Contention 1 – organ sales will save lives
The ban on organ sales for transplant has created a large and growing shortage
Williams 14 Kristy L. Williams, University of Houston Law Center, Health Law & Policy Institute;
University of Texas Medical Branch, Institute of Medical Humanities.; Marisa Finley, Baylor Scott &
White Health Center for Health Care Policy; J. James Rohack, Baylor Scott & White Health March 31,
2014 American Journal of Law and Medicine, Forthcoming Just Say No to NOTA: Why the Prohibition
of Compensation for Human Transplant Organs in NOTA Should Be Repealed and a Regulated Market for
Cadaver
Organs Instituted http://ssrn.com/abstract=2418514
Organ transplantation saves thousands of lives every year. However, many individuals die waiting for
transplants due to an insufficiency of organs.1 Currently, more than 122,000 individuals are waitlisted
for organs in the United States.2 Due to financial and other barriers to becoming waitlisted, the actual
number of Americans requiring organs is likely higher.3 This gap between available organs and the need
for organs continues to widen.4 The supply of organs is limited as only a small number of individuals
die in circumstances medically eligible for organ donation, and less than sixty-eight percent of eligible individuals
donate.5 As a result of those long waitlists and limited supply there is a substantial need to increase organ donations. This paper will focus
on increasing consent rates for cadaveric organ donation in the Unites States by repealing current law prohibiting cadaveric donors and
their estates from being financially compensated.6 The
current organ donation system in the United States relies
on the altruism of donors. The National Organ Transplantation Act (NOTA) prohibits the receipt of any form of
valuable consideration in exchange for organs to be used for transplantation.7 State statutes also prohibit the
sale of certain organs and tissue for transplantation; however, state laws vary widely as to what body parts are covered.8 As paying for
organs is prohibited, other methods
have been employed in attempts to increase donations.9 Despite the
implementation of these strategies, a severe organ shortage remains.
Varied efforts to increase voluntary donations fail – individually and in combination
Beard 8 T.RANDOLPH BEARD, JOHN D. JACKSON , AND DAVID L. KASERMAN, profs of economics,
Auburn University Winter 2008 Regulation
The Failure of US 'Organ Procurement Policy
http://object.cato.org/sites/cato.org/files/serials/files/regulation/2007/12/v30n4-3.pdf
Aware of the increasingly dire consequences of continued reliance on the existing approach to cadaveric organ procurement and alarmed
at the figures shown above, the
transplant industry has examined and adopted a series of policy options
ostensibly designed to improve the system’s performance. All of these, however, continue to
maintain the basic zero-price property of the altruistic system. As a result, the likelihood that any of
them, even in combination, will resolve the organ shortage is remote. At least seven such actions
have been implemented over the last two decades or so: ■ INCREASED EDUCATIONAL EXPENDITURES In the
absence of financial incentives, moral suasion becomes the principal avenue through which additional supply may be motivated.
Consequently, the organ procurement organizations (opos) created under the 1984 Act have launched substantial promotional campaigns.
The campaigns have been designed to both educate the general public about the desperate need for donated organs and educate
physicians and critical care hospital staff regarding the identification of potential deceased donors. Over the years, a substantial sum has
been spent on these types of educational activities. Recent empirical evidence, however, suggests that further spending on these programs
is unlikely to increase supply by a significant amount. ■ ORGAN
DONOR CARDS A related activity has been the process of
incorporating organ donor cards on states’ driver licenses. The cards can be easily completed and witnessed at the
time the licenses are issued or renewed. They serve as a pre-mortem statement of the bearer’s wish to have his or her organs removed for
transplantation purposes at the time of death. Their principal use, in practice, is to facilitate the opos’ efforts to convince surviving family
members to consent to such removal by revealing the decedant’s wishes. The 1968 Uniform Anatomical Gift Act gave all states the
authority to issue donor cards and incorporate them in drivers’ licenses. Moreover, a few states have recently begun to rely entirely on
donor cards to infer consent without requiring the surviving family’s permission when such cards are present. Survey evidence indicates
that less than 40 percent of U.S. citizens have signed their donor cards. ■ REQUIRED REQUEST Some survey evidence published
in the late 1980s and early 1990s found that in a number of cases families of potential deceased donors were not being asked to donate
the organs. As a result, donation was apparently failing to occur in some of those instances simply because the request was not being
presented. In response to this evidence, federal
legislation was passed in 1987 requiring all hospitals receiving any federal
funding (which, of course, is virtually all hospitals) to request organ donation in all deaths that occur under circumstances that
would allow the deceased’s organs to be used in transplantation. It appears that this legal obligation is now being met in most, if not all,
cases. Yet, the organ shortage has persisted and the waiting list has continued to grow. ■ REQUIRED REFERRAL While requiredrequest legislation can compel hospitals to approach the families of recently deceased potential organ donors with an appeal for donation,
it cannot ensure that the request will be made in a sincere, compassionate manner likely to elicit an agreement. Following implementation
of the required-request law, there were a number of anecdotes in which the compulsory organ donation requests were presented in an
insincere or even offensive manner that was clearly intended to elicit a negative response. The letter of the law was being met but not the
spirit. As a result, additional legislation was passed that requires hospitals to refer potential organ donors to the
regional opo so that trained procurement personnel can approach the surviving family with the donation request. This policy response has
resulted in no perceptible progress in resolving the shortage. ■ COLLABORATION A fairly recent response to the organ shortage has
been the so-called “Organ Donation Breakthrough Collaborative,” which was championed by then-secretary of health
and human services Tommy Thompson. The program was initiated shortly after Thompson took office in 2001 and is currently continuing.
The program’s basic motivation is provided by the observation of a considerable degree of variation in performance across the existing
opos. Specifically, the number of deceased organ donors per thousand hospital deaths has been found to vary by a factor of almost five
across the organizations. The presumption, then, is that the relatively successful opos employ superior procurement techniques and/or
knowledge that, if shared with the relatively unsuccessful organizations, would significantly improve their performance. Thus, diffusion of
“best practice” techniques is seen as a promising method through which cadaveric donation rates may be greatly improved. A thorough
and objective evaluation of the Thompson initiative has not, to our knowledge, been conducted. Figure 1, in conjunction with a recent
econometric study of observed variations in opo efficiency, suggests that such an evaluation would yield both good news and bad news.
The good news is that the program appears to have had a positive (and potentially significant) impact on the number of donations. In
particular, it appears that, after 2002, the growth rate of the waiting list has slowed somewhat. Whether this effect will permanently lower
the growth rate of the waiting list or simply cause a temporary intercept shift remains to be seen. The bad news, however, is unequivocal—
the initiative is not going to resolve the organ shortage. Even if, contrary to reasonable expectations, all opo relative inefficiencies were
miraculously eliminated (i.e., if al organizations’ performance were brought up to the most efficient unit), the increase in donor collection
rates would still be insufficient to eliminate the shortage. ■ KIDNEY EXCHANGES Another approach that has received some
attention recently involves the exchange of kidneys between families who have willing but incompatible living donors. Suppose, for
example, a person in one family needs a kidney transplant and a sibling has offered to donate the needed organ. Further suppose that the
two siblings are not compatible — perhaps their blood types differ. If this family can locate a second, similarly situated family, then it may
be possible that the donor in the first family will match the recipient in the second, and vice versa. A relatively small number of such
exchanges have recently occurred and a unos-based computerized system of matching such interfamily donors has been proposed to
facilitate a larger number of these living donor transactions. Two observations regarding kidney exchanges are worth noting. First, such
exchanges obviously constitute a crude type of market in living donor kidneys that is based upon barter rather than currency. Like all such
barter markets, this exchange will be considerably less efficient than currency-based trade. Puzzlingly, some of the staunchest critics of
using financial incentives for cadaveric donors have openly supported expanded use of living donor exchanges. Apparently, it is not market
exchange per se that offends them but, rather, the use of money to facilitate efficient market exchange. This combination of positions
merely highlights the critics’ lack of knowledge regarding the operation of market processes. It is quite apparent that living donor kidney
exchanges are not going to resolve the organ shortage. Opportunities for such barter-based exchanges are simply too limited. ■
REIMBURSEMENT OF DONOR COSTS Finally, in another effort to encourage an increase in the number of living (primarily
kidney) donors, several states have passed legislation authorizing reimbursement of any direct (explicit) costs
incurred by such donors (e.g., travel expenses, lost wages, and so on). Economically, this policy action raises the price paid to living
kidney donors from a negative amount to zero. As such, it should be expected to increase the quantity of organs supplied from this source.
Because the explicit, out-of-pocket expenses associated with live kidney donation are unlikely to be large relative to the longer-term
implicit costs of potential health risks, however, such reimbursement should not be expected to bring forth a flood of new donors.
Moreover, recent empirical evidence suggests that an increase in the number of living donors may have a negative impact on the number
of deceased donors because of some degree of supply-side substitutability. Again, this policy is not a solution to the organ shortage. We
must conclude that none of the above-listed policies should be expected to resolve the transplant organ
shortage. We say this not because we oppose any of these policies; indeed, each appears sensible in its own right and some have
unquestionably succeeded in raising the number of organ donors by some (perhaps nontrivial) amount. Rather, our concern is that
every time another one of these marginalist policies is devised, it delays the only real reform that is
capable of fully resolving the organ shortage.
