do not have any allies in your out of bounds views. Thank you for your views, but I likewise summarily reject that which has already been rejected by the entire renal transplant community.
Lastly, respect for the human body and the soul that resides within is not in the least idolatry, it is instead a God ordained respect for life that atheists and anti-religious people simply cannot understand. It never ceases to amaze me how far you can slip away from the topic at hand. Perhaps that is because your arguments on the topic at hand carry little weight which leaves the only opening in your continued debates to go off topic.
In any case, The Declaration of Istanbul stands firm and I continue to stand beside it as a physician and as a CKD-5 patient. I do not cast aside CKD-5 patients in the least and wish only the opportunity of good health as seen in other countries such as Australia, Europe and Japan that have strived to implement optimal dialysis to all patients and that would be soon allowed here in America.
The Philippines is unfortunately a corruptly governed nation where I know personally people that have become very wealthy as customs officers by bribery. To consider the Philippines as a place that can institute ethical governance of a renal transplant donation system is to be ignorant of the widespread conflict between right and wrong in that beautiful by chaotic and overwhelmingly corrupt nation. It is a tragedy of the greatest proportions for a nation once called the "Pearl of the Orient" yet today is more often correctly called the sick man of Asia. It is a tragedy of epic proportion that a nation with incredibly fertile land must now import rice due to the political and economic corruption that prevents even self subsitance for this beautiful nation.
Nevertheless, I will once again invoke my right to simply agree to disagree with you and be certain that I have many more allies in my opinions than you have in your outlandish support of that which has been universally condemned by all other participants in the transplant debate. Transplant tourism is universally condemned by all parties in this debate except of course by you. That is certainly your right to stand in opposition to the entire world, but in the end, it does not appear to me to be a reasonable position to take.
Thank you nevertheless for your time.
May God bless,
Peter
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I have posted another issue renal transplantation in Bill's page on the current practice of Non Heart Beat renal donation. I suspect that there is possibly a general lack of knowledge that this actually supplants that long held dead donor real of renal transplant donation. It is thus one more slippery slope of renal transplant ethics. Reviewing the medical and ethical literature on this practice, reveals the stunning conclusion that renal donation is the cause of death in these patients.
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/07/the-lazarus-org.html
How far will we go in our quest for organs? What is the moral and ethical boundaries that we should keep for the sake of the entire civilization?
I found this to be an interesting topic with astounding and appalling conclusions.
Where do others stand on this issue which is just one more offshoot of the ethical renal transplant issues that includes renal transplant tourism. How far will we go?
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Dear Stauffenberg,
You have falsely accused me of not reading the sources that you sent to me in a prior post which is not true. In fact, I have corresponded by email with Dr. Hippen several times and in fact, I call him Ben and he calls me Peter. I further published my follow up post on renal donor payment after also corresponding with Dr. Jeremy Chapman who opposes the payment system. Let me make a very clear statement. None of these people that support a system of renal donor payment support the current unethical transplant tourism that you alone support.
Here are the posts I had on the subject before and after my correspondence with Dr. Hippen and Dr. Chapman as well as one from Bill on the issue.
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/06/competing-or-co.html
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/06/what-can-dialys.html
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/06/the-truth-about.html
Once again, I would recommend that you adopt the professional attitude that I have with Dr. Hippen, even though we are on opposite sides of the issue at hand, we are both able to share what we agree and disagree on in a professional manner and in fact enjoy respect for each other professionally. You have much learning but you have not treated me with professional respect.
Your directed insults against me do not show the same professional interaction that I would expect of someone that states that they have lived in academia for decades. I would highly recommend that you start using a professinal demeanor in your posts. It lends a lack of credibility on your part in the end analysis.
Sincerely,
Peter Laird, MD
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The ethical debate over the legitimacy of paying for kidney donation to reduce the death rate among dialysis is not so one-sided as you imagine. In the collection by Caplan and Coelho, "The Ethics of Organ Transplantation" Amherst: Prometheus Books, 1998, you might want to read the articles by A. Barnett, et al, "Improving Organ Donation: Compensation versus Markets," and by J. Radcliffe-Richards, et al, "The Case for Allowing Kidney Sales." Also in vol. 18 (2002) of "Transplant Proceedings" there is an interesting discussion by B. Larijani, et al, "Rewarded Gift for Living Donors."
The fact that the states of Israel, Iran, and the Philippines allow the purchase of organs from living donors for transplant within their domestic populations suggests that at the very least 140,000,000 people think you are wrong to object to this practice, so again, don't assume that my position is so outlandish.
The defense of necessity is a universal principle of the common law tradition. It maintains that where someone's life is at risk, he can violate any statute to preserve his life if there is no other way to save it. I don't see how any legislation purporting to ban organ sales can survive that legal principle if a dying renal patient were to pay for an organ to save his life. Since the defense of necessity represents an invasion of the legal order by a moral principle, I find it quite curious that its invocation in the case of dying dialysis patients is somehow thought to defend an immoral act.
Ethical positivism affirms that what is sacred is how humans actually feel: how happy they are, how healthy they are, how long they live, how well they function, how well they feel. It denies that anything, even the lump of flesh which houses those human experiences which are sacred, can be treated as something sacred and inviolable against real human interests. Thus, if humans need to make an incursion on the human body in order to support real human interests against death and disease, then honoring the sacred, respecting humanity, endorses that incursion. You continue to repeat the analytical mistake of focusing on the imaginary sacredness-in-itself of the body, even to the point of using this as a lethal weapon against the actual sacredness of human feelings, human health, and human life. This is the ultimate reason why you oppose the win-win situation of a poor renal donor being saved from poverty, according to his own free choice to donate, and the dying renal patient being saved from death.
For every pair of persons you have in which one person has two kidneys and the other has none, you have infinitely less life, health, happiness, and human equality than if the two kidneys in that pair were redistributed so that the persons had one kidney each. To insist on preserving the former situation over the latter is to embrace human suffering and death for no positivistically real value. It is to worship the imaginary sacredness of intact human flesh over the real value of actual healthy, positive, human experience. That is hardly a position which a scientifically trained doctor should assume, especially when embracing that irrationality requires that he accept as its necessary consequence the vastly higher death rates of patients whom his profession obligates him to protect.
