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I saw an interesting article arguing that we should legalize paying for kidney donations. [1] I'm not sure how I feel about it, but the article was well argued

I saw an interesting article arguing that we should legalize paying for kidney donations. [1] I'm not sure how I feel about it, but the article was well argued. The main argument is that even if it is immoral, we are still short hundreds of thousands of kidneys unless we can somehow make them, and so this would save lives. [1] https://www.nytimes.com/2024/04/02/opinion/kidney-donations-compensation.html https://www.nytimes.com/2024/04/02/opinion/kidney-donations-...

tiagod 3y ago
I find the idea repulsive. Saving lives by paying poor people to part with organs that they would keep if it wasn't for the cash.
- pyuser583 3y ago
  I’m fine with a nominal payment. Like how they charge you 1 cent for paper bags. Enough to make it “not nothing”, but not enough to sway your conscience.
  - bombcar 3y ago
    I could see an argument that paying for donations from the dead via a bidding system could promote actually caring if the organ gets where it is going.
- astrange 3y ago
  This is a common opinion in bioethics and it doesn't really make sense. It's not moral to reward people for doing something because it might cause them to do it? It's like the idea that people shouldn't be paid for growing food or building houses because they'll profit for it. Which leaves people only being able to profit from making useless things because then nobody needs them.
  - deleted 3y ago
    [deleted]
  - ygjb 3y ago
    I think that any country that wants to consider legalizing the sale of body parts from living people should probably illustrate how they have effectively eliminated human trafficking for other forms of exploitation first. Generally speaking, it is not a moral act to reward people for harming themselves, or allowing themselves to be harmed. Most society overlook this in the name of sport, or in the name of freedom (e.g. drugs, alcohol, driving, and other massively harmful, but shockingly profitable ventures), but the balance of respecting freedom while preventing exploitation is generally a complete shit show as evidenced by the rampant human trafficking, and the ongoing exploitation of addiction that the illicit drug trade represents. The moral arguments also set aside the fact that the overall quality of "ethically sold" organs are likely to be lower due to the overall impact that a life of poverty on individual health has, and that selling an organ is most likely going to be an option of last resort for most people. Personally profiting from an act of self harm doesn't stop it being an act of predation or exploitation.
    - astrange 3y ago
      If donating an organ is self-harm why are you allowed to do it for free?
      - ygjb 3y ago
        Because when you remove the financial incentive that leads to outright exploitation, there still remains the case where self-harm can be a moral action. Donating a kidney, for example, or bone marrow, is harmful to the donor, but the trade-off is that it may save the life of another person. People make trade-offs that result in self-harm as part of a moral decision all the time. Firefighters are a great example of this. We (humans and societies in general, because this comment applies to all societies) generally block or allow moral and immoral activity based on the ability of those with power to regulate things. Some things are simple, like murder - generally, killing people is considered immoral, but even then, there is flexibility (for example, measures taken to stop an attacker from causing harm). Some things like organ donation are considered moral complex, and demand extra focus to prevent exploitation.
  - tiagod 3y ago
    Why are you comparing growing food with selling a part of your body?
- manquer 3y ago
  Why do we assume cash ? It can be in kind, we already do this a bit current donors get preferred for donations when they need it themselves. Why cannot we extend that and say entire health care expenses for the rest of the donor’s life the state will take care for example ? it doesn’t even have to in. full , they can even just improve coverage , and make insurance companies remove restrictions like pre-existing conditions for such donors . There are plenty of benefits like this the state can do, perhaps tax credits , exemptions, priority in any government program , cheaper mortgages and so on , even private sector can step in with benefits like we do for veterans. I think the point is not to pay and make it an economic transaction , but to reward I.e. incentivize people to do donate more. The benefits can also extend to next of kin like say financial aid for college etc(donors shouldn’t be that young to directly benefit from education aid)it would then also factor for non living donors
- Ekaros 3y ago
  I might find it reasonable if sums involved were life changing. So a kidney would start at something that will pay invested for rest of the donators life. Let's say 10 million. So rich who can afford them can get one. And donators don't have to work anymore.
  - tiagod 3y ago
    I interpreted the original idea as the government / public health system paying the person for the kidney. Your idea is incredibly more repulsive. I tried to elaborate, but I can't even entertain the idea for long enough to type out something I would be comfortable with submitting.
- benji-york 3y ago
  I wonder if this article would shed some light on the difference between your response and others: https://www.overcomingbias.com/p/systems-explain-stem-vs-culture-style https://www.overcomingbias.com/p/systems-explain-stem-vs-cul... (I'm not judging or trying to persuade, but wish to increase understanding between people with very different viewpoints.)
  - tiagod 3y ago