One problem is that most voluntary solutions rely exclusively on organs from
cadavers, which alone can never solve the shortage
Fry-Revere 14 Sigrid Fry-Revere. Director of bioethics studies, CATO Institute 2014
The Kidney Sellers: A Journey of Discovery in Iran p 6
At the time, what Congress did seemed reasonable, but over the following three decades, no matter
how efficient the U.S. cadaver organ procurement sys- tem became, it could not satisfy the demand.
Medical innovations keep people alive longer, and the ever-growing diabetes and hypertension
epidemics contin- ually increased the number of people who could benefit from a kidney transplant.
Today the number of kidneys provided from cadavers could never be enough, even if every organ
from every potential qualified donor could be harvested. This is true because not every death results
in useable organs. Organs can be diseased or injured, or the body can be dead too long before it
reaches the hospital. Patients who die in the hospital after a car accident or similar trauma are the
best potential organ donors because the appropriate medical equip- ment is at hand to switch gears
from saving the patient to preserving organs for transplantation. Nevertheless, given what we know
now, no matter how the process for retrieving organs from the dead improves, there will never be
enough kidneys to meet the ever-growing demand.
The possibility of complex artificial organs that actually function is at best decades
away.
Adhikari 14 Richard Adhikari has written about high-tech for leading industry publications since the 1990s
03/26/14 Bioprinting, Part 1: The Promise and the Pitfalls http://www.technewsworld.com/story/80198.html
[According to Jordan Miller, assistant professor of bioengineering at Rice University]. "Parts of the
body which require human cells to perform biomechanical functions, such as the liver or kidney, are
still several decades away from reaching human patients," Miller said. "We are still in the feasibility
stage -- not sure how to keep cells alive at high cell density and adequate size needed to match
human organs." A 3D structure will require nearly 1 billion functioning cells to approximate the
function of a liver or kidney, and "there are dozens of cell types in these organs," Miller pointed out.
"We are typically only looking at one or two cell types being put into a 3D printed structure."
NOTE SOURCE WITH QUALS EDITED INTO BEGINNING OF CARD
The shortage means many die
Beard 8 T.RANDOLPH BEARD, JOHN D. JACKSON , AND DAVID L. KASERMAN, profs of economics,
Auburn University Winter 2008 Regulation
The Failure of US 'Organ Procurement Policy
http://object.cato.org/sites/cato.org/files/serials/files/regulation/2007/12/v30n4-3.pdf
WAITING LISTS YET TO COME The consequences of our failure to adapt our cadaveric organ procurement policy to the
changed technological realities of the transplant industry have been unconscionable. Figure 2, above, suggests that more than
80,000 lives have now been sacrificed on the altar of our so-called “altruistic” system. In addition, the
unnecessary pain and suffering of those who have been forced to wait while undergoing dialysis,
unemployment, and declining health must also be reckoned along with the growing despair of family
members who must witness all of this. Nonetheless, the pain, suffering, and death imposed on the
innocents thus far pales in comparison to what lies ahead if more fundamental change is not
forthcoming. In order to illustrate the severe consequences of a continuation of the altruistic system, we use the data presented in
Figures 1 and 2 above to generate forecasts of future waiting lists and deaths. The forecasts represent our best guess of what the future
holds if fundamental change continues to be postponed. The results should serve as a wake-up call for those who argue that we should
continue tinkering with the existing procurement system while further postponing the implementation of financial incentives. The costs of
such a “wait and see” approach are rapidly becoming intolerable. CHANGING VARIABLE To produce reasonable forecasts of future waiting
lists and deaths, we must first confront an apparent anomaly in the reported data that could cast doubt on the accuracy of some of the
more recent figures. Specifically, the reported number of deaths of patients on the waiting list (plus those too sick to receive a transplant)
follows a consistently upward trend that is very close to a constant proportion of the size of the waiting list over most of the sample period.
Beginning in 2002, however, the number of deaths levels off and even starts to decline, despite continued growth of the waiting list. It is
not clear why there is an abrupt change in the observed trend in this variable. Our investigation of this issue yielded several plausible
explanations but no definitive answer. For example, it may be the case that recent advances in medical care, such as the left ventricular
assist device, have extended some patients’ lives and, thereby, reduced the number of deaths on the list. Alternatively, it may be the case
that because of rising criticism of the current system, unos has taken steps to remove some of the relatively higher-risk patients from the
list before they die. For example, the meld/peld program, which was introduced in February 2002, removed a number of liver patients
(who have a comparatively high death rate) from the waiting list. Additionally, the increasing use of so-called “extended criteria” donor
organs may have a similar effect, getting the most critically ill patients off the list prior to their deaths. Clearly, the implications of these
alternative explanations for reliance on the data are not the same. For example, if patients are, in fact, simply living longer and the data
accurately reflect that reality, then our analysis should incorporate the observations. But if the more recent figures are, instead, a
manifestation of strategic actions taken by the reporting agency, then they should be excluded. Because we have been unable to identify a
single, convincing explanation for the observed phenomenon, we elected to perform our analysis both ways — including and excluding the
post-2002 observations on the number of deaths. ESTIMATES Given the two alternative sample periods, the methodology we employ to
generate our forecasts is as follows: First, because the number of deaths appears to be causally driven by the number of patients on the
waiting list, we begin by estimating a simple linear regression model of the former as a function of the latter. The results of that estimation
are reported in Table 1 for the two sample periods described above. Next, we estimate a second linear model with the number of patients
on the waiting list regressed against time, again using the two alternative sample periods. Those results are reported in Table 2. From the
results, we
are able to produce forecasts of the expected size of future waiting lists for each of our sample
periods. We run the forecasts out 10 years from the end of our longer sample period, to 2015. Given the forecasted waiting
list values, we are then able to use the regression results in Table 1 to generate our forecasts of the number of deaths over the same
period. The two alternative sets of forecasts are shown graphically in Figures 3 and 4. Depending upon the sample period chosen, the
results show the waiting list reaching 145,691 to 152,400 patients by 2015. Of the patients listed at that time, between 10,547 and 13,642
are expected to die that year. Even more tragically, over the entire period of both actual and predicted values, a
cumulative total of
196,310 patients are conservatively expected to die by 2015 as a consequence of the ongoing
shortage. Figure 5 illustrates the results. In that figure, we incorporate several historical reference points in order to put the numbers in
perspective. No one directly involved in the transplant industry is likely to be surprised by our results. Thirty years of experience
consistently point to a continuation of the current, long-standing trends. There is nothing on the horizon that should lead anyone to expect
a sudden reversal. But our purpose is not to surprise the parties who are already knowledgeable about this increasingly severe problem.
Rather, our intent is to awaken the sleeping policymakers whose continuing inaction will inevitably lead to these results. They can no
longer continue to postpone meaningful reform of the U.S. organ transplant system in the futile hope that, somehow, things will improve.
They will not.
All economic studies agree that sales would solve
Kaserman, 7 Dr. David Kaserman is currently Torchmark Professor of Economics at Auburn University.
Issues in Law & Medicine Summer, 2007 23 Issues L. & Med. 45
Successes and The Failures lexis
ARTICLE: Fifty Years of Organ Transplants: The
Financial Incentives Proposals to resolve the organ shortage through the use of financial incentives
(or, similarly, through the formation of cadaveric organ procurement markets) have surfaced
repeatedly over the years. n56 Importantly, every economist that has written on this subject has
reached the same conclusion - i.e., that the shortage is caused by the zero price policy and that the
straightforward cure, therefore, is the elimination of that policy. Other, non-economist
commentators have reached that same conclusion as well.
Some have suggested that a market for organs would discourage altruistic donations,
but the core study on which these claims are based has proven untrue
Economist 11
The Economist Feb 16th 2011 Blood, not money
http://www.economist.com/blogs/blighty/2011/02/volunteering_and_profiteering
Blood donors are also unpaid, in Britain and elsewhere. A debate over whether or not they should be
compensated for their efforts has raged for at least four decades. In a classic 1970 study called "The
Gift Relationship: From Human Blood to Social Policy" Richard Titmuss compared the voluntary
British system favourably with the American one in which payments were then widely made. Titmuss
reckoned such a market was inefficient and wasteful, that it created shortages and surpluses, and led
eventually to a contaminated product. Although he was wrong, and such arguments have since been
widely discredited, Americans mostly no longer receive payment for giving blood. Too many people
in poor health lied about their medical histories in order to make a few bucks, endangering those
who were to receive the blood. As the World Health Organisation notes, people who give blood
voluntarily and for altruistic reasons have a lower prevalence of HIV, hepatitis viruses and other
blood-borne infections than do those who seek monetary reward. Presumably that is because being
rich is a great protection against disease.
Other sales empirically deny crowd out of voluntary donations
Boyer 12 J. Randall Boyer, J.D. candidate, April 2012, J. Reuben Clark Law School, Brigham Young University.