If you review the history of your own posts in response to mine over all the topics on which you have posted, you may find reason to question the civility of your own tone.
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If you review the history of your own posts in response to mine over all the topics on which you have posted, you may find reason to question the civility of your own tone.
Classic bullying behavior: Going around poking at people with sharp sticks, and then, when they, provoked beyond endurance, strike back, claiming to be the victim -- but not fooling anyone. For shame.
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Consider this thought experiment which might clarify the moral issue in kidney transplants considerably: Suppose the world consists of six billion and one persons, and while six billion of them have endstage renal failure and survive on dialysis, one of them, like the multi-breasted Artemis of Antiquity, has six billion and one kidneys. The multi-kidneyed person is desperately poor and eager to sell his spare kidneys to become wealthy. The six billion people on dialysis are desperately ill and eager to buy one kidney each. Now ask yourself, would the entire world choose to thwart the desperate desires of everyone on the planet in order to languish on dialysis and die out in a few years just to preserve the "supreme moral principle" that human organs should not be commodified? Of course not.
But now ask the more interesting question: Should it? Again, it seems absurd that everyone in the world should be made miserable to sustain some supposed sanctity and untouchability of the body, just because it is imagined that it is morally unjustied ever to treat it as a commodity, and that this principle trumps the claim of the world of dialysis patients to live and the claim of the impoverished quasi-Artemis to escape poverty. Is having everyone on the planet suffer and die morally superior to the alternative which infringes corporeal sanctity? If you think of this example, the whole objection to treating kidneys as a commodity is exposed in its utter ridiculousness, since there is no morally significant difference between one person needing to buy a kidney and six billion.
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I thought this was a very simple post on the issue of the Declaration of Istanbul, but it appears that I was wrong. Sanity has not returned to the discussion on renal transplant ethics, or at least not here.
Sorry to sign off my own post I started, but not much room for polite discussions left.
I trust that I have been able to state my approval well for prohibition of payment for renal donation and that all will consider the ethics of renal transplant for themselves. I hope that the post will if nothing more points to some of the different issues at stake.
Take care for now.
Peter
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Hang in there, Peter. I really value your opinions. Your professional knowledge and expertise are sorely needed here.
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While sanity may have returned to Renal Transplant Ethics Discussions elsewhere, here at IHD, the insanity by some continues.
8)
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The debate was getting pretty good, until the sharp stick got pointed at someone.
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As for the 'sharp stick,' I think you have to get passionate about this, because someone is advocating what essential amounts to the legal murder of tens of thousands of members of the same highly vulnerable, extremely abused minority group to which we all belong. I feel like a Black man listening to someone talking about how pleased he is with lynchings.
Let's face it: in a democracy laws are made by the majority, and the majority is predominantly healthy, and looks upon chronically ill people with fear and loathing, generally assuming that they are responsible for their own sickness. That majority in its infinite arrogance passes laws which control our life and our death without having any understanding at all of what we have to endure. Just think of how many idiots out there in the healthy majority think dialysis is temporary, curative, or no big deal, or that anyone can get a transplant just by asking for one.
Now what are mental processes in the healthy majority when they hear about purchasing organ transplants? Without thinking more than three seconds about the matter, they respond on the basis of their uninformed, unreflective, knee-jerk reaction that buying organs from people seems 'icky,' so they delight in feeling self-righteous by screaming out for laws to prevent it, just so they won't have to be bothered with an aesthetically disturbing image of organ trafficking while they are sipping coffee over their morning newspaper. Since organ trafficking sounds so much life drug trafficking, that only reinforces the desire of the smug majority to condemn the practise, given the purely intuitive, essentially mindless, pictorial, punning style of 'analysis' they bring to the matter. Most of them probably aren't even aware of how much human suffering and death among the dialysis patient population such laws will cause, and they will never take the trouble to inform themselves about this either, since as they all assume, dialysis patients are just a bunch of freaks who get what they deserve.
But when dialysis patients themselves -- who should know better, who should demonstrate at least enough loyalty to their fellow sufferers as not to endorse their murder by laws that bar the only way out the burning building we are all trapped in -- join in the prejudice against dialysis patients that must lie behind these bans on organ purchasing, since my unrefuted arguments above show there can be no rational basis for them, then I am astonished at how far the herd mentality can bar the route to rational analysis.
Before anyone for any reason ever endorses laws that will mean death for people, he should be 100% sure there is no possible moral alternative, and that the logic of his arguments is unimpeachable. The burden of proof in such a case has to lie entirely with those arguing for a ban on trafficking, and it has not been met.
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Stauffenberg, your position on this issue is one thing and I try to follow you there to understand your thoughts about it and might even debate you on some points, although I do not endorse your ideas and do not feel that anyone owes me their organs. We don't have to agree to discuss. However, I find your rhetoric so ridiculous in the extreme that I can't even be bothered. Genocide and now lynching comparisons. You've heard healthy people talking about how pleased they are that we, the vulnerable, are dying by the tens of thousands? You know people who think dialysis patients are a bunch of freaks who get what they deserve? You feel like a black man because of the extreme abuse at the hands of the healthy majority who oppress us, the chronically ill, all the while they fear and loathe us??
I suggest you get out more or at least change circles if you're running into these crazies as often as you appear to be.
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Consider the way dialysis patients are treated: First, the number of organs available for transplant is greatly reduced by laws which allow relatives of the deceased donors to override their wish to donate an organ. Is there any moral reason for permitting this, especially when our society does not allow those same relatives to overturn the wishes of the deceased respecting the disposition of his wealth? Of course not. But the fact that this law is well known to kill dialysis patients by denying them life-saving organs, and that governments still do nothing to change the law, can only mean they are prepared to let us die for no reason at all.
