
Transplant Brokers in Israel Lure Desperate Kidney Patients to Costa Rica - eroo
http://www.nytimes.com/2014/08/17/world/middleeast/transplant-brokers-in-israel-lure-desperate-kidney-patients-to-costa-rica.html?hp&action=click&pgtype=Homepage&version=LargeMediaHeadlineSumCentered&module=photo-spot-region&region=photo-spot&WT.nav=photo-spot&_r=0
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gojomo
The article devotes just 3 sentences, in a short aside, to the idea that
kidney sales could be encouraged, in an orderly and fair manner, rather than
prohibited. (It's the prohibition which creates black market profits and kills
thousands waiting for kidneys.)

For more on this possibility:

[http://reason.com/archives/2008/05/13/kidneys-for-
sale](http://reason.com/archives/2008/05/13/kidneys-for-sale)

[http://www.cato.org/publications/policy-analysis/organ-
sales...](http://www.cato.org/publications/policy-analysis/organ-sales-moral-
travails-lessons-living-kidney-vendor-program-iran)

Virginia Postrel, a former editor of _Reason_ who actually donated one of her
kidneys to a friend, has also written about donor chains and compensation:

[http://www.theatlantic.com/magazine/archive/2009/07/with-
fun...](http://www.theatlantic.com/magazine/archive/2009/07/with-functioning-
kidneys-for-all/307587/?single_page=true)

~~~
logicallee
Unless health turns out to be like education and clean water - potentially
better served by an other than completely private market, whether for reasons
of inelasticity of demand, public utility of 99.9% literacy, etc.

In that case there could be payment for organs, but for everyone else's too.

Also in this case, besides communal funding, compulsory "donation" might also
work. (Or compulsory "donation" but with compensation from communal funding,
and a private market might conceivably ride on top of that.)

 _edited to remove mention of "right" as it is not necessary for the analogy_

~~~
gojomo
The current policy of compensation-prohibition, derived from fuzzy
sloganeering like "health is a universal human right" [your pre-edit wording],
is resulting in thousands of unnecessary deaths a year.

And until you get 100% of what you want – perfectly equal health care for
everybody? – are we just supposed to see those deaths as a price worth paying?
When your ideal is finally implemented, be it next year, or maybe in a decade,
or maybe a century from now, will those who died be happy to know they were
noble martyrs for a good cause, a necessary demonstration of suffering to help
bring the laggards around?

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greenmountin
My favorite blogger that touches on these issues is Al Roth
([http://marketdesigner.blogspot.com](http://marketdesigner.blogspot.com)), a
professor now at Stanford.

One of the coolest ideas there is the "organ donation chain." Think of one
patient's spouse donating their kidney to another patient, and vice versa; now
add an intermediary couple, and you've got a chain where more kidneys reach
better compatible hosts. Unfortunately, because someone could always get cold
feet, a lot of these chains had been carried out simultaneously, which
naturally limits the size of such a chain.

So the cherry on top is a "non-directed" starter kidney. With this initial
gift of altruism there's a little more leeway to arrange the matches and it's
a disappointment but not a showstopper when someone finally stops the chain.

Anyways, it's always nice to think about the stopgaps between now and the sci-
fi organ-growing future.

------
carbocation
> Some physicians and ethicists question the relative morality of allowing
> thousands to die just because the means of saving them is considered
> repugnant. A regulated marketplace, they say, could all but eliminate the
> shortage.

If synthetic organ synthesis (or regenesis) is successful, the field of
transplantation will explode and the driver for this black market will
disappear. Until that time, we're stuck with an ethically delicate situation.
Curious to hear what HN thinks of creating such a regulated market, and
whether it's fundamentally different from unpaid donations or chained
donations.

~~~
tomkinstinch
carbocation, I know of the Ott lab's work on regeneration (or rather,
recellularization) of explanted organs[1].

Do you know of other pioneering work in the field, or similar efforts to
follow?

1\.
[http://ottlab.mgh.harvard.edu/?page_id=205](http://ottlab.mgh.harvard.edu/?page_id=205)

~~~
carbocation
I'm not up to date on the latest, but my understanding of the state of the art
seems similar to yours.

