LizzyM

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This morning I watched a well made, short film titled Everything. It is 16 minutes that raises an important question about bone marrow donation. http://www.everything.movie/

Should bone marrow donors be paid?

Discuss.
 

Kurk

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I don't have a problem with it if it prevents others from suffering/dying.
 
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LizzyM

LizzyM

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I don't have a problem with it if it prevents others from suffering/dying.
What arguments could be made against it? Why was it made illegal? What negative effects might lifting the ban on payment have?

Can you argue for and against?
 
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Dagrimsta1

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if donors get paid, this leads to more matches for patients which saves more lives. But who pays the donor? Insurance fusses over paying for meds, would they really pay a donor to donate? Probably not. The cost would likley have to come out of the patients pocket. This would force patients to settle the bill. Then it becomes a game of who can afford the marrow? Donors might also be tempted to donate to the patient that pays more.

If this were to come to fruition, it would have to be highly regulated with standardized pricing/donation amounts.
 

Kurk

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What arguments could be made against it? Why was it made illegal? What negative effects might lifting the ban on payment have?

Can you argue for and against?
I'm not sophisticated enough on this topic to form proper arguments. Maybe some other time. I just want to see what others have to say.
 

ndafife

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I'm not sophisticated enough on this topic to form proper arguments. Maybe some other time. I just want to see what others have to say.
I think the point of her question was to be able to explain the full scope of the issue during the interview. They don't expect you to be fully sophisticated on it, they want you to be able to understand both sides then make a decision based on that.
 
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jd989898

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There are really no compelling reasons to not establish a proper market for the sale of tissue/organs. The most prevailing arguments are that it somehow "commodifies life" or "desecrates the human body," which carry no ethical weight (at least for me). The market would need to be set up carefully by economists, of course. Currently, the government's avoidance of establishing a marrow price means the legal price = $0. Because the price is much lower than the implicit equilibrium market price, demand>>>supply, and the black market thrives. If a legal price were to be established, however, many seem to worry that it would rise so high that only the very rich could afford it. This hasn't happened with food, for example, which many poor people cannot afford. Instead of banning the market for food, we have found ways around by subsidizing the poor with food stamps. I think donors should also be required to pass health tests and have a certain baseline income, to ensure the poor/sick are not exploited. The knee-jerk avoidance of a rational, economic approach to this problem is killing so many people unnecessarily, and it's time to start thinking clearly.
 
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Eleithyia

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Paying for bone marrow became illegal under the ban on organ and tissue sale, which is understandable. It is likely that bone marrow is not treated like blood in this equation because bone marrow donation used to be a much more involved procedure with a recovery period, and part of the idea is to avoid people donating for the money without regard for the risk. Since most bone marrow donations these days aren't much different from donating blood, that reason starts to fall flat. OTOH, one could argue that a campaign to make people aware of the PBSC donation method might increase the number of people willing to donate as well.

Like Dagrimsta1 said, opening the possibility of sale could end up introducing a competitive market for blood marrow wherein wealthier people are at an advantage and poorer people are essentially denied marrow transplants. While we can say that it should be carefully set up and/or subsidized so that poor folks can afford it, the reality is that the people writing our laws are mostly wealthy, and it is a disadvantage to them & their families to avoid a free market situation. Subsidization, like jd989898 said, is an interesting proposal, but unfortunately people are sometimes outraged that those who use subsidization can have nice things, like fresh produce (or, say, healthy donated organs/tissues), and then budgets or restrictions on entering the subsidization program get tightened.

It's not a simple issue, even though it feels like it should be :(

What do you say to a question like this if you don't really know anything about it?
As long as you know what bone marrow donation is and know that organ/tissue sales are illegal, I think you could talk your way through it.
I guess the point is probably to read up on a variety of ethical issues :)

Edited for correction of repetitive phrasing.
 

ndafife

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There have been some good reasons for. Ill throw out a few arguments against it.

1. When you start assigning a monetary value to certain organs, you start assigning a value to human life.

2. Healthcare is already expensive. This makes it more expensive.

3. When you need to pay your donor you get into the "healthcare for the wealthy" argument.
 

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Why can't this be like platelet donations? Correct me if i'm wrong but don't people get paid to donate platelets? I can see it being a big deal if patient's pay donors directly but what if they were paid by the hospitals that they donate to? Keep track of how often they donate to mitigate any "frequent fliers" and everyone stays happy. BTW anyone who donates marrow is a hero in my book. That procedure is no joke.
 

