Let Me Go, Never - Part 2

Warning, this is a continuation from Friday's post, and deals with topics that may spoil the book Never Let Me Go.

Finally, organ donation. There's still some hope that we'll learn to grow human organs in pigs, so maybe an animal version of this book isn't too far away. But for now, I actually have some fairly radical views on how it can be better. First of all, obviously we have China showing us an even worse world that the one presented in Never Let Me Go, by arresting and harvesting from innocent citizens, both in a state sponsored way and on the black market. I'll leave it to the apt intelligence of my reader(s) to understand why the fact that hunting might be more ethical than ranching isn't relevant here. However, there is real suffering caused if a state can't get enough voluntary organ donors, and I think our status quo bias leads us to undervalue this suffering compared to other pain we could cause. There are easy fixes, famous studies show that countries where organ donation is "opt out" have a much higher level of donors than countries in which it's "opt in". But I'm radical enough to leave these comfortable experiments from Austria or Scandinavia for a different state policy. How about Iran?

Iran is the one country that allows for financial compensation of kidney donors. Dialysis is a very expensive process, so this can be made economically reasonable, while being rewarding for donors and even more rewarding for needy people living painful, trapped lives waiting for a donation. I've heard many objections to this idea, but I think they're all surmountable.

"It's going to take advantage of the poor." Okay, then means test it. If you need the money, you can't get it. This seems a little pointless and vindictive, but if it's the price to pay for people to buy into this system and improve the lives of thousands (24,000 in Canada in 2013, 468,000 in the States). We will pay only well off people to donate a kidney, poor people have to give them for free like now.

"Rich people with kidney failure will be more likely to get a transplant." Maybe in the U.S. In Canada we seem very staunchly against private options and cost sharing, so I don't know why this should be any different.

"It's simply wrong to commodify the human body." I think this might be a fundamental disagreement, and the philosophy behind it is to much for me to go into now. This is the same bias that turns people against sex work, paid blood donation, surrogacy, and more. It's bunk. Obviously all of these things can be unhealthy, and adding an incentive to an unhealthy activity can make it worse. The same could be said about lawyers. Sex work and surrogacy are a blog post to themselves, but all of these things when healthy should be happily tolerated, if not promoted.

"People should donate out of compassion. Capitalism ruins everything." They should. Some do. Even some strangers. Most Canadians, most Americans, are on dialysis when we know they could be significantly healthier and more mobile with a transplant. Again, the state controlled model right now is China.

Kidney donation is a very safe, established procedure. We should absolutely be moving to "opt out" systems for all organ donations, and eventually to a "someone is dying, you're in" system. I am, however, one vote for providing a financial incentive for kidney donations. If you think I missed an important reason why this is wrong, let me know.