Until now, I have not commented on the story regarding the Dutch game-show giveaway of two kidneys, which may surprise CQ readers, since the issue is one that hits very close to home for my family. Michael van der Galien’s post about the television competition for a dying woman’s organs expresses frustration about how the controversy reflects on The Netherlands, but the show is only the symptom of a global problem with organ donation — and a demonstration that market forces will prevail in any situation where demand far exceeds supply:
In the Netherlands we have a new television show: De Grote Donor Show (The Big Donor Show). What’s the show about you ask? Well, quite simple: this Friday 37 year old Lisa will donate one of her kidneys… on television. Three people who need a new kidney will be there. They have to answer questions. After that, Lisa will decide who gets her kidney. The viewers have an active role as well: they can SMS (to advise Lisa probably).
There is a lot of debate going on about this show in the Netherlands. Some consider it a good thing: we do not have enough people who are willing to donate their organs (after they die). This ’stunt’ or show, might make it easier for people to make the decision to donate their organs. However, there are also people who object, who find it tasteless. Members of Parliament have asked questions about the show, some want the government to ban it (it’s being broadcasted on a government-owned channel). …
Well, this certainly puts the Netherlands on the map once again. I am very pleased to see that whenever the world talks about us, it is usual about something ridiculous, like now. Wouldn’t want the world to take us seriously, now would we? No, lets happily enforce the idea that we are more liberal than liberal, more tolerant and open-minded than tolerant and open-minded: no rules. No moral values. No nothing! Hedonism rules!
Reuters also noted this controversy a couple of days ago. The Dutch government and the EU registered protests with the broadcaster, BNN, objecting to the network turning organ donation (and death) into entertainment. BNN still plans on airing the program tomorrow night.
This follows on the heels of a Washington Post column that caught my eye a month ago by Dr. Sally Satel, arguing for a market approach to organ donation in order to increase the supply:
It is a sad time for the 96,000 patients waiting for kidneys, livers, hearts and lungs: The chasm between supply and demand grows wider each year. By this time tomorrow, 18 people in need of an organ will be dead because they did not get one soon enough.
Kidneys are in highest demand; currently, 71,000 people need a renal transplant. They will spend, on average, five years on dialysis while waiting for an organ from a deceased donor. At least half will die or become too sick to undergo a transplant before their name is called. …
Lamentably, too many transplant professionals are resigned to rationing. The alternative is to create a larger supply of organs — and the most likely way to achieve it is through a safe, regulated system in which donors can receive compensation for their organs. The idea of rewarding living donors for a kidney, or their estates if they give an organ after death, has long been taboo. Yet as thousands die every year the idea is being taken more seriously — and it should be.
If we had not found a donor for the First Mate, she would not have survived long enough to get a cadaver donor in the present system. She had been on dialysis for only a year, and she barely made it to the finish line with a live donor. Another couple of months on that plan, and it would have meant the end for her. When I tell you that her donor is a hero, I mean that very literally.
So what do we do to save the lives of everyone else on the list? The simple fact is that we have a rationing system that does not work, as Dr. Satel explains. We have a demand that far exceeds the supply, and we have put in place regulations that artificially keeps the supply low — for noble reasons, but those noble reasons are costing thousands of lives every year.
The kidney transplants with the best track record for success are live transplants, even those where the donor is unrelated to the recipient, as was the case with the FM. Many brave people volunteer for these every year, even for people they don’t know. However, these donors face significant financial disincentives. The recipient’s insurance covers 100% of the medical costs, but the donor loses time at work, a significant period of recovery in some instances, and restrictions on activity. By law, they can receive no compensation. If they could, it’s at least possible that more would donate.
And that’s just the American system. In the single-payor systems, the supply problem is not organs as much as it is transplant surgeons. Three years ago, the London Telegraph reported that viable kidneys had to be discarded due to the lack of qualified transplant surgeons. The government rationing of compensation for doctors provided no incentive to spend the extra time and money to learn that specialty. It created a shortage on another part of the distribution chain that ended up with the same result: people who needed organ transplants didn’t get them in time.
When we ration irrationally, we get irrational results. The BNN show tomorrow night is an example of this. Denied the ability to acquire a kidney through some rational method, these kidney-failure victims will abase themselves in public in order to save their lives. Denied a rational method of receiving compensation for her donation, the terminally ill woman will have to choose other, less objective means for rationing her kidneys. It sounds terrible, and it is, but you’d better believe that I would have jumped at the chance the first few months of this year to get one of those kidneys, had we not already found a donor.
I’m not suggesting a kidney bazaar, where the highest bidder gets the organs and only the rich can find transplants. However, we have to find a system that generates a much larger supply for organs than the one we have now, and we have to move away from the old methods of rationing if we want to save lives. Satel’s proposals put us on the right track. It’s certainly less disturbing than grinding up embryos to find elusive treatments for diseases, and much less ethically objectionable.
UPDATE: Virginia Postrel, one of the heroes who donated one of her kidneys not long ago, has more thoughts about the “egregious” status quo (via Instapundit).