Hierophant

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An argument can be made that bone marrow donation should remain upaid because compensating donors nullifies the moral value of the transaction. People currently sign up for bone marrow registries for the sole purpose of benefiting others and the warm fuzzy feeling that comes along with that. If you incentivize bone marrow donation you lose this draw. If you start paying some of the donors, you risk crowding out potential donors who don't need the compensation. This affect is often included in the list of arguments against compensating blood donation.

I haven't watched the film, but I suspect the compensation part comes after becoming a match. Can compensation be a greater incentive than the guilt of backing out on a potentially life-saving donation?

As far as who pays for the bone marrow, I would be interested if anyone has any insight into the cost-effectiveness analysis of paying for bone marrow donations. What's more expensive for insurance companies or Medicare/Medicaid to pay for: bone marrow transplant and associated risks/complications or other treatments for leukemia, lymphoma, etc?

EDIT: Flip side of this argument is that with only 2% of the population on a bone marrow registry, altruism is proving to be a pretty crappy motivator and it's time to try something new. Also with the new ways that hematopoietic stem cells can be harvested now, HHS might be overextending the auspices of NOTA and it's time for some reinterpretation of a 30 year old bill.
 
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I see that others have mentioned the potential harm in creating an economic market for human tissue, as increased demand comes increased cost which could price out the poor. But I would add that creating a reimbursement for human tissue would draw people towards donation out of financial desperation, which already happens where people can be paid for blood products. A bone marrow donation is not an especially high risk procedure, but it is not without risk. There's a reason that in biomedical research, remunerations for study participation have to be looked at closely, lest they become coercive. So there's definitely a potential for harm to the donor. If payment is coercive in nature because of the sheer desperation on the part of the donor, that may motive them to fail to disclose issues which may diminish their potential to donate. That could lead to harm for either the donor or the recipient.
 
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I am by no means an expert, but I find this topic very interesting. I appreciate everyone's posts - you all invariably bring up something I haven't considered and broaden my perspective.

Cons:

1) There are other methods available to address the donor/organ shortage. In some nations, citizens are automatically considered donors unless they actively choose to opt out, for example. The opt-in structure of the donor system in the U.S. facilitates the passive perpetuation of the problem.

2) Compensating donors creates incentive for donors to put their own health at risk (when their health may already be compromised due to poverty, malnutrition, etc), and an incentive for donors who need money to lie. There are regulations in place in some plasma centers to prevent people who are homeless from donating, but in my (arguably young and limited) experience, I would never underestimate human resourcefulness.

3) Healthcare is already expensive, and paid donation could open the door to increased stratification of healthcare for the wealthy - only those who could afford to pay a donor might receive marrow.

Pros:

1) Women can already be paid for egg donation, and eggs are not replenishable. Bone marrow is replenishable. My understanding is that the risks of bone marrow donation were more comparable to that of donating a kidney, and this is why it was covered under NOTA. As medicine has improved since 1984, the risks have greatly decreased for bone marrow donation today, and the risks now are more like donating plasma.

2) In 2011, the 9th Circuit Court of Appeals ruled that it was legal to pay bone marrow donors. This only applies to the states under the 9th Circuit, but does set a precedent.

3) Ethical concerns about creating a direct market for bone marrow seem not to take into account the low probability of finding a genetic match - this would not be a great way to make money. Concerns about creating a market for general human tissue could be ameliorated by compensating donors with vouchers that can be used for medical expenses, housing, food, education, etc., rather than simply paying donors cash money (I think this is actually how it's done with marrow in the states where it is legal).

4) There is a real concern that people desperate for money would be put at risk by a program allowing organs to be sold for money. However, these people are already at risk due to the thriving black market as @jd989898 pointed out. The creation of a legal, regulated market would likely actually increase protection for those who currently feel compelled to sell their organs.

5) Financial compensation does increase donation and supply (just look at the plasma center model, where paid U.S. donors supply about 70% of worldwide plasma).
 

efle

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I can't come up with any good arguments against paying donors. Payment logistics/fair access is a separate hurdle all sorts of medical treatments face, and doesn't present a challenge at the ethical level anyways, unless you think nobody getting X is better than wealthy people getting X. Some people might oppose it for religious reasons, I suppose. Paying people to put their health in danger seems like a weak objection. It's very safe, and we pay people to be police/military/firefighting etc. As the war on drugs has shown us, it's better to do stuff out in the open under regulation and supervision if the alternative is a black market.