2012 Brigham Young University Law Review 2012 B.Y.U.L. Rev. 313 COMMENT: Gifts of the Heart ... and Other
Tissues: Legalizing the Sale of Human Organs and Tissues lexis
It should also be noted that allowing the sale of organs would not preclude someone from donating
without compensation. n156 Currently, the sale of blood and ova is allowed under law, but many of
the donations of these tissues take place without compensation. n157 In fact, giving the donor the
right to sell could actually increase the value of an uncompensated donation by providing donors
with more power to ensure the recipient receives the surplus value of the organ through
contractually stipulated prices to prevent any inflation by middlemen.
With organs, altruism is even less likely to be affected since the donations are
primarily for friends and relatives
Gill 2 Michael Gill, Ph.D., Assistant Professor, Department of Philosophy, College of Charleston AND Robert
Sade, M.D.,Professor in the Department of Surgery and Director of the Institute of Human Values in Health Care,
Medical University of South Carolina. Kennedy Institute of Ethics Journal 12.1 (2002) 17-45
Paying for Kidneys: The Case against Prohibition http://muse.jhu.edu/journals/kennedy_institute_
of_ethics_journal/v012/12.1gill.html
3. In the early 1970s, Titmuss (1971) and Singer (1973) argued that the existence of financial incentives
for blood products would decrease the amount of blood products overall, and some people might
believe that the same argument can be extended to financial incentives for kidneys, leading to the
conclusion that payment for kidneys will decrease the overall number of kidneys available for
transplant. Singer and Titmuss's criticisms of payment for blood products are consequentialist—they
argue that such payment is wrong because it would reduce the amount of blood for people who needed
it. We believe, first of all, that their consequentialist arguments against payment for blood products
have turned out to be inconclusive at best—that the available evidence does not support the conclusion
that payment for blood products has reduced blood supply in the United States. And we believe,
secondly, that because live kidney donations are usually between family members, there is a significant
difference between blood and kidneys that makes it illegitimate to transfer Titmuss and Singer's
conclusions to the kidney debate. We do, however, remain open to the possibility that future evidence
may vitiate our belief that payment for kidneys will increase supplies. For discussion of Titmuss and
Singer in relation to kidney sales, see Campbell (1992, pp. 41-42); Cherry (2000, pp. 340-41); and Harvey
(1999, p. 119).
Even if some crowd out occurred, sales would still provide an adequate supply of
organs. Study by Becker and Elias 14
Gary S. Becker, Nobel Prize-winning professor of economics at the University of Chicago and a senior
fellow at the Hoover Institution; and Julio J. Elias, economics professor at the Universidad del CEMA in
Argentina. Updated Jan. 18, 2014 Wall Street Journal Cash for Kidneys: The Case for a Market for
Organs
http://online.wsj.com/news/articles/SB10001424052702304149404579322560004817176?mod=WSJ_hpp_MIDDL
ENexttoWhatsNewsFifth
Finding a way to increase the supply of organs would reduce wait times and deaths, and it
would greatly ease the suffering that many sick individuals now endure while they hope for a
transplant. The most effective change, we believe, would be to provide compensation to people
who give their organs—that is, we recommend establishing a market for organs. Organ transplants
are one of the extraordinary developments of modern science. They began in 1954 with a kidney transplant performed at
Brigham & Women's hospital in Boston. But the practice only took off in the 1970s with the development of immunosuppressive
drugs that could prevent the rejection of transplanted organs. Since then, the number of kidney and other organ transplants has
grown rapidly, but not nearly as rapidly as the growth in the number of people with defective organs who need transplants. The
result has been longer and longer delays to receive organs. Many of those waiting for kidneys are on dialysis, and life expectancy
while on dialysis isn't long. For example, people age 45 to 49 live, on average, eight additional years if they remain on dialysis,
but they live an additional 23 years if they get a kidney transplant. That is why in 2012, almost 4,500 persons died while waiting
for kidney transplants. Although some of those waiting would have died anyway, the great majority died because they were
unable to replace their defective kidneys quickly enough. Enlarge Image The toll on those waiting for kidneys and on their
families is enormous, from both greatly reduced life expectancy and the many hardships of being on dialysis. Most of those on
dialysis cannot work, and the annual cost of dialysis averages about $80,000. The total cost over the average 4.5-year waiting
period before receiving a kidney transplant is $350,000, which is much larger than the $150,000 cost of the transplant itself.
Individuals can live a normal life with only one kidney, so about 34% of all kidneys used in transplants come from live donors.
The majority of transplant kidneys come from parents, children, siblings and other relatives of those who need transplants. The
rest come from individuals who want to help those in need of transplants. In recent years, kidney exchanges—in which pairs of
living would-be donors and recipients who prove incompatible look for another pair or pairs of donors and recipients who would
be compatible for transplants, cutting their wait time—have become more widespread. Although these exchanges have grown
rapidly in the U.S. since 2005, they still account for only 9% of live donations and just 3% of all kidney donations, including
after-death donations. The relatively minor role of exchanges in total donations isn't an accident, because exchanges are really a
form of barter, and barter is always an inefficient way to arrange transactions. Exhortations and other efforts to encourage more
organ donations have failed to significantly close the large gap between supply and demand. For example, some countries use an
implied consent approach, in which organs from cadavers are assumed to be available for transplant unless, before death,
individuals indicate that they don't want their organs to be used. (The U.S. continues to use informed consent, requiring people
to make an active declaration of their wish to donate.) In our own highly preliminary study of a few countries—Argentina,
Austria, Brazil, Chile and Denmark—that have made the shift to implied consent from informed consent or vice versa, we found
that the switch didn't lead to consistent changes in the number of transplant surgeries. Other studies have found more positive
effects from switching to implied consent, but none of the effects would be large enough to eliminate the sizable shortfall in the
supply of organs in the U.S. That shortfall isn't just an American problem. It exists in most other countries as well, even when
they use different methods to procure organs and have different cultures and traditions. Paying donors for their
organs would finally eliminate the supply-demand gap. In particular, sufficient payment to
kidney donors would increase the supply of kidneys by a large percentage, without greatly
increasing the total cost of a kidney transplant. We have estimated how much individuals
would need to be paid for kidneys to be willing to sell them for transplants. These estimates take
account of the slight risk to donors from transplant surgery, the number of weeks of work lost during the surgery and recovery
periods, and the small risk of reduction in the quality of life. Our conclusion is that a very large number of
both live and cadaveric kidney donations would be available by paying about $15,000 for
each kidney. That estimate isn't exact, and the true cost could be as high as $25,000 or as low as $5,000—but even the high
estimate wouldn't increase the total cost of kidney transplants by a large percentage. Few countries have ever allowed the open
purchase and sale of organs, but Iran permits the sale of kidneys by living donors. Scattered and incomplete
evidence from Iran indicates that the price of kidneys there is about $4,000 and that waiting
times to get kidneys
have been largely eliminated. Since Iran's per capita income is one-quarter of that of the U.S., this evidence supports
our $15,000 estimate. Other countries are also starting to think along these lines: Singapore and Australia have recently
introduced limited payments to live donors that compensate mainly for time lost from work. Since the number of
kidneys available at a reasonable price would be far more than needed to close the gap
between the demand and supply of kidneys, there would no longer be any significant waiting
time to get a kidney transplant. The number of people on dialysis would decline dramatically,
and deaths due to long waits for a transplant would essentially disappear. Today, finding a
compatible kidney isn't easy. There are four basic blood types, and tissue matching is complex and involves the combination of
six proteins. Blood and tissue type determine the chance that a kidney will help a recipient in the long run. But the sale of organs
would result in a large supply of most kidney types, and with large numbers of kidneys available, transplant surgeries could be
arranged to suit the health of recipients (and donors) because surgeons would be confident that compatible kidneys would be
available. The system that we're proposing would include payment to individuals who agree that their organs can be used after
they die. This is important because transplants for heart and lungs and most liver transplants only use organs from the deceased.