Second, many procedures that could greatly increase the number of life-saving organs for transplant, such as presumed consent to donate for all deceased persons who have not registered their objection; permitting paired donations between non-related persons (not allowed in eight Canadian provinces); or permitting purely altruistic donation from non-realtives (not allowed anywhere in Canada) are denied by the authorities for no assignable moral reason. The Canadian Medical Society has been 'officially studying' these suggestions for more than a decade now, but it finds playing God with our lives so amusing that they have still to decide how many of us shall be required to die to service their informal, intuitive, and as yet unjustified sense that something must be wrong with these options. Also in Canada there are so few hospitals outside the major urban centers with the life support machines necessary to harvest organs for transplant from brain dead donors that again, many donated organs go to waste unnecessarily.
Third, look at the way dialysis patients are treated by society while they are waiting for a transplant. In the US, the statutory requirement for inspection of dialysis centers for quality control is so lax as to be literally non-existent, because the main interest of the federal government is to ensure that the private, for-profit dialysis centers make as much money as possible, no matter how many dialysis patients are slaughtered by substandard care. The death rate among dialysis patients at the very few public, not for profit dialysis centers in the US is equal to that in the rest of the industrialized world, but it is double the death rate of the rest of the industrialized world in the for-profit dialysis centers, yet the government does nothing to repair this situaton. In Europe, dialysis sessions are almost always available only from 9 AM to 5 PM, for the convenience of the healthy staff, even though this utterly destroys the capacity of dialysis patients to achieve rehabilitation by re-entering the work force. In Canada, dialysis stations are simply not being built by the government to keep pace with the demand, so many patients are forced to travel huge distances to outlying dialysis centers because the near-by ones are overcrowded, and again, this destroys the capacity of patients for rehabilitation by making it impossible for them to work, given the travel time to and from dialysis.
Fourth, we have the laws which bar the final door of escape from this lethally discriminatory system, which is the resort of dying dialysis patients to the purchase of organs from willing donors abroad. Why do Western governments, which care nothing about the enormous financial exploitation of third world residents by international capitalism, suddenly become so solicitous of the importance of not exploiting these people when dialysis patients seek freely to contract with them to save their lives? Why are Western governments so unconcerned when new medications are carelessly tested by first world drug companies on third world patients, maiming and killing many of them, and so unconcerned when first world industries operating in the third world pollute and poison the local people, and yet suddenly they become so worried about protecting thrid world residents when dialysis patients seek to save their lives by cooperating with them in paid organ donation? Doesn't this huge difference between Western disinterest regarding capitalist exploitation of the third world and Western outrage regarding renal patients' recourse to third world donors make you in the least suspicious?
I am sure you cannot be so naive as to believe that there is not a HUGE amount of discrimination against the chronically ill in all these irrational and unjustified policies which needlessly and enormously magnify the suffering and death rate among dialysis patients. The Holocaust required the death of millions of Jews for the sake of a vague moral intuition that racial purity was an ethical imperative for the good of humanity. Laws forbidding organ sales would require the death of about 35,000 renal patients a year for the sake of a vague moral intuition that human life should be sacrificed to preserve the sacred untouchability of human organs by commercial transactions. Given that studies have shown that renal donors in the West actually live LONGER than the average lifespan, I see no rational reason to excuse this slaughter of renal patients.
The very fact that so many people are willing to endorse the ban on organ sales on extremely shakey grounds -- and I believe all the arguments I have developed in this thread show that those grounds are far from certain -- has to be explained by something other than rationality, and I believe discrimination -- the refusal of the healthy majority to care to think seriously about the plight of dialysis patients before condemning many of them to a needless death, is the explanation. Before any decent and moral person argues for any policy which will cause the needless death of 35,000 people a year, he should be 100% certain of his justification, and you have to admit that I have at the very least shown that 100% certainty is impossible for that position. The foundation of morality has to be found in the credo of the Jewish philosopher Hillel: "First, choose life," not in vague, indefensible intuitions about the human body being so sacred that that sacredness can require the death of the people it should serve.
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Any future personal attacks beyond simple disagreements will result in a minimum 90 day ban of all IHD family of sites.
Play nice.
Sluff/Admin
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not being too smart myself- I read this
Second, there have been studies done as I listed in my post on Bill Peckham's page showing the adverse health effects of renal donation to the majority of those that donated and much evidence that shows that it does not in the least change the status of their poverty. In fact, with the adverse health consequences well documented in several studies, many donors find themselves in a worse situation since they are no longer able to work at their prior level.
not being concerned with the poverty aspect- but the donating is harmful aspect....Is this just because of the donation happening in a third world country- or does that apply to everyone who donates everywhere? I thought it was not harmful in any way to the donor?
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In that case, Sluff, I would also propose that you ban for life future comments from any person posting messages (aside from news story reports) advocating government policies which would kill thousands of dialysis patients. I cannot see how you can be consistent unless you add this ban, since messages endorsing policies killing thousands of dialysis patients are at least a million times more hurtful and a million times less respectful of other dialysis patients than mere personal insults.
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Glitter: The health effects on live kidney donors of donating an organ have been measured over thousands of patients for over a thirty-year period post-transplant, and no net negative effects of any statitstical significance have been observed, other than a slight, clinically insignificant increase in blood pressure. In fact, one Swedish study even found that kidney donors typically live a LONGER than normal lifespan. (See I. Fehrman-Eckholm, et al, "Kidney Donors Live Longer," Transplantation, vol. 64, no. 7 (1997) pp. 976-978. Occasionally you hear rhetoric from opponents of organ purchasing about all the physical harm this is doing to the donors, but the science simply does not support this.
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In that case, Sluff, I would also propose that you ban for life future comments from any person posting messages (aside from news story reports) advocating government policies which would kill thousands of dialysis patients. I cannot see how you can be consistent unless you add this ban, since messages endorsing policies killing thousands of dialysis patients are at least a million times more hurtful and a million times less respectful of other dialysis patients than mere personal insults.
Proposal struck down. Sorry.
Sluff/Admin
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Your decision should be explained and justified, don't you agree?
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Your decision should be explained and justified, don't you agree?
