JamulBlog

Domino liver transplant – the liver removed from a patient receiving a heart/liver transplant became the new liver for another patient.  The primary motivation for this was the rules regarding allocation of donor organs.  The second patient wouldn't have lived long enough to have received a liver under those rules.

Some day, when you're in need of brain pain and heart ache, read up on the debate over how donor organs are allocated.  The main problem is that there are fewer organs donated than are needed. 

Usually the debate is framed as a problem in deciding who will live and who will die.  Today in the U.S. we use a complicated formula that attempts to make a judgment about which recipient will get the most use from the donor organ.  Thus, all other things being equal, a 20 year old recipient will be get a donor organ before the 70 year old, and a healthy 60 year old recipient would come before a 60 year old with leukemia.  There is an attempt to keep money out of the equation, but this doesn't really work, as if one has enough money organs are available in other countries.

Occasionally you'll see it framed as a problem in getting more organs for donation.  There are many proposed ways of doing this, ranging from high-tech “organ farms” to making donation obligatory to “harvesting” organs from prisoners on death row.  All of these approaches have ethical and moral concerns, some more so than others.  In some countries organs are so readily available that there is suspicion that harvesting from prisoners (perhaps not even awaiting a death sentence) is already taking place.

I don't have any conclusions about this, though I do have a sneaking suspicion that by keeping the free market completely out of it we are, in this case, actually killing people.  Just one example will suffice to make my point.  Suppose one of your loved ones faced death within a few months unless they got a heart transplant.  Further suppose that an ideal donor was killed in a car accident – but the victim had never authorized donation, and his surviving family didn't want to donate the heart.  Today, that would be the end of it – that heart wouldn't be used, and your loved one would die. 

Now imagine just one change to the (quite common) scenario I just described: suppose you could afford to pay $10,000 for that heart, you made the offer to the victim's family, and they accepted it.  They get $10,000, and your loved one lives.  Is that so bad?  Under today's rules, that's illegal.  Should it be?  I think not...but I absolutely agree that making such “purchases” legal would greatly increase the possibility of dodgy dealings.  In this case, though, I think the cure is worse than the disease...