Bioethics

Well, perhaps having all those ethicists floating around at Biopolis has been good for Singapore, which has announced a ground-breaking plan to pay organ donors:

Singapore is to allow compensation for kidney transplants and for eggs. A government proposal has been approved by a bioethics committee and legislation will be introduced early next year. The committee declared that reimbursement for kidney donation was acceptable as long as it is not "an undue inducement, nor amounting to organ trading".

What exactly this means for kidneys is difficult to fathom. According to the BMJ, a sum of S$10,000 was mentioned. According to the Straits Times, the health minister, Mr Khaw Boon Wan, mentioned "at least a five-figure sum, possibly even six-figure" as appropriate reimbursement. This would include expenses, such as transport and medical costs, as well as loss of earnings. Also, the donor should be covered for follow-up medical costs and higher insurance premiums as a result of losing a kidney.

Although Singapore is eager to become a hub for medical tourism, the government does not want to become tainted by a black market in organ trading. Back in July a retail magnate was convicted for trying to buy a kidney for S$23,700. He spent a day in jail and was fined S$17,000. The donors – poor Indonesian labourers -- were given two weeks' jail and a $1,000 fine and 14 weeks' jail and a S$2,000 fine.

The notion of paying women for eggs so that more will be available for research seems a particularly sound one (I feel queasier about people selling their kidneys somehow because it seems they might suffer worse health effects than they imagine). AFAIK this system already exists in the US, although it is obscured somehow; I used to know someone who made decent money selling her eggs.

Comments

[PG]

I always have been opposed to selling anything you can't grow more of. Hair, adipose cells, eggs, sperm, blood, bone marrow, maybe even liver lobes are OK. You can't grow more kidney.

I'd strongly prefer alternative means of encouraging donations, such as giving donors and their 5 nearest and dearest priority on their own medical needs, including organ transplantation.

[Indie]

Belle, have you ever seen "Dirty Pretty Things," a British film with Audrey Tatou. It's about the illegal immigrant population in London and how easily their poverty and desperation allows them to be exploited. Selling their organs was one of those ways.

That film is good and has interesting insights into what you're seeing happen in Singapore.

Maybe the fact that it's NOT black market there will help regulate it and keep it from getting too exploitative. Maybe.

[woof]

This might work if limited to trades among Singaporean citizens. If non-Singaporeans can participate, there is no way to stop exploitation and no way to provide decent medical follow-up to donors after their temporary stay.

[Bloix]

The problem with allowing people to sell stuff is that once they're allowed to sell, they can be forced to sell.

A study was done of kidney selling (illegal but not uncommon) in India. In virtually every case the seller was attempting to pay off crushing family indebtedness and in virtually every case the seller was soon worse off than before. Seventy percent of the sellers were woman and the study authors felt that it was very possible that they had been coerced into selling.

http://www.voanews.com/english/archive/2002-10/a-2002-10-01-38-Study.cfm

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1124324

http://www.hinduonnet.com/fline/fl1922/stories/20021108004008100.htm

http://news.bio-medicine.org/medicine-news-2/Selling-a-kidney-does-not-benefit-the-seller-6954-1/

[Benjamin]

I'm actually surprised organlegging isn't more prevalent. I definitely think people should be able to sell their organs post-mortem. Like, if you have an awesome heart, it could be sold, possibly at auction. I mean, why do I just get to "donate" my lungs? A good auction could help pay for my funeral costs and would give me the peace of mind my family deserves. To spell out the joke, life-insurance policies pay you to die afterall. There's no moral hazard - no-one wants to die and if you have a crazy abusive husband, you could opt-out at the DMV just to dissuage being killed for profit. Plus, it's a great incentive to stay healthier. I could give a shit about my body, generally, but if my kids were going to get paid, hey!