No explanation should be necessary. IHD is not a democracy.
8)
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not being too smart myself- I read this
Second, there have been studies done as I listed in my post on Bill Peckham's page showing the adverse health effects of renal donation to the majority of those that donated and much evidence that shows that it does not in the least change the status of their poverty. In fact, with the adverse health consequences well documented in several studies, many donors find themselves in a worse situation since they are no longer able to work at their prior level.
not being concerned with the poverty aspect- but the donating is harmful aspect....Is this just because of the donation happening in a third world country- or does that apply to everyone who donates everywhere? I thought it was not harmful in any way to the donor?
This should be clarified. When I was considering being a donor for my husband, I gathered as much information as I could, discussed it with the medical professionals and then weighed the risks for myself. Maybe I felt more comfortable doing this than the average person because I spend most of my time engaged in research for my job. As far as I could assess from the available information/research, the highest risk of donation is associated with the actual surgery. In developed countries, many of us do not dwell much on the possible complications of surgery when we are faced with the need for a surgery that we know is going to be clearly beneficial. Think here in terms of emergency caesareans for childbirth (I had one), knee surgery, even open heart surgery (something my father went through last year). This is because the risks are relatively low as judged by the perceived and measured benefits. When thinking about donation, the perspective changes. The risks remain relatively low, but must be more closely considered because a donor will face no surgery-related risks if they do not donate.
I presume that the original quote relates to conditions other than those we typically encounter in the developed countries.
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Glitter: The health effects on live kidney donors of donating an organ have been measured over thousands of patients for over a thirty-year period post-transplant, and no net negative effects of any statitstical significance have been observed, other than a slight, clinically insignificant increase in blood pressure. In fact, one Swedish study even found that kidney donors typically live a LONGER than normal lifespan. (See I. Fehrman-Eckholm, et al, "Kidney Donors Live Longer," Transplantation, vol. 64, no. 7 (1997) pp. 976-978. Occasionally you hear rhetoric from opponents of organ purchasing about all the physical harm this is doing to the donors, but the science simply does not support this.
Another point of view: Here is an interesting article that discusses the limitations of the studies of living donation that have been done to date. Please note that I have included only the abstract and discussion here; to read the full article, use the link(s) below.
Clin J Am Soc Nephrol 1: 885-895, 2006
© 2006 American Society of Nephrology
doi: 10.2215/CJN.00840306
Medical Risks in Living Kidney Donors: Absence of Proof Is Not Proof of Absence
Elizabeth S. Ommen, Jonathan A. Winston, and Barbara Murphy
Mount Sinai Medical Center, Division of Nephrology, New York, New York
Abstract
Living-kidney donation has become increasingly widespread, yet there has been little critical analysis of existing studies of long-term medical outcomes in living donors. This review analyzes issues in study design that affect the quality of the evidence and summarizes possible risk factors in living donors. Virtually all studies of long-term outcomes in donors are retrospective, many with large losses to follow-up, and therefore are subject to selection bias. Most studies have small sample sizes and are underpowered to detect clinically meaningful differences between donors and comparison groups. Many studies compare donors with the general population, but donors are screened to be healthier than the general population and this may not be a valid comparison group. Difficulties in measurement of BP and renal function may underestimate the impact of donation on these outcomes. Several studies have identified possible risk factors for development of hypertension, proteinuria, and ESRD, but potential vulnerability factors in donors have not been well explored and there is a paucity of data on cardiovascular risk factors in donors. Prospective registration of living kidney donors and prospective studies of diverse populations of donors are essential to protect living donors and preserve living-kidney donation.
Discussion
The Council on Ethical and Judicial Affairs of the American Medical Association issued a report on the transplantation of organs from living donors that stated, "The risks to a kidney donor... are fairly well understood, have a relatively low incidence, and are considered minimal beyond the regular risks of surgery" (79). This sense of understanding, at first glance, may seem justifiable given the number of studies on living donor outcomes and the long duration of follow-up of several of these studies. When we examine many studies closely, however, we find limitations that weaken our confidence. Early in the history of living donation, it was necessary and appropriate to obtain fairly quickly data that would provide us with preliminary reassurance that donation posed no great harm. Retrospective study designs that included small numbers of subjects and comparisons with the general population were reasonable approaches at that time and have advanced the field. We should be reassured that there have been no consistent increases in BP or large decreases in GFR. However, we have not considered adequately small changes in GFR, proteinuria, and hypertension and the evidence that risk in certain donors may be enhanced by nephrectomy. We also must consider the potential long-term CV risk that is associated with such changes. Moreover, we have not evaluated these issues in donors from minority populations. The history of clinical research has taught us that extrapolation of results in white individuals to other racial and ethnic groups may underestimate the risks in a more diverse group of donors.
Moving forward, it no longer seems sufficient to base practices and consensus statements on the existing studies and the existing methods. It is time for the transplant community to call for prospective registration of living kidney donors and prospective studies of diverse populations of donors that may be compared with groups with similar compositions of race, ethnicity, and family history.
The United Network for Organ Sharing maintains a database on outcomes of living kidney donors. However, an analysis of the completeness of these data found that only 60% of 6-mo follow-up forms were returned to the United Network for Organ Sharing from transplant centers, and those forms that were returned revealed that 36% of donors already were lost to follow-up (51). It is understandably difficult to maintain a relationship with donors who wish to think of themselves as healthy individuals. However, the South-Eastern Organ Procurement Foundation reported on efforts to follow living donors with questionnaires and found an overall response rate of 90% (80). The authors attributed the maintenance of a high response rate to the fact that donors were enrolled prospectively and knew that participation was a part of their follow-up care. It is likely that registries or programs that involve hospital visits and blood tests, which are necessary to ensure adequate and accurate data, would have a lower rate of donor participation than seen in this study. However, it also is likely that if donors understand that the risks of donation are not completely clear and understand from the outset that follow-up of their health is part of the donation process, then we will be able to obtain sufficient information to gain a better understanding of risks of living donation.