Yeah, I got nothing good to oppose with, seems fine to me.
 
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What arguments could be made against it? Why was it made illegal? What negative effects might lifting the ban on payment have?

Can you argue for and against?
If it is a paid system, then it must be HEAVILY regulated, or there could be severe exploitation of the system by crooked people. A crude example would be a person taking his mentally challenged adult nephew to donate marrow, then taking the money. I imagine paying for marrow was made illegal for that exact reason. If one person is able to exploit the system, then hundreds are. If the system stays as is, there will be no exploitation, but very little donation. A necessary trade off to avoid exploitation of the system.

This is a lot more dangerous than selling plasma or blood, so it would need a higher pay out and much more stringent regulations, ethics committees, psych evals, and even in depth government involvement.

Lifting the ban would require local regulation committees to be set up to make the process as safe and exploit-free as possible. That would require billions of dollars in funding, so I doubt that it would ever happen at least in America.


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Lucca

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There's not a lot new for me to add to this discussion. A couple of things:

I think the essential ethical question is this: should anyone else have a right to your tissues/organs/bodily products? I think the straightforward and uncontroversial answer to this question is "No". OK, since the answer is "No" what does that mean for the law? It means the law ought not be in such a way to make the answer "Yes". So what's the solution? What we have now, you either have donations or you pay people for their "stuff".

Therefore, I actually don't think there is an essential ethical question posed by this scenario. There is a secondary ethical question, namely the one being discussed, "which is better, donations or incentivizing donation?". This is an empirical question. I don't have time to look up the data but I will speculate that paying for things means you have more of that thing. The first consequence of that has already been mentioned several times: stratification of healthcare.

Here is my contribution: there is a simple workaround. Anyone who lists themselves as a donor for X,Y, and Z is mandated by law to receive insurance benefits (in the form of lower payments, more coverage, however you want to tweak it) proportional to the "cost" of X, Y, and Z on that individual. For example, donating a kidney while you are still alive is serious business so big incentives. Donating blood not so much. Bone marrow is a bit riskier. And become an organ donor upon death poses 0 costs to the donor unles there is some kind of cultural restriction, which can be taken into account. Your religion doesn't let you be an organ donor? That's fine, but no benefits for you. This way, the cost is passed on to precisely where it ought to be passed: insurance providers and not individuals. Therefore, if a poor person or a rich person need some transplant or donation they will receive it at precisely the same cost and with equal expediency because they do not have to make the additional "purchase" of a donor. It's absurd to even suggest an individual who needs the donation should foot this bill, and if anyone is curious I think it's fairly straightforward to show that is the case.

There is a second problem that I don't think has been mentioned, although it is a bit tangential. In most of the arrangements discussed in the thread, it is the sick individual who foots the bill for the donation. Ok, well then why should a poor person become a donor *even if they get paid* if were that poor person in the patient's shoes they would not be able to receive care (because they could not afford it)??? The simple answer is, well, they need the money. Well if you are essentially purchasing someone else's tissue for money they need but denying them the ability to take care of their own tissue to begin with then you cannot be acting in a moral way. That is essentially another form of wage slavery except you replaced labor with tissues.
 

efle

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Well if you are essentially purchasing someone else's tissue for money they need but denying them the ability to take care of their own tissue to begin with then you cannot be acting in a moral way.
Not sure I follow the logic here. I can pay someone to bodyguard me and be willing to take injury and death for my sake, while refusing to do or provide the same for them. This precludes me from being moral? Whether a poor person has access to X themselves seems a totally different argument than whether it is right or wrong to pay them to provide X to another.
 

Lucca

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Not sure I follow the logic here. I can pay someone to bodyguard me and be willing to take injury and death for my sake, while refusing to do or provide the same for them. This precludes me from being moral? Whether a poor person has access to X themselves seems a totally different argument than whether it is right or wrong to pay them to provide X to another.
If the only way for the bodyguard to survive is to work as your bodyguard and you pay him just enough to survive (or even less) to do so but do not actually provide a way for him to survive (in the form of shelter, guaranteed protection, a pension or securities if he falls ill or becomes disabled) then that man is your slave, not a bodyguard.