Under a new system, individuals would sell their organs "forward" (that is, for future use), with payment going to their heirs
after their organs are harvested. Relatives sometimes refuse to have organs used even when a deceased family member has
explicitly requested it, and they would be more inclined to honor such wishes if they received substantial compensation for their
assent. The idea of paying organ donors has met with strong opposition from some (but not all) transplant surgeons and other
doctors, as well as various academics, political leaders and others. Critics have claimed that paying for organs would be
ineffective, that payment would be immoral because it involves the sale of body parts and that the main donors would be the
desperate poor, who could come to regret their decision. In short, critics believe that monetary payments for organs would be
repugnant. But the claim that payments would be ineffective in eliminating the shortage of organs
isn't consistent with what we know about the supply of other parts of the body for medical
use. For example, the U.S. allows market-determined payments to surrogate mothers—and surrogacy takes time, involves great
discomfort and is somewhat risky. Yet in the U.S., the average payment to a surrogate mother is only about $20,000. Another
illuminating example is the all-volunteer U.S. military. Critics once asserted that it wouldn't be possible to get enough capable
volunteers by offering them only reasonable pay, especially in wartime. But the all-volunteer force has worked well in the U.S.,
even during wars, and the cost of these recruits hasn't been excessive. Whether paying donors is immoral because it involves the
sale of organs is a much more subjective matter, but we question this assertion, given the very serious problems with the present
system. Any claim about the supposed immorality of organ sales should be weighed against the morality of preventing thousands
of deaths each year and improving the quality of life of those waiting for organs. How can paying for organs to increase their
supply be more immoral than the injustice of the present system? Under the type of system we propose, safeguards could be
created against impulsive behavior or exploitation. For example, to reduce the likelihood of rash donations, a period of three
months or longer could be required before someone would be allowed to donate their kidneys or other organs. This would give
donors a chance to re-evaluate their decisions, and they could change their minds at any time before the surgery. They could also
receive guidance from counselors on the wisdom of these decisions. Though the poor would be more likely to sell their kidneys
and other organs, they also suffer more than others from the current scarcity. Today, the rich often don't wait as long as others
for organs since some of them go to countries such as India, where they can arrange for transplants in the underground medical
sector, and others (such as the late Steve Jobs ) manage to jump the queue by having residence in several states or other means.
The sale of organs would make them more available to the poor, and Medicaid could help pay for the added cost of transplant
surgery. The altruistic giving of organs might decline with an open market, since the incentive to give organs to a relative, friend
or anyone else would be weaker when organs are readily available to buy. On the other hand, the altruistic giving of money to
those in need of organs could increase to help them pay for the cost of organ transplants. Paying for organs would lead to
more transplants—and thereby, perhaps, to a large increase in the overall medical costs of transplantation. But it would
save
the cost of dialysis for people waiting for kidney transplants and other costs to individuals
waiting for other organs. More important, it would prevent thousands of deaths and improve
the quality of life among those who now must wait years before getting the organs they need.
Sales in Iran have resulted in a surplus of donors – there is a waiting list to donate
Minton 14 Michelle Minton • March 27, 2014 Human Achievement of the Day from HumanProgress.org:
Organ Replacement Technology
https://cei.org/blog/human-achievement-day-humanprogressorg-organ-replacement-technology
Medical breakthroughs are giving hope to hundreds of thousands of people waiting for organ
transplants. There are 120,000 people waiting for organ transplants in the United States alone. By
this time tomorrow, twenty to thirty Americans will die because they cannot get a new kidney—not
to mention other organs. Compare this man-made shortage to Iran where organ donors may be
compensated with cash. In contrast to the United States, there is a donor waiting list in Iran. As long
as the industrialized world rejects the Iranian model, we must turn to innovation to resolve the organ
shortage crisis.
Setting the price at a market clearing level guarantees a sufficient number of organs.
Watkins 5 Christy M. Watkins, University of Tulsa Journal of International and Comparative Law
Spring,
2005 5 JICL 1 ARTICLE: A Deadly Dilemma: The Failure of Nations' Organ Procurement Systems and Potential
Reform Alternatives n1 lexis
2. The Market Process
A minimum of five groups would be seriously affected by an organ market: (1) current and potential transplant candidates; (2)
actual and potential organ donors and their families; (3) hospitals, physicians, and other transplant caregivers; (4) The United
Network for Organ Sharing, the Organ Procurement and Transplantation Network, and other organ procurement [*27]
organizations; and (5) taxpayers and those who finance patient care. n214 First, the organ supplier (potential
donor or his or her surviving relatives) would be offered a market-determined price, which
would fluctuate depending on supply and demand. n215 Price flexibility would eliminate
surpluses or shortages automatically. n216 Organ procurement firms would then remove the organs at death and
sell them to transplant centers that have put in an organ order. n217 In turn, the centers would include the price paid to the firm
in the operation bill, with the resale price being the price paid to the donor plus the firm's collection and distribution cost. n218
From here, the center could allocate the organs in "precisely the same fashion they are allocated today" under the guidelines of
the UNOS. n219 The firms acquiring the organs for sale would presumably operate competitively on a for-profit basis, resulting
in powerful market incentives to create and use the best strategies in finding potential donors and encouraging them to donate.
n220 Procurement agencies currently operate on a nonprofit basis, and while they may work diligently, it is doubtful they could
match the performance of the competitive for-profit firms. n221
Contention 2 Organ sales will end the illegal market
The US ban on sales has created an international illegal market
Hughes 9 J. Andrew Hughes, J.D. candidate, Vanderbilt University Law School, May 2009.
Vanderbilt Journal of Transnational Law January, 2009 42 Vand. J. Transnat'l L. 351
Note: You Get What You Pay For?: Rethinking U.S. Organ Procurement Policy in Light of
Foreign Models
U.S. organ procurement policy has consequences beyond a domestic organ shortage. A
thriving global black market in human organs has resulted from U.S. policy banning organ
sales. n78 While nearly all developed nations have banned the sale and purchase of human organs, many countries do not
strictly enforce these laws. n79 The illegality of the organ trade is insufficient to discourage many of
those faced with the possibility of dying on an organ waiting list, and "transplant tourism"
has become its own industry. n80 In Bombay in 2001, nearly US$ 10 million were exchanged for kidney transplants.
n81 Patients use kidney brokers to locate sellers, who circumvent a ban on kidney sales by signing an affidavit swearing that they
are not being paid. n82 Before the U.S. invaded Iraq in 2003, that country was known as "one of [the] world's best black
marketplaces for human organs." n83 The lack of effective prosecution of these transactions extends beyond Asia and the Middle
East to Europe, as recent cases in Estonia and Germany suggest. n84 U.S. doctors perform illegal transplants,
too, often under hospitals' "don't ask, don't tell" policy regarding transplants involving
foreigners who claim to be related. n85 U.S. hospitals set their own rules for who can be a live organ donor, and
organ brokers can locate hospitals that do not question a purported familial relationship between "donors" and "donees." n86
The lack of a regulated organ marketplace in the U.S. has resulted in exploitation of the poor
throughout the world. n87 Organ sellers often face debt, unemployment, and serious health problems; as such, they are
easy targets for abuse. n88 Prisoners and the homeless are among those exploited. n89 Sellers of organs on the black market are
often paid less than what they were initially promised, while their financial situations and health often grow worse after the
transplants. n90 Data from the Indian black market trade in kidneys [*363] support the concern about sellers' lack of adequate
information about the risks involved. In one study, 86% of the sellers there reported that their health had "deteriorated
substantially" after their organ sales, and "four out of five sellers would not recommend that others follow their lead in selling
organs." n91 In short, U.S. policy and its ban on organ sales have produced some of the same
immoral and unethical consequences the ban was designed to avoid. n92
Economically desperate people are coerced into selling their organs in the hope of
bettering their situation. As a result of the actions of unscrupulous organ brokers
and inadequate medical care, they are actually made worse off.
Jaycox 12 Michael P. Jaycox, teaching fellow and Ph.D. candidate in theological ethics at
Boston College,
Developing World Bioethics Volume 12 Number 3 2012 pp 135–147 COERCION, AUTONOMY, AND THE
PREFERENTIAL OPTION FOR THE POOR IN THE ETHICS OF ORGAN TRANSPLANTATION
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-8847.2012.00327.x/pdf
Pakistani surgeon and bioethicist Farhat Moazam offers the results of a recent study in
which he interviewed thirty-two farm laborers in Pakistan, each of whom had sold a kidney within the past three years. 14
He found that almost all of these organ vendors were in significant debt to wealthy
landlords at the time they sold their kidneys; the average debt of each was 130,000 rupees at the time of
sale. Although the vendors were promised by third-party brokers an average price of
160,000 rupees per kidney, the amount actually received by the vendors was an average
of 103,000 rupees. As a result, a majority (17) of them were ‘either still in debt or had
accumulated new debts’ at the time of their interviews. 15 Moreover, a majority of the vendors
experienced long-term physical and psychological malady as a result of their
nephrectomies, and a majority also expressed regret or shame for their decision because
they were not freed from their debts and/or felt they had committed a morally wrong act.
When asked why they had made the decision, ‘the most common [Urdu] words they used were majboori (a word that
arises from the root jabr, which means a state that is beyond one’s control) and ghurbat (extreme
poverty).’16, Moazam
summarizes his findings with the conclusion that the sale
of kidneys functions to reinforce the poverty of those who sell them: In the
words of the vendors, they sell a kidney...in order to fulfill what they see as obligations toward immediate and extended
families in which they are inextricably embedded, and within systems of social and economic inequalities which they can
neither control nor escape. They sell kidneys in hopes of paying off loans taken to cover their families’ medical expenses or
to meet the responsibilities for arranging marriages and burying their dead. These are recurring expenses, and for most
the debts rapidly accumulate again, even if they have been partially or completely paid back with the money from selling a
kidney. 17 4 F. Moazam, R.M. Zaman & A.M. Jafarey. Conversations with Kidney Vendors in Pakistan: An Ethnographic
Study.Hastings Cent Rep 2009; 39: 29–44. Due to recent legislation (18 March 2010), the sale of human organs is now
illegal in Pakistan, although the social effects of this new legislation remain to be studied; see T.M. Pope. Legal Briefing:
Organ Donation and Allocation. J Clin Ethics 2010; 21: 243–263: 254.