How, then, in the era before the creation of a national donor registry and before the development of long-term prospective studies in diverse donor populations should we evaluate and counsel potential living kidney donors? The transplant community continues to revisit this question, most recently at the international Amsterdam Forum in 2004. The report that was generated from this meeting was published in 2005, and we direct the readers to this article for a comprehensive discussion of the currently accepted guidelines for living donation (81). As discussed in this article, however, the data on which these guidelines are based are not complete. Given these circumstances, prudence suggests the exclusion of "marginal living donors"—prospective donors with medical abnormalities that have been shown to increase overall medical risk in the general population. We should recognize that the use of marginal living donors as a response to the growing number of patients who have ESRD and are dying while awaiting renal transplantation may be in direct conflict with our responsibility to potential donors to "do no harm." A recent multicenter study of potential living donors in Canada found that acceptance of potential donors who were excluded for mild hypertension or proteinuria would have resulted in only a 3% increase in the number of patients who receive a transplant (82). Liberalization of these exclusion criteria would have a minimal impact on the waiting list and would not offset its steady growth. However, the impact would be great for the potential donor who has hypertension and is eager to donate to his or her child. The evaluation of potential donors therefore must balance our respect for donor autonomy with our level of comfort with the risk involved. It is not paternalism but protection of our own core beliefs that prevents us from facilitating a donation that we have reason to believe may cause substantial harm to the donor. Perhaps the most compelling argument for maintenance of cautious donor acceptance criteria and for proceeding with registries and research studies is our dependence on public trust and goodwill for continuation of living-donor transplantation. If certain donor characteristics, including medical abnormalities, confer greater medical risks, then it likely will be discovered many years in the future. If the transplant community has not made appropriate efforts, through registries and research, to understand potential risks, then living-donor transplantation and the health care system will be irreparably damaged.
As Henry David Thoreau said, "To know that we know what we know, and that we do not know what we do not know, that is true knowledge." We must acknowledge to ourselves and to potential donors the limits of our knowledge and request of our donors another gift: That of continued participation in research and in registries. It is only by further study that we may truly protect our living donors and preserve the practice of living donation.
Full text version: http://cjasn.asnjournals.org/cgi/content/full/1/4/885?ck=nck
PDF: http://cjasn.asnjournals.org/cgi/reprint/1/4/885?ck=nck
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Excellent article, xtrememoosetrax! Additional points of view are always welcome.
8)
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I agree - thanks extrememoosetraxs for that contribution. I personally have viewed living donation only through the lenses of healthy individuals who are using their heads and their hearts to make a decision.
Right now the medical community seems to be in a position of playing catch up. The availability of information on the internet has exploded over the last decade and forums such as IHD speed up information transfer among interested parties. I certainly want to base decisions on the best available science for any aspects of my healthcare. More studies and better data will help the medical community make better recommendations for potential donors and may also make it possible at some point in the future for some on dialysis to more willingly accept the idea of related living or altruistic donations.
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Interesting article. Thanks.
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As for the risks of the renal transplant surgery for the donor, they are so minimal as to be comparable to the risks of death in an automobile accident while the donor is driving to the hospital where the surgery is to be performed. They amount to one death per three thousand operations. This operation was first performed by Dr. Murray and colleagues in Boston in 1954, so it is a very old, well-established, and now routine procedure. The possibility of now performing a much less invasive laparoscopy surgery on the donor further reduces the risk and the recovery time, although this may increase the damage to the kidney.
The several huge statistical studies published by I. Fehrman-Eckholm, et al, and showing NO negative health effects for the donor from renal transplantation simply blow all the dissenting views out of the water. (I have cited some of these above.) The health impact on donors is so utterly minimal that they actually live LONGER than the general population on average. News stories which need to sensationalize their melodramatic tales of the horrors of the kidney market create a lot of confusion by misrepresenting the medical downside of kidney donation. The best evidence of the safety of kidney donation is that the ultimate vultures of the healthcare system, the medical insurance companies, which have no interests at heart except their own profit, have conducted massive statistical studies on the health of kidney donors and have decided not to charge them higher premiums because of their donation.
When considering the minimal risks to the donor in a kidney transplant, it is important to look at the net health of the pair of people involved in the procedure -- both the kidney donor and the kidney recipient. Since the net health and longevity of that pair is enormously increased by distributing the available kidneys between them so that each has one, rather than leaving two in one person and none in the other, the issue comes out 100% in favor of donation.
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Ok this is the way I see it. Selling organs isn't right especially from the people that most of the discussions are about. Your wanting to "harvest" organs from unhealthy people that from the sounds of it live in squaller. To me this would be compairable to me going to Chicago, finding a bum and telling him I'll give him money if he sells me his Kidney. Even if he was a match who in their right mind would want that kidney first off and secondly is that bum going to have a better quality of life because he has one less kidney and some cash in his pocket? Just because he donated a kidney does not mean that he suddenly will live in clean conditions and be able to take care of himself. He will spend that money on booze or other things and in no time flat end up back in the same filth he came from. He will most likely get extremely sick and possibly die because of not taking care of the surgical area causing an infection that wont get treated because he can't afford it. So now once again you have 1 person with a good kidney and someone else dead or dying not 2 people with good kidneys and all smiles. All the stats shown in this thread that are in favor of it seem to be from various unrelated parts of the world being lumped together as 1 factual mass involving healthy individuals instead of the target audience. Until I see more compelling arguments I stand by this belief and my statement.
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OK this is the way I see it. Selling organs isn't right especially from the people that most of the discussions are about. Your wanting to "harvest" organs from unhealthy people that from the sounds of it live in squaller. To me this would be compairable to me going to Chicago, finding a bum and telling him I'll give him money if he sells me his Kidney. Even if he was a match who in their right mind would want that kidney first off and secondly is that bum going to have a better quality of life because he has one less kidney and some cash in his pocket? Just because he donated a kidney does not mean that he suddenly will live in clean conditions and be able to take care of himself. He will spend that money on booze or other things and in no time flat end up back in the same filth he came from. He will most likely get extremely sick and possibly die because of not taking care of the surgical area causing an infection that wont get treated because he can't afford it. So now once again you have 1 person with a good kidney and someone else dead or dying not 2 people with good kidneys and all smiles. All the stats shown in this thread that are in favor of it seem to be from various unrelated parts of the world being lumped together as 1 factual mass involving healthy individuals instead of the target audience. Until I see more compelling arguments I stand by this belief and my statement.