Similarly, in a society where extreme poverty exists selling your tissues might become necessary for survival. While extreme poverty exists, there is essentially no choice involved in the matter of selling yourself/labor/what have you and therefore you are a slave.
 
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efle

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If the only way for the bodyguard to survive is to work as your bodyguard and you pay him just enough to survive (or even less) to do so but do not actually provide a way for him to survive (in the form of shelter, guaranteed protection, a pension or securities if he falls ill or becomes disabled) then that man is your slave, not a bodyguard.
So say he could survive on minimum wage and/or welfare, or get paid very well to bodyguard me. Is it wrong to hire them? That seems to me the more accurate parallel.

The fact that they don't get a barrier against attack/cancer themselves, does not make it wrong to pay them to be my barrier against attack/cancer.
 

Lucca

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So say he could survive on minimum wage and/or welfare, or get paid very well to bodyguard me. Is it wrong to hire them? That seems to me the more accurate parallel.

The fact that they don't get a barrier against attack/cancer themselves, does not make it wrong to pay them to be my barrier against attack/cancer.
It is not wrong to hire them in the circumstances you listed. However, I disagree that it is accurate since we have a society with extreme poverty and inability to access healthcare.

The second paragraph is exactly what I am saying is wrong. It is not a right to have a bodyguard. I claim that it is your right to receive healthcare when you are ill. When you have a system where rights are not given but must be purchased, giving people just enough or less money to purchase the rights they ought to have to begin with and nothing else is morally wrong.
 

efle

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I claim that it is your right to receive healthcare when you are ill.
Still not clicking for me. Say both rich and poor deserve healthcare. In scenario A, the poor have this denied to them, while the rich can purchase it. In scenario B, the poor have this denied to them, and the rich cannot purchase it. B is better? (Obviously we are both fans of scenario C, everyone can get it, that's not being argued about here at all)
 

Lucca

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Still not clicking for me. Say both rich and poor deserve healthcare. In scenario A, the poor have this denied to them, while the rich can purchase it. In scenario B, the poor have this denied to them, and the rich cannot purchase it. B is better? (Obviously we are both fans of scenario C, everyone can get it, that's not being argued about here at all)
That's not what I'm saying, or what I think I was implying. C is the only acceptable option. What I'm saying is that accepting A or B is wrong, it doesn't matter if one is less wrong than another.

The arrangement i described in my first post might be one way to get there within the current structure.
 
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efle

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That's not what I'm saying, or what I think I was implying. C is the only acceptable option. What I'm saying is that accepting A or B is wrong, it doesn't matter if one is less wrong than another.
There we go with the absolutism again! To me there is a clear order of C > B > A. Denying someone treatment they could afford for their cancer because the guy in the next room over wasn't as lucky with the family he was born into is wasteful, spiteful and wrong. We should be mad if we're at B instead of C, there is injustice in it - but shouldn't demand to regress or halt at A until a leap to C is available.
 
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Lucca

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There we go with the absolutism again! To me there is a clear order of C > B > A. Denying someone treatment they could afford for their cancer because the guy in the next room over wasn't as lucky with the family he was born into is wasteful, spiteful and wrong. We should be mad if we're at B instead of C, there is injustice in it - but shouldn't demand to regress or halt at A until a leap to C is available.
If staying at B prevents C from coming about but A moves us to accept C then abolishing B is the right option
 

efle

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If staying at B prevents C from coming about but A moves us to accept C then abolishing B is the right option
This I agree with, but how would this ever be the case? This isn't how our society works, the rich don't get held hostage until they agree to fund something they need for the poor as well. Something like legislation to stop that pre-existing condition nonsense, for example, didn't come about based on whether the rich could afford the unfairly raised rates or not.
 
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Hierophant

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There we go with the absolutism again! To me there is a clear order of C > B > A. Denying someone treatment they could afford for their cancer because the guy in the next room over wasn't as lucky with the family he was born into is wasteful, spiteful and wrong. We should be mad if we're at B instead of C, there is injustice in it - but shouldn't demand to regress or halt at A until a leap to C is available.
To me this is a classic example of a nirvana fallacy. You're comparing B, a concrete realistic alternative, to C: an at present unrealistic, idealized scenario. I disagree that scenario B is a regression from scenario A.
 

efle

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To me this is a classic example of a nirvana fallacy. Your comparing B, a concrete realistic alternative, to C: an at present unrealistic, idealized scenario. I disagree that scenario B is a regression from scenario A.
This would be a great criticism if C wasn't already the standard system in the rest of the western world. But that's a whole nother debate. I think that means you agree with me, since I see B as progress.
 