For many, the coercion is more violent
Bowden 13 Jackie Bowden, 2013 J.D. graduate from St. Thomas University School of Law.
Intercultural Human Rights Law Review 2013 8 Intercultural Hum. Rts. L. Rev. 451
ARTICLE: FEELING EMPTY? ORGAN TRAFFICKING & TRADE: THE BLACK MARKET FOR
HUMAN ORGANS lexis
[*452] Introduction Organ trafficking has been depriving innocent people of their fundamental
right to life for decades. n1 Imagine living in a poor country, where you wake up in the morning and set out
to find work and food for the day. As you walk peacefully to your home at the end of the day, you are grabbed
and thrown into the back of an unmarked truck. n2 You wake up, screaming from excruciating pain, as a
surgeon slices through your flesh to remove your kidney. Due to the costs associated with such a procedure,
no anesthesia is administered and no medication is given to prevent infection. n3 In the event that
the surgery does not go as planned, no forms of emergency assistance are available. Your body is then dumped on a
side street, and you are extremely lucky if you live. Should you report the incident to government officials?
What if the government is actually involved in this inhumane activity? n4 [*453] There are conflicting views on whether people
are actually kidnapped for their organs. n5 In fact, many believe these stories are just myths. n6 However, there are
reported accounts suggesting that abduction of organs is a harsh reality of organ trafficking.
n7 Reports indicate organ trafficking is so prevalent that there is a surplus of organs available for transplantation. n8
Furthermore, there is evidence of governmental involvement, which contributes to and
exacerbates the problem. n9 Fortunately, most countries have enacted laws to prevent and prohibit organ trafficking
from occurring. n10
And that market is widespread and expanding—desperation and profit ensures
expansion and exploitation
Samadi 2012 – Vice Chairman of the Department of Urology and Chief of Robotics and
Minimally Invasive Surgery at the Mount Sinai School of Medicine (David, May 30, 2012,
“Consequences of the rise in illegal organ trafficking,” Fox News,
http://www.foxnews.com/health/2012/05/30/consequences-rise-in-illegal-organ-trafficking/,)
Earlier this week, the World Health Organization (WHO) released a report demonstrating a rise in the
number of human organs being sold on the black market. According to the paper, in 2010 over 10,000
organs were sold, translating to more than one organ sold every hour. Organ transplantation is a
necessary treatment for many individuals whose organs have failed and has been in practice in the United States since the 1950s. In
the U.S. organ donations are regulated by an independent non-for-profit organization, United Network for Organ Sharing (UNOS).
Organs are given to those whose need is the greatest, regardless of wealth or position. Unfortunately, the need for
organs greatly outweighs the current supply. As of March 2012 over 113,115 patients are currently waiting for an
organ to become available. An illegal market has capitalized on these individuals’ desperation, and the
prospects of large profits are creating unfortunate incentives, with patients willing to pay up to
$200,000 for a kidney. According to the WHO report, 76 percent of organs sold were kidneys, reflecting the growing
demand secondary to complications of high blood pressure and diabetes. There are many ethical and health
concerns surrounding the trafficking of human organs. In the majority of situations, those
selling their organs represent members of vulnerable populations . In countries like Pakistan,
China or India, a person can sell a kidney for $5,000, while those handling the transaction make
a substantial profit. Prior reports have also demonstrated that the recipients of illegal organs tend
to fair worse than those who have received one legally. A recent meta-analysis involving 39 original publications
revealed that those obtaining organs abroad are at a higher risk of contracting transmissible
diseases, such as hepatitis B or HIV. Furthermore the patient and organ survival rates abroad are
significantly lower. These statistics might even underestimate the risk as the data is vulnerable to
survivor bias; those who do not survive the procedure and return home are often not included in
studies. Additionally, given the duplicitous nature of illegal organ trade, there are many scams. In
2010, a former psychiatrist was sentenced to more than 15 years in prison for offering false promises of organ transplants in the
Philippines, while taking over $400,000 dollars from patients. Over five patients actually travelled to the Philippines only to find out
that there was no organ awaiting them. One of these patients died in the Philippines. Regretfully, the number of
individuals needing organs continues to grow while the number of donors remains stable
The illicit market exploits in a way like slavery
Delmonico 3 Francis L. Delmonico, Director of the Renal Transplantation Unit at Massachusetts
General Hospital, the medical director at the New England Organ Bank, and Professor of
Surgery at Harvard Medical School; and Nancy Scheper-Hughes.Director of Organs Watch and Professor of Medical
Anthropology at the University of California at Berkeley Zygon, vol. 38, no. 3 (September 2003)
WHY WE SHOULD NOT PAY FOR HUMAN ORGANS
Ebsco
Although class distinctions are an almost naturalized part of social life in all complex societies, in this
particular instance the exploitation of organ sellers veers dangerously close to human slavery, as
argued by Giovanni Berlinguer (Berlinguer and Garrafa 1996). The pressures put by organ brokers
upon the desperation of the world’s dislocated, refugee, and poorest populations to provide the
scarce commodities reveals the limits of argu- ments based solely on individual autonomy. Yes, even
the poorest people of the world “make choices,” but they do not make these freely or under social or
economic conditions of their own making. Further, the pressure of organ brokers upon the poor
makes their decision to sell an organ anything but a free and autonomous choice. These secular
arguments reach a conclusion similar to one derived from Christian morality—that the sale of human
organs is unethical. The most disturbing issue of organ sales to both Christian and secular ethicists is
the formation of an economic underclass of organ donors throughout the world to serve the wealthy.
This is not to suggest that proponents of organ sales are in favor of exploiting the poor but, rather,
that they are indifferent to the social and individual pathologies that markets in kidneys and other
body parts produce, such as the documented evidence of postsurgery medical complications, chronic
pain, psychological problems, unemployment, decreased earning power, social ostracism, and social
stigma faced by kidney sellers in many parts of the world (see Zargooshi 2002; Jimenez and ScheperHughes 2002a; Ram 2002).
The illegal market is also a threat to public health—spreads anti-biotic resistant
bacteria
Kelly 13 Emily Kelly, Executive Comment Editor for the Boston College International &
Comparative Law Review. Boston College International and Comparative Law Review
Spring, 2013 36 B.C. Int'l & Comp. L. Rev. 1317 NOTE: INTERNATIONAL ORGAN
TRAFFICKING CRISIS: SOLUTIONS ADDRESSING THE HEART OF THE MATTER lexis
[*1324] With regard to recipients, the dangers of receiving medical care in developing countries can outweigh the benefits of
life-saving transplant tourism. n66 Because governmental disease control agencies do not monitor
underground organ trafficking, recipients risk contracting infectious diseases like West Nile
Virus and HIV. n67 Tragically, transplant tourists also have "a higher cumulative incidence of acute [organ] rejection in the
first year after transplantation." n68 Transplant tourism also harms global public health policies. n69 Most
notably, the underground market impedes the success of legal organ donation frameworks. n70 For example, Thai patients have
difficulty accessing health care because local doctors are preoccupied with the lucrative practice of treating transplant tourists.
n71 In 2007, China banned transplant tourism because wealthy foreigners--rather than the 1.5 million Chinese on the waiting
list--received an overwhelming amount of organ transplants. n72 Grisly tales of transplant tourism and conspiracy theories
surrounding organ theft may also discourage individuals from agreeing to altruistic donation upon death out of fear that their
bodies may be exploited. n73 This further contributes to the global organ shortage and exacerbates the underlying causes of OTC
trafficking. n74 Additionally, transplant tourism and broader medical tourism facilitate the
spread of antibiotic-resistant bacteria. n75 Because such bacteria are frequently found in
hospitals, tourists are easily exposed and transmit these unique strains across borders upon
returning to their home countries. n76 As a result of these effects, transplant tourism has drawn increasing
attention to the root of the problem: organ shortages. n77
Independetly, Increasing reliance on the illegal market means the threat is
serious—specifically causes tropical disease
Franco-Paredes 10 Carlos Franco-Paredes, Jesse T. Jacob. Alicia Hidrona, Alfonso J.