I just want to first off say that I do not believe in selling organs period. I also do not believe in receiving organs from unhealthy people.
Now, the only thing I wanted to say in regards to this post was that comment: "He will spend that money on booze or other things and in no time flat end up back in the same filth he came from."
That is very stereotypical, rude, and the list goes on. To categorize someone who is homeless into one group and that being a group that only spends what money they get on booze, and to imply they choose to live in filth and that's what they will always end up going back to, is disgusting to say. There are PLENTY of people who are homeless by no fault of their own and any money they get is spent on them trying to survive and get out of the situation they are in. There are PLENTY of people who are homeless with children and it is no fault of their own and they would give anything to be off the streets and sure as hell don't spend what help they get on booze. I feel bad for people who are in reality homeless and have ended up in that situation trying their hardest to not end up there and can't get the help they need due to people like you who assume they will spend it on booze. How sad.
Of course there is a group of people who fit into that category, but the way you said it... you put everyone into it.
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Also, Hawkeye, why do you presuppose in your reasoning that the bum would sell you his kidney for less than he needs to earn from it to restore his prosperity? After all, you need the kidney more than he needs to sell it, since you will die (or live a vastly shortened life expectancy) without it, while he will only live a more materially comfortable life by selling it. Thus he holds all the cards.
Consider the landmark legal case I have mentioned a few times in my comments, Post v. Jones. In that case, a whaling ship had crashed on the ice near the North Pole, and another ship happened by and offered to rescue the stranded crew, who were starving to death, and take them with the ship to Hawaii. The captain of the rescue ship insisted, however, that the captain of the stranded sailors pay him the entire value of the stranded ship's cargo for the rescue, which was many times higher than the actual costs of transporting the crew to Hawaii.
Once in Hawaii, the courts refused to enforce this contract, holding that it was immoral exploitation. The reason why the court said it was immoral exploitation was that the stranded sailors were in danger of losing their lives if they did not accept the terms offered, while the rescue ship only wanted to make money, so they were not under comparable pressure to accept any bargain offered. The case applies to organ purchasing as well: It is the purchaser, not the donor, who is the desperate person likely to be exploited, since he will die without the contract for sale, while the donor only wants some extra money, and can live without it.
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Zach, even in an autocracy, administrative law principles presuppose that decisions which purport to be reasonable carry a moral duty to those affected by them to demonstrate their reasonableness by stating and defending their reasoning. That principle is not a matter of democracy, but of the basic human right of people affected by another's power not to be treated like dirt.
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The reasoning in that article by Ommen, et al, displays all the illogic I have come to expect on this topic. In saying that potential living donors whose health status makes them only marginally acceptable as donors we violate the principle of 'first, do no harm,' the authors utterly neglect the glaring fact that enormous harm is done by doing nothing, since the dialysis patient who does not receive a transplant has about half the life expectancy (one third if he is also diabetic), or the one who does receive a transplant. The duty not to do harm should be measured over the pair of people involved in the donation relationship, thus including the recipient as well as the donor, and the net gain in health and longevity in the pair if the kidneys are redistributed from one person having two and the other having none to each having one is unquestionably enormous. So to rely on the Hippocratic 'first, do no harm' principle as an excuse for excluding marginal living donors is idiotic, since a moral duty to do no harm is owed to both parties, not just to the potential donor.
The authors then note that even if marginal donors were accepted, this would yield 'only' a 3% increase in kidney transplants, which they arrogantly announce is too small to count. But since this procedure saves the lives of those who receive transplants, and the value even of a single human life saved is infinite, the authors demonstrate their utter idiocy and moral bankruptcy when they characterize this as only a small gain.
They reason with equal foolishness when they try to defend themselves against the charge that they are being paternalistic by denying willing potential donors the the right to donate, because they are just protecting their health. But it is the universal practice of society in every other context to allow people to make idealistic, altruistic choices to benefit others at their own risk. There is no legal power in the police to prevent a frantic parent from rushing into a burning building to save his or her child. The state never intervenes to deny people the right to choose dangerous professions by joining the police, the fire department, the military, or by becoming coal miners. During World War II, the state itself experimented with untested and potentially dangerous anti-malaria drugs on prisoners in return for giving them favorable parole consideration. From all these usages, we can see that it is generally accepted in society that people are free to take medical risks for what they perceive are their own interests. In fact, we award medals to people who risk their health or incur injury to save others, and we build statues to those who die in the attempt to rescue others. So where is the excuse for this sudden and massively inconsistent paternalism when it comes to stopping people from saving the lives of dialysis patients?
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Your decision should be explained and justified, don't you agree?
nope.
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The policemen did not stop the woman from running in to the burning building, but the policemen did not likewise go in as well.
Your analogy of a person wishing to donate no matter what the risk is asking the surgeon to run into the burning building with the mother. They do not have to take such a risk upon themselves, it is a personal decision.
As a physician, the burden of not harming your patient weighs heavily upon decisions made. The physician does not have to succumb to all the wants and wishes of their patients when it goes outside of the bounds of the fiduciary responsibility to that patient. The patient is free to find another physician if the initial MD declines requests outside of his practice or outside of his personal ethics. I suspect that you will advocate otherwise. Thankfully, we have not taken away professional and personal judgements from physicians yet in this nation, but the utilitarian ethos present will soon I am sure. So, you need not advocate for the world to come. It will be filled with many such utilitarian principles.