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Lucca

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To me this is a classic example of a nirvana fallacy. You're comparing B, a concrete realistic alternative, to C: an at present unrealistic, idealized scenario. I disagree that scenario B is a regression from scenario A.
I think perhaps you meant to quote me? I disagree because I do not think C is unrealistic
 

Lucca

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This I agree with, but how would this ever be the case? This isn't how our society works, the rich don't get held hostage until they agree to fund something they need for the poor as well. Something like legislation to stop that pre-existing condition nonsense, for example, didn't come about based on whether the rich could afford the unfairly raised rates or not.
This is how society *ought* to work, and it can. The right to strike is enshrined in the French constitution.
 
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Hierophant

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This would be a great criticism if C wasn't already the standard system in the rest of the western world. But that's a whole nother debate. I think that means you agree with me, since I see B as progress.
I think perhaps you meant to quote me? I disagree because I do not think C is unrealistic
I agree with @efle and yes I meant to quote @Lucca

Thousands die each year waiting for bone marrow transplants. Telling the wealthy, privileged leukemia patient that they can't have access to a life-saving transplant because they live in a society where wealth and healthcare are stratified, is just as immoral as telling a poor patient that they can't have access to a life-saving transplant because they can't afford it. Both are victims of the society they were born into.

My argument is that waiting in scenario A for scenario C to be realized, while option B can be put into effect more immediately is wrong. Our current healthcare system is just a result of a series of solutions that created different problems, which we eventually find solutions to, rinse, repeat. My opinion is that it would be easier to reach option C from option B. I believe trying to get to option C in one grand reform is unrealistic, will delay progress, all the while people that otherwise might have lived in scenario B are dying waiting around for the utopia of option C.

EDIT: spelling is hard sometimes
 
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efle

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This is how society *ought* to work, and it can. The right to strike is enshrined in the French constitution.
Since I'm curious - is there any precedent here? When was the last time that progress in the US was driven by the rich being denied something until the poor got it too?
 

Lucca

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Since I'm curious - is there any precedent here? When was the last time that progress in the US was driven by the rich being denied something until the poor got it too?
40 hour work week, end of child labor, etc. Most labor rights were obtained bottom-up not top-down.

If you replace "rich" with "powerful" you can include basically any meaningful social advance in all of history.

History has also given us some quite nice controls. In countries were labor rights haven't been viciously assaulted the trend continues. In the US it has reversed
 

Lucca

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I agree with @efle and yes I meant to quote @Lucca

Thousands die each year waiting for bone marrow transplants. Telling the wealthy, privileged leukemia patient that they can't have access to a life-saving transplant because they live in a society where wealth and healthcare are stratified, is just as immoral as telling a poor patient that they can't have access to a life-saving transplant because they can't afford it. Both are victims of the society they were born into.

My argument is that waiting in scenario A for scenario C to be realized, while option B can be put into effect more immediately is wrong. Our current healthcare system is just a result of a series of solutions that created different problems, which we eventually find solutions to, rinse, repeat. My opinion is that it would be easier to reach option C from option B. I believe trying to get to option C in one grand reform is unrealistic, will delay progress, all the while people that otherwise might have lived in scenario B are dying waiting around for the utopia of option C.

EDIT: spelling is hard sometimes
I agree with you insofar as C is unattainable. I would actually say B keeps C from happening since it keeps the class with all of the actual power, the wealthy, in a comfortable enough position to delay or prevent action. I think C is very attainable. It is also the democratic solution since it has widespread popular support. What it doesn't have is legislative support. If A were the case and the people preferred B to C then I would make the move that B is the way to go since it is less immoral than A. The case we actually have is that C is the democratic option and what we are given is B. This is unacceptable.
 