Rodriguez-Morales,David Kuhara, and Angela M. Caliendoa all with Division of Infectious
Diseases, Emory University School of Medicine except Redriguez-Morales at Division of
Immunoparasitology, Tropical Medicine Institute, Universidad Central de Venezuela
International Journal of Infectious Diseases Volume 14, Issue 3, March 2010, Pages e189–
e196 Transplantation and tropical infectious diseases
http://www.sciencedirect.com/science/article/pii/S1201971209002045
More transplantation procedures are being performed annually, resulting in an increase in
the number of immunocompromised hosts.1, 2, 3, 4, 5, 6 and 7 Most of the literature in infectious diseases in
transplantation has focused on common pathogens prevalent in industrialized Western countries, where most transplantation
surgeries occur.1, 2, 4, 5, 6 and 7 However, in the last decade, there has been a growing identification of
tropical infectious diseases occurring in transplant hosts in endemic and non-endemic
settings.3, 4, 7, 8, 9, 10 and 11 The epidemiologic reasons for the growing number of reports of
tropical infections appearing in transplant recipients include: (1) increasing travel of transplanted
patients to the tropics and subtropics;8, 12 and 13 (2) increasing population immigration from endemic areas for tropical
infections to non-endemic settings;6, 14 and 15 (3) increasing numbers of transplantation procedures
taking place in tropical countries;11, 16, 17, 18 and 19 and (4) many individuals traveling overseas
for ‘transplant tourism’ in countries with high prevalence of tropical infectious diseases.20 and
21 In general, transmission of these infections occurs through three main routes: donor-derived infections,3, 4, 6, 15 and 22
reactivation or recrudescence of latent infections,16, 22, 23 and 24 or transmission de novo during the post-transplant period.4
and 16 Infectious pathogens may be carried by the graft or the infection may be acquired through transfusion of blood products
during or after the transplantation.3, 4
Plan solves 2 internal links-First, It dries up the demand for illegal organs
Upchurch 12 Ryan Upchurch, Seton Hall Law 1-1-12 Seton Hall Law eRepository "The
Man who Removes a Mountain Begins by Carrying Away Small Stones: Flynn v. Holder and a
Re-Examination of The National Organ Transplantation Act of 1984" (2012).
http://erepository.law.shu.edu/student_scholarship/18
By increasing the supply of available organs in the United States through compensation, American
citizens would have less reason to travel elsewhere to pay for an organ. For example, Aadil Hospital in
Lahore, Pakistan advertises two transplant packages catered towards foreign patients: $14,000 for the first transplant and
$16,000 for the second if the first organ fails.118 If demand dried up from foreign citizens, transplant tourism
in
these countries would take a major hit because brokers would fetch lower sums for organs they procure. Statistical
information is difficult to come by for obvious reasons, but presumably American citizens make up a
substantial percentage of the tourist patients seeking a new organ they cannot attain
domestically. As one report about impoverished Bangladeshi villagers taken advantage of for their organs succinctly
stated, “Most of those organs ended up transplanted into American citizens.”119 The black market
for organs in other countries is not fueled by local patients. Rather, it is driven upwards and out of control by those American as
well as European citizens who cannot acquire what they need domestically.120 One estimate is that the black market accounts
for as high as twenty percent of all kidney transplants worldwide.121 Nadley Hakim, transplant surgeon for St. Mary’s Hospital
in London, offered an interesting take on this problem of the black market when he said, “this trade is going on anyway, why not
have a controlled trade where if someone wants to donate a kidney for a particular price, that would be acceptable? If it is done
safely, the donor will not suffer.”122 Within the past month, an indigent Chinese teenager sold his kidney so that he could
purchase an iPad and iPhone.123 The unnamed teenager now suffers from renal deficiency.124 Sadly, the boy received roughly
ten percent of what the buyer paid, with the rest going to the surgeon and others involved in coordinating the operation.125 If
those American citizens with the means to purchase were not forced abroad to find an organ,
it is very possible that stories like this would become much less commonplace.
Second, Legalizing organ sales in the US spills over globally
Calandrillo 4 Steve P. Calandrillo, Associate Professor, Univ. of Washington School of Law.
J.D., Harvard Law School. B.A. in Economics, Univ. of California at Berkeley. George Mason
Law Review Fall, 2004 13 Geo. Mason L. Rev. 69 ARTICLE: Cash for Kidneys? Utilizing
Incentives to End America's Organ Shortage lexis
Moreover, if we cannot prevent the black markets in human organs that continue to thrive
worldwide today, a thoughtful and responsible regulatory solution in America might be the
best response. Many scholars have chronicled the reality that today's black markets lead to a host of abuses, provide for no
follow-up health care, and generally exploit the poor to the wealthy's advantage. n180 Stephen Spurr details the potential for
misrepresentation and fraud against both buyers and sellers today, as prices spiral out of control for organs that are of dubious
quality. n181 Gloria Banks decries the exploitation of society's most vulnerable individuals in the organ sale trade, and urges
legal and ethical safeguards for their protection. n182 Susan Hankin Denise adds that a properly regulated organ market may
therefore be a better solution to the problem of scarcity than the outright ban we witness today. n183 FOOTNOTE ATTACHED
n183 See Denise, supra note 72, at 1035-36 (arguing that regulated markets are superior to the existing ban on organ sales in the
U.S.). Of course, even a well-regulated legalized market in the U.S. may not completely eliminate
black markets worldwide if patients can still find organs more cheaply abroad. However, it is reasonable to
suspect that an American market would significantly reduce the demand for black
market organs, especially given the ability of a regulated market to better ensure the
quality of its product. Furthermore, a legalized market in the U.S. (with appropriate
safeguards to prevent abuse of sellers) may lead to similar structures abroad. On the other
hand, one might argue that competing markets might lead to a "race to the bottom" in terms of regulatory standards, as each
country tries to gain more market share.
Illegal market abuses are not an indication of what legal sales would be like – just the
opposite
Kaserman, 7 Dr. David Kaserman is currently Torchmark Professor of Economics at Auburn University.
Issues in Law & Medicine Summer, 2007 23 Issues L. & Med. 45
Successes and The Failures lexis
ARTICLE: Fifty Years of Organ Transplants: The
In a truly ironic twist of logic, some opponents of the use of financial incentives for cadaveric organ
donors have cited various human rights abuses and extraordinarily high prices associated with such
black market activities as har-bingers of the sorts of outcomes likely to accompany legalized organ
markets. n32 This line of "reasoning" is equivalent to arguing that legalization of liquor sales would lead
to the sorts of mafia-related activities that arose during prohibi-tion. This argument stands accepted
economic theory on its head. The truth is that the types of behavior and price levels that frequently
accompany black market sales tend to disappear when trade is legalized. Legalized trade allows the
market price to fall as legitimate businesses enter the market and increase supply. Moreover, costs
decrease as the risks of both prosecution and violent actions by rival producers are eliminated. The
outcome is lower prices, an increase in the volume of trade, and a cessation of criminal activities. Thus,
the types of conduct associated with illegal suppliers involved in black market trade and the prices at
which such trade takes place do not accurately reflect the behavior and prices likely to result from
legalized sales. In fact, it has long been recognized that the most effective remedy for undesirable black
market activity is to eliminate restrictions on trade. Stated succinctly, the cure for black market abuses is
legalized trade. That conclusion holds a fortiori, in the case at hand. Eliminating the shortage of
cadaveric organs through legalization of financial incentives would greatly reduce, if not eliminate, the
demand for living donor kidneys obtained through black markets. Therefore, if one is opposed to current
black market activities, then one should favor financial incentives for cadaveric organ donors.
The United States Federal Government should amend the National Organ Transplant
Act to permit regulated sale of human organs. A government agency should be
established to purchase organs from those living in the United States, with payment in
vouchers with a cash value set at an adjusted market-clearing price. Organs should be
placed in the Organ Procurement and Transplantation Network.
Contention 3 The Plan establishes well-regulated organ sales
A program with a government intermediary is viable means for "organ sales"
Wilkinson 11
Stephen Wilkinson, Professor of Bioethics, Lancaster University (UK) 10-17-11 Stanford
Encyclopedia of Philosophy, "The Sale of Human Organs" http://plato.stanford.edu/entries/organs-sale/
. Different Kinds of Organ Sale System The
expression ‘organ sale’ covers a wide range of different
practices. People most readily associate it with the case in which one individual (who needs or wants
money) sells his or her kidney to another (who needs a kidney). But there are other possibilities too. One (in
countries where the prior consent of the deceased is required for cadaveric organ donation) is to pay people living now for rights
over their body after death. Another (in countries where the consent of relatives is required for cadaveric organ donation) is to pay
relatives for transplant rights over their recently deceased loved ones' bodies. Since the kidney is the most commonly transplanted
organ and since the ethics literature on organ sale is mainly about kidney sale from live donors, that is the practice on which this
entry will focus. ‘Organ sale’ as the term is used here does not include the sale of body products (a category which includes blood,
eggs, hair, and sperm) since this is different in some important respects. For example, the risk of permanent harm is generally much
less in the case of blood and hair donation; while, the donation of eggs and sperm raises additional issues relating to the creation and
parenting of additional future people. That said, many of the fundamental issues are similar and the very same concerns about (for
example) exploitation and consent arise in both cases. An important preliminary point is that almost all serious advocates of
allowing payment for human organs argue not for an unfettered ‘free market’ but for a regulated one. Radcliffe Richards et al. (1998,
1950) for example, in their paper “The Case for Allowing Kidney Sales” say: It must be stressed that we are not arguing for the
positive conclusion that organ sales must always be acceptable, let alone that there should be an unfettered market. While Wilkinson
(2003, 132) is typical of organ sale defenders in wishing to distance himself from today's (largely ‘underground’) organ trade: … far
from being a reason to continue the ban on sale, the dreadfulness of present practice may be a reason to discontinue prohibition, so
that the organ trade can be brought ‘overground’ and properly regulated. Different scholars have different views about the precise
scope and extent of the regulation required, but most support the requirements that organ sellers give valid consent, are paid a
reasonable fee, and are provided with adequate medical care. Taylor (2005, 110) for example, says that: At minimum … a market
should require that vendors give their informed consent to the sale of their kidneys, that they not be coerced into selling their
kidneys by a third party and that they receive adequate post-operative care. One noteworthy policy proposal comes
from Erin and Harris (1994; 2003) who suggest that a market in human organs should have the
following features: It is limited to a particular geopolitical area, such as a state or the European Union, with only citizens or residents
of that area being allowed to sell or to receive organs. There is a central public body responsible for making (and
funding) all purchases and for allocating organs fairly in accordance with clinical criteria. Direct
sales are banned. Prices are set at a reasonably generous level to attract people voluntarily into the
market.