Utilitarianism advocates for the greater good for the most people. In such, a concerted discussion on 18th century slavery where the labour of the few benefited the masses of the south is one such utilitarian argument that could be made. Yet, by justice, we know that the practice of slavery is, was and should always be routed out. In just the same colonialism of the labour of a few subjugated by the rich is the entire transplant tourism argument. The rich who can afford to pay are subjugating the poor but they are not compensating them enough for placing their lives at risk. (Mortality in American renal donors is 1/3000. This is a number for people to take note of.)
Thank you Sluff for setting the standards on IHD. It will be a pleasure to continue posting with people dedicated to preserving a place for congenial discussions and exchange of information. It has already been a pleasure and I look forward to many future discussions. Thank you all.
Peter
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Zach, even in an autocracy, administrative law principles presuppose that decisions which purport to be reasonable carry a moral duty to those affected by them to demonstrate their reasonableness by stating and defending their reasoning. That principle is not a matter of democracy, but of the basic human right of people affected by another's power not to be treated like dirt.
Your premise is quite flawed with regard to IHD.
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Here is a follow up article on the Declaration of Istanbul. It is a large document in light of the calls for global colonization of poor organ donors by those that not only support payment for renal donation those that actually approve of the current black market organ donor pools.
http://www.newscientist.com/article/dn14273-transplant-tourists-running-out-of-destinations.html
The WHO and several influential renal care networks stand behind this declaration.
Colonial subjugation of poor people in impoverished nations should not be the ethical choice of how to treat CKD-5 patients. There are limits to how far we can go.
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OK this is the way I see it. Selling organs isn't right especially from the people that most of the discussions are about. Your wanting to "harvest" organs from unhealthy people that from the sounds of it live in squaller. To me this would be compairable to me going to Chicago, finding a bum and telling him I'll give him money if he sells me his Kidney. Even if he was a match who in their right mind would want that kidney first off and secondly is that bum going to have a better quality of life because he has one less kidney and some cash in his pocket? Just because he donated a kidney does not mean that he suddenly will live in clean conditions and be able to take care of himself. He will spend that money on booze or other things and in no time flat end up back in the same filth he came from. He will most likely get extremely sick and possibly die because of not taking care of the surgical area causing an infection that wont get treated because he can't afford it. So now once again you have 1 person with a good kidney and someone else dead or dying not 2 people with good kidneys and all smiles. All the stats shown in this thread that are in favor of it seem to be from various unrelated parts of the world being lumped together as 1 factual mass involving healthy individuals instead of the target audience. Until I see more compelling arguments I stand by this belief and my statement.
I just want to first off say that I do not believe in selling organs period. I also do not believe in receiving organs from unhealthy people.
Now, the only thing I wanted to say in regards to this post was that comment: "He will spend that money on booze or other things and in no time flat end up back in the same filth he came from."
That is very stereotypical, rude, and the list goes on. To categorize someone who is homeless into one group and that being a group that only spends what money they get on booze, and to imply they choose to live in filth and that's what they will always end up going back to, is disgusting to say. There are PLENTY of people who are homeless by no fault of their own and any money they get is spent on them trying to survive and get out of the situation they are in. There are PLENTY of people who are homeless with children and it is no fault of their own and they would give anything to be off the streets and sure as hell don't spend what help they get on booze. I feel bad for people who are in reality homeless and have ended up in that situation trying their hardest to not end up there and can't get the help they need due to people like you who assume they will spend it on booze. How sad.
Of course there is a group of people who fit into that category, but the way you said it... you put everyone into it.
Yes it was a stereotypical remark you are correct and I should have thought about how I stated that before I wrote because I know as well that there are many people out there that are homeless for various reasons. It was really just meant to make a point that regardless of the money gotten that there is no reasonable amount that could be paid that would lift them out of their current situations permanently especially since in our world it seems that the more vulnerable or dependant you are on others the more likely you will be taken advantage of and not given your due. Yes I know that sounds stereotypical too, but just look at all the cases where the elderly have all there money stolen or are severely mistreated by their caregivers and nursing homes.
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Here is another follow up article on the Declaration of Istanbul that presents some interesting commentary on the issue.
http://health.asiaone.com/Health/News/Story/A1Story20080710-75872.html
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Here is another follow up article on the Declaration of Istanbul that presents some interesting commentary on the issue.
http://health.asiaone.com/Health/News/Story/A1Story20080710-75872.html
I found this to be an excellent article with many valid points.
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HD: Have you ever asked yourself who is really poorer, the diabetic dialysis patient in his forties who has at the very start of dialysis an eight-year life expectancy, and who in New England faces a seven-year average waiting time for a transplant, or in Canada an eight-year average waiting time, which gives him a very good chance of being dead prior to transplant -- or the perfectly healthy but economically poor person in the Philippines, who is not under any immediate medical pressure to enter into the contract to sell one kidney or die?
I think you are simply being misled by the STEREOTYPICAL IMAGE of the rich, exploitative Westerner and the poor, pitiful third world resident, when in fact the dialysis patient, with his miserable quality of life, typical inability to work, burgeoning co-morbidities, and severely limited life expectancy is in fact INFINITELY poorer. I would prefer any day to be healthy and poor than to be profoundly unhealthy and on the verge of death and wealthy.
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HD: To your other point regarding the fiduciary duty of physicians to frustrate what their patients autonomously deem to be their own, highly personal, real medical interests because the physicians arrogantly assume they have the right to dominate and control their patients access to the medical care they want, I believe that represents an outmoded attitude of the 'Doctor as God' which we are now thankfully getting away from.
Although in theory the patient can go to another doctor, as for example if she desires an abortion and her own physician will not cooperate, for many medical choices this is simply not possible, since the medical profession often operates as a monolithic force, imposing its uniform ethical presupppositions --many times through professional practice guidelines of the governing body -- on patients who have no other options.
An important question to ask in this context is who gave the authority to the medical profession to bar the ability of patients to exercise their autonomy over the most vital expression of personal freedom conceivable, which is to determine how to realize one's own physical health and preserve oneself from death. The medical profession, in my experience, knows so little about medical ethics -- which I have never observed to be a required course at any medical school -- that they would not be able to get a grade any better than D minus on any standard exam in the field. So knowledge does not give them the right to determine what should be the moral limits of the patient's autonomy. There is no connetion between medical skill per se and analytical sophistication regarding medical ethics, for which many years of highly technical philosophical training are required. You might as well ask an electrician instead of a judge and jury about who in justice deserves to be electrocuted for a crime as to ask a physician to assess a complex problem in medical ethics.