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The Knife & Gun Club

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There are really no compelling reasons to not establish a proper market for the sale of tissue/organs. The most prevailing arguments are that it somehow "commodifies life" or "desecrates the human body," which carry no ethical weight (at least for me). The market would need to be set up carefully by economists, of course. Currently, the government's avoidance of establishing a marrow price means the legal price = $0. Because the price is much lower than the implicit equilibrium market price, demand>>>supply, and the black market thrives. If a legal price were to be established, however, many seem to worry that it would rise so high that only the very rich could afford it. This hasn't happened with food, for example, which many poor people cannot afford. Instead of banning the market for food, we have found ways around by subsidizing the poor with food stamps. I think donors should also be required to pass health tests and have a certain baseline income, to ensure the poor/sick are not exploited. The knee-jerk avoidance of a rational, economic approach to this problem is killing so many people unnecessarily, and it's time to start thinking clearly.
1) there is not a thriving black market for bone marrow or any other organ in the US. In some 3rd world countries maybe but that's not Americas problem.

2) I agree that marrow donors should be paid, as it is not detrimental to ones health to donate marrow and there is a significant shortage.

3) solid organ/tissue donation should absolutely not be on a for profit/free market basis. The demand for solid organs massively outstrips the finite supply, so right now we allocate the limited organs available to those in the greatest need/at the most immediate risk. I could go into specifics of why it doesn't work to have free market price settings in this situation if you're still confused.

4) blood is a special case since there are currently enough blood products available to meet demand without paying donors. In my opinion paying donors could pervert the incentives and encourage people to donate blood who should not be donating (such as very poor people who may engage in some "risky" behaviors).
 

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It shouldn't be illegal in the first place.
A government has one role and one role only; protect an individual's natural rights. Therefore, choosing to give my bone marrow for complement or money is nobody's business.
As for Ethics and morality, government cannot legislate that, not in a free society at least. Ethics cannot exist without morals. Ethics are moral guidelines and morals are relative. In a free society, no one can force moral values on others.
 
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there was a lengthy article I read about how organ donation is prohibited upon payment due strictly to its ethical complaints. I can definitely agree with this as needful donors may be trapped in providing upon payment and then later regret the decision since it was not a conscious decision and rather an economic trade needed upon a time. With blood donation, payment is provided to those exceptionally needful; however it is a completely different scope of practice since hematopoiesis reflushes the lost storage. Bone marrow falls in the organ category and it is an invasive procedure that has many risks. I cannot see such a sacrifice being done through manipulation of means outside of a humanitarian act.
 

wizzed101

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Therefore, if a poor person or a rich person need some transplant or donation they will receive it at precisely the same cost
I just want to inform you that such practice is why communism failed.

My #5 reason against the practice is that the only way this can possibly be acceptable for the public is a price cap on compensation. Hello, black market organs in the US!

About the vid: 5,000$????? Jesus, I thought she was gonna offer like 50,000$.
 

exacto

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I believe it should be legal.

If it were made legal, there would be a much larger pool of potential donors. If there was a much larger pool of potential donors than yes, some donors will only take the higher bids, but many more donors will take the lower bid offers too, thus you will most likely have matches for all classes.
 

Sesamoid_Gnome

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Organ and tissue donations should not be compensated for the simple reason that it provides an incentive for people which by its very nature compels some people to give while others will not feel such a compulsion. You're essentially taking away agency, and as we're talking about the "donation" of a nonessential and somewhat unlimited resource, people who need money are going to see this as a means to get some quick and easy money. Conversely, those with money would be less likely to need to do such giving, and thus you've created a market that is unbalanced and has an unjust incentive for only part of the population, and a marginalized and vulnerable one at that.

We could also talk about the beneficence of the situation; where you're doing good for some people. On the other side you're doing this immense disservice to a whole other subset of people by compelling them to give and nominally harming them.

Basically I tend to run through the basic ethical principles as a good framework: Autonomy, justice, beneficence, and non-maleficence.

Needless to say I am staunchly opposed to money as an incentive or mechanism to get people to donate their organs, tissue, or bodies.
 

Hierophant

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40 hour work week, end of child labor, etc. Most labor rights were obtained bottom-up not top-down.

If you replace "rich" with "powerful" you can include basically any meaningful social advance in all of history.

History has also given us some quite nice controls. In countries were labor rights haven't been viciously assaulted the trend continues. In the US it has reversed
These are not examples of where the rich and powerful were held hostage by the poor until they found a solution that worked for both. The rich and powerful were completely insulated from the negative affects of child labor, no limits on weekly hours, and other labor issues. In fact, they exploited and benefited from the absence of these rights. The impetus for change was not that conditions were bad for the rich as well so they did something about it.