    I think I do understand why the other people in this thread wrote what they did. It's true their worldview is probably extremely different from mine. I find the extreme wealth inequality we witness to be a great tragedy. That people are destroying their minds and bodies to be given the privilege to exist on this planet, while people lucky enough to be rich can simply order 99% of other humans around, and convince them that it's a good thing. That it's fair they're giving away their health, their sexuality, their blood or all of their time, as they are getting paid money in exchange. Something that to them is only achievable by hard work and extreme sacrifice, and in small quantities, while the same amount represents a minuscule value to the person on the other side of the deal. Adding to that legally selling your organs, is inconceivable to me. What's next, selling babies for adoption? I'm sorry if this seems poorly thought out and weakly formed argument, but I don't even know how to begin expressing my opinion on this matter. I can't see how I can be convinced this is all OK and something to be intensified.
deleted 3y ago
[deleted]
kobalsky 3y ago
> and so this would save lives lives of people who can buy a kidney. this is a transfer of longevity from poor people to rich people. and since because everything balances, in the future it will take selling a kidney to get to the average, and poor people will end in the same place but with only one kidney
- intuitionist 3y ago
  The linked article suggests that the federal government would be a monopsony buyer in the US kidney market. My understanding is that most serious policy proposals along these lines would have the same feature. Medicare already covers care for nearly all US citizens with severe chronic kidney disease; paying for kidney donations would move some number of patients from dialysis to transplant but they wouldn’t be out of pocket.
  - keybored 3y ago
    I don’t see how that solves the potential problem. You could still end up in the same place of “balancing out” where the extra money from your kidney becomes something you need i.e. a transfer from poor to rich people.
    - intuitionist 3y ago
      Well, the people receiving the kidneys won’t be rich on average, although it’s possible they’ll be richer on average than the compensated donors. There’s a big shortfall of available kidneys but the number is pretty tiny compared to the number of people living paycheck-to-paycheck in America. So it seems unlikely to me that in the future everyone needs to donate a kidney just to stay in the same place—that’d be a couple orders of magnitude more kidneys than we need.
      - keybored 3y ago
        Fair point that there isn’t a high enough demand to cause a lot of poor people to be monokidneys.
RheingoldRiver 3y ago
I don't agree with paying for kidney donations, but I think we should pay people to be organ donors via some tax deduction if you've been registered as a donor for the past 2 years (so you can't like, register then file taxes then unregister)
DoreenMichele 3y ago
If you are rich enough to think buying kidneys makes sense, I implore you to advocate for better health care which improves the odds of keeping your own original equipment from the manufacturer functioning adequately. Transplant is not all upside. You remain on drugs for life. You may die anyway if your body rejects the transplant. I see a lot of pro-transplant headlines on HN. People don't seem to want to hear any criticism of organ transplants. But I think organ transplants are "ooh, shiny tech" that makes for good headlines not actually good medicine. I think good medicine would fix you, not turn you into Frankenstein so doctors can feel powerful. Keeping people healthy is boring, doesn't really get tracked, no one cares. Letting their lives go to hell and then "saving" them makes for good headlines. I have a condition that accounts for a lot of organ transplants. I would rather keep my own organs functioning. All of HN loathes me for having that opinion. But if you think you are at risk of "needing" a transplant and have resources, I encourage you to actively look for other solutions to advocate for. We mostly don't hear the horror stories about transplant. If that got more publicity, maybe people wouldn't be so quick to act like I'm some kind of nutter for having opinions about the topic.
- lazyasciiart 3y ago
  > If you are rich enough to think buying kidneys makes sense, I implore you to advocate for better health care which improves the odds of keeping your own original equipment from the manufacturer functioning adequately. Congratulations on having a condition that gives you some control over whether you need an organ transplant in the future. I assume that nobody on HN cares whether you keep your own organs functioning, and nobody thinks you are a nutter just for "having opinions about the topic": they object to your declaration that they should prioritize not needing an organ transplant because of your values and the circumstances of your own life. > Keeping people healthy is boring, doesn't really get tracked, no one cares. That's a fun contrarian statement too. If only there was ever anything written about preventative health care and lifestyle improvements. Maybe you can publish the first book on it!
  - DoreenMichele 3y ago
    Congratulations on having a condition that gives you some control over whether you need an organ transplant in the future. I'm not supposed to have any such control. I exercised it anyway, thus my opinions. I don't expect anyone to care about me or my opinions or my agenda and I don't know what the PC language is for this. There seems to be none. But "more access to transplants" isn't your only option if you are thinking long term about your own health issues.
lazyasciiart 3y ago
It would probably be a decent first step to commit to covering all the direct and indirect costs of donating a kidney. Not everyone can afford the time off work and life required to go through the operation and recover, and then guarantee that they'll have reliable health care for the rest of their lives. There's lots of room to debate whether income replacement should be included and at what level, but among the dozens of existing systems that do it (jury duty, unemployment, disability leave, parental leave...) it should be plausible to find a model that people feel is acceptable.