There is also no democratic warrant for the authority of the medical profession to enslave the patient population into service of its own uneducated intuitions about which treatments are proper and which are not. Ususally the medical profession has been treated by governments as a self-governing profession, meaning that the democratic will of the people manifested in the government does not penetrate to the medical profession and control it in the public interest. This means that the intuitions of the medical profession about the ethically acceptable limts of patient autonomy are utterly lacking in democratic legitimacy.
The scandalous record of what the medical profession has, in its infinite ethical wisdom, determined to be proper moral practice abundantly illustrates how foolish it is to grant then any authority over medical ethics at all. From the cooperation of American doctors with the infamous Tuskegee experiment, to the cooperation of German doctors with eye color transformation experiments at Auschwitz, we have evidence enough that a medical education warrants no special license to be the master of patients' medical autonomy.
In any case, all of this is irrelevant to the topic at hand, which is the legitmacy of payment for organ donation from living donors.
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Dear Staufenberg,
In response to your first post. I do not concur with your assessment that my views are stereotypical of a misled image of the rich expolitive westerner and the pitiful third world resident, nor do I deny the health consequences of a rich 40 year old with diabetes and CKD-5. I have devoted a large part of my life in taking care of these patients and expending much energy to do so effectively. The health consequences of being poor include many health related issues such as food insecurity, lack of sanitary water and exposure to poor sanitation which kills more people than any organ specific disease. I wish that I had an answer to their issues of poverty, but I do know that selling a kidney to secure a future for their family as so many have done does not accomplish that goal.
Now, back to the article, this issue is not about me specifically and my views as you wish to turn this debate, it is about the article that I have posted and the views of the WHO and other large renal related organizations that stand in opposition to transplant tourism. Simply because I am in agreement with this view does not in the least diminish the impact that the WHO has to say in taking its own stand on this issue.
Please list the supporting organizations that you are aware of that condone transplant tourism and perhaps we may have an interesting exchange.
Once again, I sincerely doubt that there are many people that will even take note of my own personal views, this issue is much larger than you or me. I continue to stand in support of the courageous stand that the members of the Declaration of Istanbul have taken.
Peter
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The patient that comes to a surgeon to donate a kidney is not in a relationship at which his condition warrents "therapy" that would then be the fiduciary responsibility of the doctor to ethically treat to the best of his ability. If the surgeon believes that the operation will harm this patient, then that surgeon is under NO obligation whatsoever to proceed against his better judgement. Let him seek another in my profession that reguards money higher than personal responsibility to first do no harm.
Secondly, please tell me which planet you are considering having a monolithic medical ethics? I have been in this profession and I must confess that the ethical posture of my colleagues runs the same range as it does in the general population. There are conservative, liberal, theological, atheistic views just as in the general population.
Now, the examples of out of control experimentation is precisely the background to the Declaration of Istanbul in recognizling that physicians can be motivated by actions and rewards other than a direct fiduciary responsibility. Contrary to your slanted implied definition of fiduciary, it is instead a real world daily reality in caring for patients that place their trust in you to perform to the best of your abilities what is right and just for them individually. It is not a God complex at all as you imply but instead a heavy burden of responsibility that has interupted the sleep of many doctors including myself worrying about whether we have forgotten to do anything that we were supposed to do for our patients that day. At times this review in the late hours of night has the purpose of reminding us of important parts of a patient's care that we should attend to immediately and phone calls to nurses in the middle of the night with new orders is a routine that every doctor that I know can relate to.
Further, I have spent the majority of my adult life conversing and consoling and learning from my colleagues. Indeed, my honest appraisal of the majority of my colleagues is a deep paranoia of missing the diagnosis, missing the right treatment and in any manner harming those that they are dedicated to serve. Sorry, but I have not met any gods in my many years of practice.
What you find instead is that medicine is a very humbling profession in that we are always in a state of searching for answers that often are difficult to find. No, my dear friend, your version of medical practice has no bearing whatsoever to that in which I have dedicated over half of my life to learn and to serve.
Back to the issue, a physician is not under any ethical obligation to adhere to patient requests when they may harm that patient.
Further, I would ask what profession deals DAILY with medical ethics? THe professor in the ivory tower? The high paid lawyer? No, my friend, it is the medical doctor that needs to be highly knowlegeable on the daily practice manifestations of ethical behavior and legal ramifications. As in any profession, some are better at it than others, but I know of no doctor that can get a D- in medical ethics on a day to day basis that will stay in practice for long. Once again, your views are quite apart from the reality of modern medicine.
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The medical profession, in my experience, knows so little about medical ethics -- which I have never observed to be a required course at any medical school
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http://medcatalog.harvard.edu/coursedetails.aspx?cl=preclinical1&id=14946
Well, I didn't have to go very far to find a rebuttal to your false statement.
Peter
Fixed quote from Stauffenberg-Boxman,Moderator
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Obviously there have to be some exceptions to the general rule that a medical ethics course is not required of medical students, given the thousands of medical schools around the world, but the point about the defective knowledge of most physicians regarding the philosophical discipline of ethics stands. When I was at the University of Berlin in 1984, our course on medical ethics was NOT required, and this was standard throughout Germany. When I went to the course on the first day, there were only four students there out of a class of 300 -- three Arab students and me, and the only reason the Arab students were there was because they were foreigners and were not in the loop so did not pick up on the fact that the course was not required. Later, in 1994, I took the Royal Society of Apothecaries diploma course on medical ethics in London, which was run as a seminar. The comments I heard from the physicians there were embarrassingly primitive. So I stand by my generlization that, apart from that small group of physicians with separate philosophical training, physicians do not know enough about ethics to be put in charge, as the law allows them to be, of their patient's moral autonomy over their own bodies.