This approach would maximize organ sales while avoiding common objections –
negative arguments must be linked to government purchasing rather than an
unregulated market
Erin and Harris 3 Charles A Erin and John Harris, Institute of Medicine, Law and Bioethics, School of Law,
University of Manchester J Med Ethics 2003; 29 :141 Janet Radcliffe Richards on our modest proposal
http://jme.bmj.com/content/29/3/138.full.pdf+html
Thus when Radcliffe Richards says: “Of course there is something undesirable about a one way international traffic from poor to
rich; but that is not enough to settle the all things considered question of whether it should be allowed” she is again right. It is
not enough to settle that question. Our paper was not trying to settle that question. 2 We have proposed a scheme
that would maximise organ sales by meeting the most common and persistent objections
to commerce in body parts. In our paper we note that:“In 1994, we made a proposal in which we outlined possibly the
only circumstances in which a market in donor organs could be achieved ethically, and in a way that minimises the dangers
normally envisaged for such a scheme” and this is the proposal that we repeat in abbreviated form. The claim we make, which it
seems Radcliffe Richards judges tobe too strong, is that our proposal outlines “possibly the only circumstances in which a
market in donor organs could be achieved ethically”; but note that there is a qualification to this claim, namely that if the first
part of our claim is true it is so because it defends organ sales “in a way that minimises the dangers normally envisaged for such
a scheme”. It may be that organ sales could be defended (possibly by Janet Radcliffe Richards and for that matter by the present
authors) in a way that does not minimise such dangers. But that is not what we were trying to do in our paper.
The legalization of sales, rather than purchases avoids problems with the unregulated
market
Gill 2 Michael Gill, Ph.D., Assistant Professor, Department of Philosophy, College of Charleston AND Robert
Sade, M.D.,Professor in the Department of Surgery and Director of the Institute of Human Values in Health Care,
Medical University of South Carolina. Kennedy Institute of Ethics Journal 12.1 (2002) 17-45
Paying for Kidneys: The Case against Prohibition http://muse.jhu.edu/journals/kennedy_institute_
of_ethics_journal/v012/12.1gill.html
First, we are arguing for the claim that it ought to be legal for a person to be paid for one of his or her
kidneys. We are not arguing that it ought to be legal for a potential recipient to buy a kidney in an
open market. We propose that the buyers of kidneys be the agencies in charge of kidney
procurement or transplantation; that is, we propose that such agencies should be allowed to use
financial incentives to acquire kidneys. We assume that allocation of kidneys will be based on
medical criteria, as in the existing allocation system for cadaveric organs. Kidneys will not be traded
in an unregulated market. 2 A similar system is currently in place for blood products: a person can
receive money for providing blood products, but one's chances of receiving blood are distinct from
one's financial status. We further note that transplant recipients or their agents—e.g., insurance
companies, Medicaid—pay for organs now, compensating the organ procurement organization that
organizes the organ retrieval, the surgeon who removes the organ, the hospital where the organ is
procured, and so forth. The only component of the organ procurement process not currently paid is
the most critical component, the possessor of the kidney, who is sine qua non for organ availability.
Second, we believe the legalization of kidney sales will increase the number of kidneys that are
transplanted each year and thus save the lives of people who would otherwise die. We base this
belief on two views that seem to us very plausible: first, that financial incentives will induce some
people to give up a kidney for transplantation who would otherwise not have done so; and second,
that the existence of financial incentives will not decrease significantly the current level of live kidney
donations. The first view seems to us to follow from the basic idea that people are more likely to do
something if they are going to get paid for it. The second view seems to us to follow from the fact
that a very large majority of live kidney donations occur between family members and the idea that
the motivation of a sister who donates a kidney to a brother, or a parent who donates a kidney to a
child, will not be altered by the existence of financial incentives. Although we think these views are
plausible, we acknowledge that there is no clear evidence that they are true. If subsequent research
were to establish that the legalization of kidney sales would lead to a decrease in the number of
kidneys that are transplanted each year, some of the arguments we make would be substantially
weakened. 3 Third, we are arguing for allowing payment to living kidney donors, but many of the
kidneys available for transplantation come from cadavers. [End Page 19] We believe that payment
for cadaveric organs also ought to be legalized, but we will not discuss that issue here. If we
successfully make the case for allowing payment to living donors, the case for payment for cadaveric
kidneys should follow easily. The Prima Facie Case for Kidney Sales With these preliminary points in
mind, we will proceed to the initial argument for permitting payment for kidneys. 4 This argument is
based on two claims: the "good donor claim" and the "sale of tissue claim." The good donor claim
contends that it is and ought to be legal for a living person to donate one of his or her kidneys to
someone else who needs a kidney in order to survive. These donations typically consist of someone
giving a kidney to a sibling, spouse, or child, but there are also cases of individuals donating to
strangers. Such donations account for about half of all kidney transplants. 5 Our society, moreover,
does not simply allow such live kidney donations. Rather, we actively praise and encourage them. 6
We typically take them to be morally unproblematic cases of saving a human life. The sale of tissue
claim contends that it is and ought to be legal for living persons to sell parts of their bodies. We can
sell such tissues as hair, sperm, and eggs, but the body parts we focus on here are blood products. A
kidney is more like blood products than other tissues because both are physical necessities: people
need them in order to survive. Our proposed kidney sales are more like the sale of blood products in
that both involve the market only in acquisition and not in allocation: the current system pays people
for plasma while continuing to distribute blood products without regard to patients' economic status,
just as we propose for kidneys. We do not typically praise people who sell their plasma as we do
people who donate a kidney to save the life of a sibling. At the same time, most people do not brand
commercial blood banks as moral abominations. We generally take them to be an acceptable means
of acquiring a resource that is needed to save lives. 7 It is doubtful, for instance, that there would be
widespread support for the abolition of payment for plasma if the result were a reduction in supply
so severe that thousands of people died every year for lack of blood products. If both the good donor
claim and the sale of tissue claim are true, we have at least an initial argument, or prima facie
grounds, for holding that payment for kidneys ought to be legal. The good donor claim implies that it
ought to be legal for a living person to decide to transfer one of his or [End Page 20] her kidneys to
someone else, while the sale of tissue claim implies that it ought to be legal for a living person to
decide to transfer part of his or her body to someone else for money. It thus seems initially plausible
to hold that the two claims together imply that it ought to be legal for a living person to decide to
transfer one of his or her kidneys to someone else for money. Of course, there seems to be an
obvious difference between donating a kidney and selling one: motive. Those who donate typically
are motivated by benevolence or altruism, while those who sell typically are motivated by monetary
self-interest. 8 The sale of tissue claim suggests, however, that this difference on its own is irrelevant
to the question of whether kidney sales ought to be legal, because the sale of tissue claim establishes
that it ought to be legal to transfer a body part in order to make money. If donating a kidney ought to
be legal (the good donor claim), and if the only difference between donating a kidney and selling one
is the motive of monetary self-interest, and if the motive of monetary self-interest does not on its
own warrant legal prohibition (the sale of tissue claim), then the morally relevant part of the analogy
between donating and selling should still obtain and we still have grounds for holding that selling
kidneys ought to be legal. There is also an obvious difference between selling a kidney and selling
plasma: the invasiveness of the procedure. Phlebotomy for sale of plasma is simple and quick, with
no lasting side effects, while parting with a kidney involves major surgery and living with only one
kidney thereafter. It is very unlikely, however, that there will be any long-term ill effects from the
surgery itself or from life with a single kidney. 9 Indeed, the laws allowing live kidney donations
presuppose that the risk to donors is very small and thus morally acceptable. The good donor claim
implies, then, that the invasiveness of the procedure of transferring a kidney is not in and of itself a
sufficient reason to legally prohibit live kidney transfer. If the only difference between selling plasma
and selling a kidney is the risk of the procedure, and if that risk does not constitute grounds for
prohibiting live kidney transfers, then the morally relevant part of the analogy between selling
plasma and selling a kidney still should obtain and we still have grounds for holding that kidney sales
ought to be legal. The point of the preceding two paragraphs is this: if we oppose the sale of kidneys
because we think it is too dangerous, then we also should oppose live kidney donations. But we do
not oppose live kidney donations because we realize that the risks are acceptably low and worth
taking [End Page 21] in order to save lives. So, it is inconsistent to oppose selling kidneys because of
the possible dangers while at the same time endorsing the good donor claim. Similarly, if we oppose
kidney sales because we think people should not sell body parts, then we should also oppose
commercial blood banks. But most people do not oppose blood banks because they realize that the
banks play an important role in saving lives. So, it is inconsistent to oppose selling kidneys because it
involves payment while at the same time endorsing the sale of tissue claim. 10 The considerable
emotional resistance to permitting kidney sales may be based on a combination of distaste for
payment and worry about risk. But if neither of these concerns on its own constitutes defensible
grounds for opposing payment, then it seems unlikely that the two of them together will do so. This
initial argument does not imply that we should legalize the sale of hearts and livers. The initial
argument holds only that, if it is medically safe for living people to donate an organ, then people
should also be allowed to sell that organ. But it is not medically safe for a living person to donate his
or her heart or liver. Our reliance on the good donor claim does, however, commit us to the idea that
if it is morally correct to allow someone to donate an organ or part of an organ, then it is morally
correct to allow someone to sell that organ or organ part. If, therefore, it is morally correct to allow
people to donate liver lobes and parts of lungs, then, according to our initial argument, it ought to be
legal for a person to sell a liver lobe or part of a lung as well. Our proposal does not address the
purchase of kidneys, which is a separate question. Many of the arguments against legalizing the
purchase of kidneys do not apply to the sale of kidneys. For example, one argument against
permitting the buying of kidneys is that it will lead to fewer kidneys for transplantation overall.