I agree with you insofar as C is unattainable. I would actually say B keeps C from happening since it keeps the class with all of the actual power, the wealthy, in a comfortable enough position to delay or prevent action. I think C is very attainable. It is also the democratic solution since it has widespread popular support. What it doesn't have is legislative support. If A were the case and the people preferred B to C then I would make the move that B is the way to go since it is less immoral than A. The case we actually have is that C is the democratic option and what we are given is B. This is unacceptable.
My point is that C is unattainable quickly. The scenario you preposed discriminates against unhealthy people who are unable to donate blood, organs, bone marrow etc. If you don't sign up to donate, no benefits right? This by extension discriminates against poor people, who are more likely to be unhealthier than wealthier people. This proposal also discriminates against cultures that restrict blood/organ/bone marrow donation. Your proposal would raise costs astronomically. Who is paying for these insurance benefits that 90% of the population is now eligible for? All they have to do is check yes that they are a donor. The costs would be passed to insurance companies, and then IMMEDIATELY passed to those paying the premiums. Also imagine the bureaucratic costs of implementing this reform. In a system where rich people are already better off, a reform that benefits everyone equally is actually regressive. To reduce the healthcare stratification, you would need a progressive reform just to get everyone on equal footing. I believe even if you addressed all of these concerns, the resulting legislation would be massive and difficult to get through Congress. This is why I think option C is unrealistic in the foreseeable future, and we shouldn't remain in option A for this to occur.
 

Vladimir7

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-I saw the argument above about Healthcare in America, and I don't think the solution comes from just doing what other countries do. Why? because "the grass always looks greener on the other side.." is not a valid argument IMHO. Canada has its own issues that it faces, and yes, healthcare is included in those issues. The United Kingdom has the NHS, and that too, has a lot of problems. Also spending so much on the NHS has affected other areas of the UK's system like price of living, taxes, etc.. We can't just compare the US to what other countries are doing because the issues the US faces are not the same issues those countries face.

-I also saw the statement about $5000 vs $50,000, and I don't believe that the issue here is about how much money is spent but instead, i think its about the fact that money is being spent (no matter the price) illegally.

My argument here is to take the popular psychologist view (Lawrence Kohlberg's stages of moral development) and apply it here. I can't get into the exact specifics but the last stages (in the post-conventional level) is about Universal Ethical Principles. It's about being morally developed enough to understand that while the law is important, we must also understand that it is human and therefore faulty. And if there are unjust laws, it is therefore just to break them. So since the law, I believe, is intended to allow people access to "life, liberty, and the pursuit of happiness", how can you be free or even pursue happiness if you're dead. The answer then would be to do whatever we can to save lives. I think that is the purpose of medicine, and it is also my reasoning for pursuing medicine.
 
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Lucca

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These are not examples of where the rich and powerful were held hostage by the poor until they found a solution that worked for both. The rich and powerful were completely insulated from the negative affects of child labor, no limits on weekly hours, and other labor issues. In fact, they exploited and benefited from the absence of these rights. The impetus for change was not that conditions were bad for the rich as well so they did something about it.



My point is that C is unattainable quickly. The scenario you preposed discriminates against unhealthy people who are unable to donate blood, organs, bone marrow etc. If you don't sign up to donate, no benefits right? This by extension discriminates against poor people, who are more likely to be unhealthier than wealthier people. This proposal also discriminates against cultures that restrict blood/organ/bone marrow donation. Your proposal would raise costs astronomically. Who is paying for these insurance benefits that 90% of the population is now eligible for? All they have to do is check yes that they are a donor. The costs would be passed to insurance companies, and then IMMEDIATELY passed to those paying the premiums. Also imagine the bureaucratic costs of implementing this reform. In a system where rich people are already better off, a reform that benefits everyone equally is actually regressive. To reduce the healthcare stratification, you would need a progressive reform just to get everyone on equal footing. I believe even if you addressed all of these concerns, the resulting legislation would be massive and difficult to get through Congress. This is why I think option C is unrealistic in the foreseeable future, and we shouldn't remain in option A for this to occur.
To be more accurate in what I meant, I was referring to strikes, demands made by labor unions, and other forms of organizing which in effect did hold the rich "hostage" in the sense that the labor their wealth depended on was withheld until a solution was reached.

I actually agree with your analysis. I think getting everyone on equal footing is the necessary first step. However I differ that it is for that reason I advocate C. C is unsustainable unless you have a more equitable system underlying it; therefore, in order to move to C you do the steps in between. Getting through or not getting through Congress does not really matter to me, what matters to me is what is the right thing to do. Ideally, the legislature would be accountable to public opinion.
 
