Five years in prison, $50,000 fine

The ban on compensation for human transplants goes back to 1983 legislation, according to the preface of When Altruism Isn't Enough. It was apparently a reaction to a doctor-entrepreneur who planned to bring poor folks to the U.S. for paid kidney donations. Strangely, it didn't really hit home to me before that compensated donation was more than merely frowned on, but is punishable be a stretch in federal prison. If compensated donation will ever occur, Congress will have to act -- if the book makes its case, Congress will be undoing their own damage. They're better at the damaging than the undoing.

When Altruism Isn't Enough: book review

So the rant blog re-emerges for a slow-motion book review. I am beginning When Altruism Isn't Enough: The Case for Compensating Kidney Donors.

Why? I'm on the Board of Directors of Iowa Donor Network, the agency that collects and distributes donated organs in Iowa. IDN succeeds in obtaining donations about 50 times each year. It's surprising how few deaths yield transplantable organs, and it's disheartening how many of those go to waste because the decedent hasn't registered advance consent with the donor registry, and the family declines donation. Every consent declined creates a second death -- the person who dies while waiting for a transplanted organ.

There are 424 names on the Iowa list for organ transplant. That means at least a four-year average wait for a transplant. Many patients die on the list, and those who make it to transplant do so only after a long spell of expensive and debilitating dialysis. The national numbers are worse.

I'm sympathetic to the idea of compensated organ donation, especially for live kidney donors. If compensating the families of dead folks will improve consent rates, wonderful. But compensation for live kidney donors has the biggest potential to save lives. For obvious reasons (everyone has an extra), kidneys are the only organ where current technology allows folks to donate and live. While there are live donations, they are relatively rare.

There are potential objections to compensated donation. The ones that come to mind:

- It's too dangerous for the live donor.
- It's not the most effective treatment.
- It's not cost effective.
- It's just wrong somehow.

I don't have patience for the fourth one. It's a strange morality that outlaws taking money for saving a life. Nobody (I hope) says its wrong for a surgeon to make a living doing transplants, or the hospital. Why is the donor the only person cut out of the deal?

As I read the book, I'll see how the book addresses the other potential objections. As I will do this in my own time, and I'm in the middle of tax season, I can't promise that I will do this quickly. I hope that blogging my thoughts will help me read the book carefully and critically. If it proves useful to others, even better.