tiagod 3y ago

I find the idea repulsive. Saving lives by paying poor people to part with organs that they would keep if it wasn't for the cash.

pyuser583 3y ago
I’m fine with a nominal payment. Like how they charge you 1 cent for paper bags. Enough to make it “not nothing”, but not enough to sway your conscience.
- bombcar 3y ago
  I could see an argument that paying for donations from the dead via a bidding system could promote actually caring if the organ gets where it is going.
astrange 3y ago
This is a common opinion in bioethics and it doesn't really make sense. It's not moral to reward people for doing something because it might cause them to do it? It's like the idea that people shouldn't be paid for growing food or building houses because they'll profit for it. Which leaves people only being able to profit from making useless things because then nobody needs them.
- deleted 3y ago
  [deleted]
- ygjb 3y ago
  I think that any country that wants to consider legalizing the sale of body parts from living people should probably illustrate how they have effectively eliminated human trafficking for other forms of exploitation first. Generally speaking, it is not a moral act to reward people for harming themselves, or allowing themselves to be harmed. Most society overlook this in the name of sport, or in the name of freedom (e.g. drugs, alcohol, driving, and other massively harmful, but shockingly profitable ventures), but the balance of respecting freedom while preventing exploitation is generally a complete shit show as evidenced by the rampant human trafficking, and the ongoing exploitation of addiction that the illicit drug trade represents. The moral arguments also set aside the fact that the overall quality of "ethically sold" organs are likely to be lower due to the overall impact that a life of poverty on individual health has, and that selling an organ is most likely going to be an option of last resort for most people. Personally profiting from an act of self harm doesn't stop it being an act of predation or exploitation.
  - astrange 3y ago
    If donating an organ is self-harm why are you allowed to do it for free?
    - ygjb 3y ago
      Because when you remove the financial incentive that leads to outright exploitation, there still remains the case where self-harm can be a moral action. Donating a kidney, for example, or bone marrow, is harmful to the donor, but the trade-off is that it may save the life of another person. People make trade-offs that result in self-harm as part of a moral decision all the time. Firefighters are a great example of this. We (humans and societies in general, because this comment applies to all societies) generally block or allow moral and immoral activity based on the ability of those with power to regulate things. Some things are simple, like murder - generally, killing people is considered immoral, but even then, there is flexibility (for example, measures taken to stop an attacker from causing harm). Some things like organ donation are considered moral complex, and demand extra focus to prevent exploitation.
- tiagod 3y ago
  Why are you comparing growing food with selling a part of your body?
manquer 3y ago
Why do we assume cash ? It can be in kind, we already do this a bit current donors get preferred for donations when they need it themselves. Why cannot we extend that and say entire health care expenses for the rest of the donor’s life the state will take care for example ? it doesn’t even have to in. full , they can even just improve coverage , and make insurance companies remove restrictions like pre-existing conditions for such donors . There are plenty of benefits like this the state can do, perhaps tax credits , exemptions, priority in any government program , cheaper mortgages and so on , even private sector can step in with benefits like we do for veterans. I think the point is not to pay and make it an economic transaction , but to reward I.e. incentivize people to do donate more. The benefits can also extend to next of kin like say financial aid for college etc(donors shouldn’t be that young to directly benefit from education aid)it would then also factor for non living donors
Ekaros 3y ago
I might find it reasonable if sums involved were life changing. So a kidney would start at something that will pay invested for rest of the donators life. Let's say 10 million. So rich who can afford them can get one. And donators don't have to work anymore.
- tiagod 3y ago
  I interpreted the original idea as the government / public health system paying the person for the kidney. Your idea is incredibly more repulsive. I tried to elaborate, but I can't even entertain the idea for long enough to type out something I would be comfortable with submitting.
benji-york 3y ago
I wonder if this article would shed some light on the difference between your response and others: https://www.overcomingbias.com/p/systems-explain-stem-vs-culture-style https://www.overcomingbias.com/p/systems-explain-stem-vs-cul... (I'm not judging or trying to persuade, but wish to increase understanding between people with very different viewpoints.)
- tiagod 3y ago
  I think I do understand why the other people in this thread wrote what they did. It's true their worldview is probably extremely different from mine. I find the extreme wealth inequality we witness to be a great tragedy. That people are destroying their minds and bodies to be given the privilege to exist on this planet, while people lucky enough to be rich can simply order 99% of other humans around, and convince them that it's a good thing. That it's fair they're giving away their health, their sexuality, their blood or all of their time, as they are getting paid money in exchange. Something that to them is only achievable by hard work and extreme sacrifice, and in small quantities, while the same amount represents a minuscule value to the person on the other side of the deal. Adding to that legally selling your organs, is inconceivable to me. What's next, selling babies for adoption? I'm sorry if this seems poorly thought out and weakly formed argument, but I don't even know how to begin expressing my opinion on this matter. I can't see how I can be convinced this is all OK and something to be intensified.