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acetylmandarin

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Paying for bone marrow became illegal under the ban on organ and tissue sale, which is understandable. It is likely that bone marrow is not treated like blood in this equation because bone marrow donation used to be a much more involved procedure with a recovery period, and part of the idea is to avoid people donating for the money without regard for the risk. Since most bone marrow donations these days aren't much different from donating blood, that reason starts to fall flat. OTOH, one could argue that a campaign to make people aware of the PBSC donation method might increase the number of people willing to donate as well.

Like Dagrimsta1 said, opening the possibility of sale could end up introducing a competitive market for blood marrow wherein wealthier people are at an advantage and poorer people are essentially denied marrow transplants. While we can say that it should be carefully set up and/or subsidized so that poor folks can afford it, the reality is that the people writing our laws are mostly wealthy, and it is a disadvantage to them & their families to avoid a free market situation. Subsidization, like jd989898 said, is an interesting proposal, but unfortunately people are sometimes outraged that those who use subsidization can have nice things, like fresh produce (or, say, healthy donated organs/tissues), and then budgets or restrictions on entering the subsidization program get tightened.

It's not a simple issue, even though it feels like it should be :(



As long as you know what bone marrow donation is and know that organ/tissue sales are illegal, I think you could talk your way through it.
I guess the point is probably to read up on a variety of ethical issues :)

Edited for correction of repetitive phrasing.
I did not know that organ/tissue sales were illegal...haha
 

bonedoc5576

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Arguing from the premise that the most egalitarian solution to the problem of limited access to bone marrow is the best solution leads to the conclusion that bone marrow donation should be mandatory.
The same argument might then be applied to kidney donation. Perhaps the government ought to operate the facilities for harvesting organs. Everyone gets chopped up equitably.
 

Psai

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There are really no compelling reasons to not establish a proper market for the sale of tissue/organs. The most prevailing arguments are that it somehow "commodifies life" or "desecrates the human body," which carry no ethical weight (at least for me). The market would need to be set up carefully by economists, of course. Currently, the government's avoidance of establishing a marrow price means the legal price = $0. Because the price is much lower than the implicit equilibrium market price, demand>>>supply, and the black market thrives. If a legal price were to be established, however, many seem to worry that it would rise so high that only the very rich could afford it. This hasn't happened with food, for example, which many poor people cannot afford. Instead of banning the market for food, we have found ways around by subsidizing the poor with food stamps. I think donors should also be required to pass health tests and have a certain baseline income, to ensure the poor/sick are not exploited. The knee-jerk avoidance of a rational, economic approach to this problem is killing so many people unnecessarily, and it's time to start thinking clearly.
No compelling reason until you wake up in a ice filled bathtub because someone wanted to sell your kidney
 
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JJRousseau

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It shouldn't be illegal in the first place.
A government has one role and one role only; protect an individual's natural rights. Therefore, choosing to give my bone marrow for complement or money is nobody's business.
As for Ethics and morality, government cannot legislate that, not in a free society at least. Ethics cannot exist without morals. Ethics are moral guidelines and morals are relative. In a free society, no one can force moral values on others.
An uncompromising neoliberal viewpoint indeed. I apologise for picking on your post, but it's a bit of a sticking point for me. I believe you mean that you believe the government should have one role. I just wanted to point out that you framed your post as a positivist statement, indeed a positivist truth, but the above is, in fact, extremely normative. Logically, I feel their ought to be a few more "should's" in your statement (e.g. "no one should force moral values on others", "A government should have one role", "A government should not legislate that"). Indeed I only have to name a single government (and willing to bet I could pick at random from any that currently exist) that has more that the "one role and one role only" you prescribe. The liberal thinkers of the enlightenment were brilliant, but I would prefer to not diminish their legacy by offering up distillations of their dialogue in short normative responses that effectively obliterate the nuance surrounding every social, economic, and political issue we face today (If you cannot tell, I do not have a favourable view of quasi-religious brand of neoliberalism that seems to abound today) .

Trading in bone marrow is an interesting question to ask in an interview, precisely because there is no simple answer; it is filled with empirical, moral, economic, and institutional nuance. Generally, I've really enjoyed reading the discussion on this thread for exactly that reason.
 
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