Sanity Returns to Renal Transplant Ethics Discussions

[Hemodoc]

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

[stauffenberg]

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.

[Hemodoc]

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.

[stauffenberg]

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.

[Zach]

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).

[Hemodoc]

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.

[stauffenberg]

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. 

[Hemodoc]

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

[Hemodoc]

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?

[Hemodoc]

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

[stauffenberg]

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.

[xtrememoosetrax]

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.

[stauffenberg]

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.

[Hemodoc]

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

[flip]

Hang in there, Peter. I really value your opinions. Your professional knowledge and expertise are sorely needed here.

[Zach]

While sanity may have returned to Renal Transplant Ethics Discussions elsewhere, here at IHD, the insanity by some continues.

[kitkatz]

The debate was getting pretty good, until the sharp stick got pointed at someone. 

[stauffenberg]

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.

[monrein]

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. 

[stauffenberg]

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.

[Sluff]

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

[glitter]

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?

[stauffenberg]

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.

[stauffenberg]

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.

[Sluff]

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