deleted 3y ago

[deleted]

kobalsky 3y ago

> and so this would save lives lives of people who can buy a kidney. this is a transfer of longevity from poor people to rich people. and since because everything balances, in the future it will take selling a kidney to get to the average, and poor people will end in the same place but with only one kidney

intuitionist 3y ago
The linked article suggests that the federal government would be a monopsony buyer in the US kidney market. My understanding is that most serious policy proposals along these lines would have the same feature. Medicare already covers care for nearly all US citizens with severe chronic kidney disease; paying for kidney donations would move some number of patients from dialysis to transplant but they wouldn’t be out of pocket.
- keybored 3y ago
  I don’t see how that solves the potential problem. You could still end up in the same place of “balancing out” where the extra money from your kidney becomes something you need i.e. a transfer from poor to rich people.
  - intuitionist 3y ago
    Well, the people receiving the kidneys won’t be rich on average, although it’s possible they’ll be richer on average than the compensated donors. There’s a big shortfall of available kidneys but the number is pretty tiny compared to the number of people living paycheck-to-paycheck in America. So it seems unlikely to me that in the future everyone needs to donate a kidney just to stay in the same place—that’d be a couple orders of magnitude more kidneys than we need.
    - keybored 3y ago
      Fair point that there isn’t a high enough demand to cause a lot of poor people to be monokidneys.

RheingoldRiver 3y ago

I don't agree with paying for kidney donations, but I think we should pay people to be organ donors via some tax deduction if you've been registered as a donor for the past 2 years (so you can't like, register then file taxes then unregister)

DoreenMichele 3y ago

If you are rich enough to think buying kidneys makes sense, I implore you to advocate for better health care which improves the odds of keeping your own original equipment from the manufacturer functioning adequately. Transplant is not all upside. You remain on drugs for life. You may die anyway if your body rejects the transplant. I see a lot of pro-transplant headlines on HN. People don't seem to want to hear any criticism of organ transplants. But I think organ transplants are "ooh, shiny tech" that makes for good headlines not actually good medicine. I think good medicine would fix you, not turn you into Frankenstein so doctors can feel powerful. Keeping people healthy is boring, doesn't really get tracked, no one cares. Letting their lives go to hell and then "saving" them makes for good headlines. I have a condition that accounts for a lot of organ transplants. I would rather keep my own organs functioning. All of HN loathes me for having that opinion. But if you think you are at risk of "needing" a transplant and have resources, I encourage you to actively look for other solutions to advocate for. We mostly don't hear the horror stories about transplant. If that got more publicity, maybe people wouldn't be so quick to act like I'm some kind of nutter for having opinions about the topic.

lazyasciiart 3y ago
> If you are rich enough to think buying kidneys makes sense, I implore you to advocate for better health care which improves the odds of keeping your own original equipment from the manufacturer functioning adequately. Congratulations on having a condition that gives you some control over whether you need an organ transplant in the future. I assume that nobody on HN cares whether you keep your own organs functioning, and nobody thinks you are a nutter just for "having opinions about the topic": they object to your declaration that they should prioritize not needing an organ transplant because of your values and the circumstances of your own life. > Keeping people healthy is boring, doesn't really get tracked, no one cares. That's a fun contrarian statement too. If only there was ever anything written about preventative health care and lifestyle improvements. Maybe you can publish the first book on it!
- DoreenMichele 3y ago
  Congratulations on having a condition that gives you some control over whether you need an organ transplant in the future. I'm not supposed to have any such control. I exercised it anyway, thus my opinions. I don't expect anyone to care about me or my opinions or my agenda and I don't know what the PC language is for this. There seems to be none. But "more access to transplants" isn't your only option if you are thinking long term about your own health issues.

lazyasciiart 3y ago

It would probably be a decent first step to commit to covering all the direct and indirect costs of donating a kidney. Not everyone can afford the time off work and life required to go through the operation and recover, and then guarantee that they'll have reliable health care for the rest of their lives. There's lots of room to debate whether income replacement should be included and at what level, but among the dozens of existing systems that do it (jury duty, unemployment, disability leave, parental leave...) it should be plausible to find a model that people feel is acceptable.