Another argument is that while allowing individuals to purchase kidneys might not reduce the overall
number of kidneys available for transplantation, it will reduce the number of donated kidneys and
harm the poor who will not be able to afford to buy a kidney. Both arguments rest on empirical
claims that are often stated as fact, yet have no supporting evidence. Even if the empirical claims
were accurate, moreover, their moral importance could be disputed. Perhaps there are powerful
moral reasons to legalize the buying of organs even if doing so leads to fewer organs overall or
reduces the chances of a poor person's receiving a kidney transplant. Then again, perhaps a negative
effect on the overall supply of kidneys or on the transplantation prospects [End Page 22] for the poor
will turn out to be a conclusive reason not to legalize the buying of kidneys. The important point is
that our proposal will not be affected either way. As already noted in our preliminary points, our
proposal can be reasonably expected both to increase the overall number of kidneys for
transplantation and to increase the chances that a poor person who needs a kidney will receive one.
Therefore, in arguing for the legalization of kidney sales, we put aside the separate question of
whether buying kidneys ought to be legal as well.
government purchaser avoids exploitation
Erin and Harris 3 Charles A Erin and John Harris, Institute of Medicine, Law and Bioethics,
School of Law, University of Manchester, J Med Ethics 2003;29:137-138 An ethical market in
human organs
http://jme.bmj.com/content/29/3/137.full
While people’s lives continue to be put at risk by the dearth of organs available for
transplantation, we must give urgent consideration to any option that may make up the
shortfall. A market in organs from living donors is one such option. The market should be ethically
supportable, and have built into it, for example, safeguards against wrongful exploitation.
This can be accomplished by establishing a single purchaser system within a confined
marketplace.
Inequality in ability to purchase is avoided with central purchasing
Radcliffe-Richards et al 98 J. Radcliffe-Richards, Department of Philosophy, the Open
University, Milton Keynes et al J; Daar, A S; Guttmann, R D; Hoffenberg, R; Kennedy, I; Lock,
M; Sells, R A;
Tilney, N The Lancet Volume 351(9120) 27 June 1998 pp 1950-1952 The case for allowing
kidney sales
http://elsa.berkeley.edu/pub/users/webfac/held/157_VIII.pdf
Another familiar objection is that it is unfair for the rich to have privileges not available to the
poor. This argument, however, is irrelevant to the issue of organ selling as such. If organ selling is wrong for this reason, so are
all benefits available to the rich, including all private medicine, and, for that matter, all public provision of medicine in rich
countries (including transplantation of donated organs) that is unavailable in poor ones. Furthermore, all purchasing
could be done by a central organization responsible for fair distribution. [12]
Coercion of the poor does not apply to central purchasing – experience with egg
donations proves
Sobota 4 Margaret R. Sobota, J.D. Candidate (2005), Washington University School of Law. Washington
University Law Quarterly Fall, 2004 82 Wash. U. L. Q. 1225 NOTE: THE PRICE OF LIFE: $ 50,000 FOR AN EGG, WHY NOT
$ 1,500 FOR A KIDNEY? AN ARGUMENT TO ESTABLISH A MARKET FOR ORGAN PROCUREMENT SIMILAR TO THE CURRENT
MARKET FOR HUMAN EGG PROCUREMENT lexis
A. Arguments Opposing a Market for Organ Procurement
The main argument against establishing a market for organ procurement is economic coercion. n141
Market opponents insist that poor, destitute people from around the world will be forced into selling
their organs without making an in-formed decision. n142 There are several flaws with this argument.
n143 First, the economic coercion argument is based on the false premise that the prices donors will
be paid for their organs will be high enough to override their doubts and ethical concerns about
becoming a donor. n144 In the proposed market system for organ procurement, either OPOs or the
state will be paying the donors; thus preventing potential wealthy recipients from driving up the
prices paid for organs. n145 With only moderate prices being paid to organ donors, economic
incentives would likely not outweigh a donor's moral objections to donation, and thus no economic
coercion would occur. n146 Additionally, the current market system for egg donation suggests that
economic coercion would not be a problem in a market for organ procurement. n147 A majority of
egg donors are not poor or minority women, and the amounts paid to them for their donations are
usually not an "undue inducement to undergo the medical [*1246] risks involved." n148 These facts
suggest that if a system of financial compensation for organ donation were established, comparable
to the system already in place for egg donation, there would similarly be no economic coercion of
donors.
With sales limited to government purchasing transplants under the plan would be
based on medical need
Gill 2 Michael Gill, Ph.D., Assistant Professor, Department of Philosophy, College of Charleston AND Robert
Sade, M.D.,Professor in the Department of Surgery and Director of the Institute of Human Values in Health Care,
Medical University of South Carolina. Kennedy Institute of Ethics Journal 12.1 (2002) 17-45
Paying for Kidneys: The Case against Prohibition http://muse.jhu.edu/journals/kennedy_institute_
of_ethics_journal/v012/12.1gill.html
The international black market in kidneys is worthy of moral condemnation, and the popular press
has been right to expose it. But the horrible stories do not constitute justification for a blanket
rejection of payment for kidneys in this country because there are two crucial differences between
the international black market and the legal domestic program we propose.
First, in our proposal the medical setting in which legal kidney transfer would take place is that of
contemporary transplantation, safe and medically sophisticated. Screening would select only
potential kidney sellers whose kidneys are suitable for transfer and whose medical condition predicts
minimal risk. Follow-up care would be scrupulous. Sellers would receive exactly the same medical
attention and treatment that living kidney donors now receive in this country. The people to whom
the kidneys are transferred will also receive the same medical attention and treatment that kidney
recipients currently receive.
Second, the domestic program we propose involves money only in the acquisition of kidneys, unlike
the international black market. Allocation of kidneys would be based on medical criteria, as it is
today. No private individual would be able to buy a kidney outside the system. Poor individuals will
have just as much chance of receiving one of the kidneys.
The plan does not introduce the dollar sign into transplants. Organs are already paid
for by others in the transplant process
Boyer 12 J. Randall Boyer, J.D. candidate, April 2012, J. Reuben Clark Law School, Brigham Young University.
2012 Brigham Young University Law Review 2012 B.Y.U.L. Rev. 313 COMMENT: Gifts of the Heart ... and Other
Tissues: Legalizing the Sale of Human Organs and Tissues lexis
B. Commoditization Has Already Happened The societal interests supporting the prohibition of organ
sales also assume that quantifying the value of the human body is bad. n137 However, the current
system, to which no ethical qualms are raised, in fact quantifies the value of the human body. n138
As such, an analysis of the consequences of quantification does not have to be simply hypothetical,
but can be based on current observation. In the context of this current commoditization, the ethical
objections to the sale are simply not as grave as when viewed in isolation. On an empirical level,
there is no disputing that the human corpse now has a substantial economic value. n139 And while
the law has prohibited at least the initial sale of organs, it has not prohibited the purchase of an
organ. n140 Simply put, to say that the law prohibits attaching a price tag to a donated organ is to
ignore reality. n141 The high demand and willingness to pay for organs, coupled with the short
supply, has created a lucrative business for organ-brokering middlemen, who flip essentially costless,
donated organs for large profits. n142 In fact, the prices at which organs are traded are [*334] so
high that they have enticed many to undertake more creative methods of procurement. n143
Further, organs are often subject to a string of transactions in which they are appraised and
exchanged for money. Organs are first donated by individuals, then sold by hospitals to tissue banks,
then sold by tissue banks to biotech companies, then processed and refurbished before being sold to
hospitals and dentists, and finally implanted into the "end-consumer." n144 At each of these
transfers - with the exception of the very first - money is exchanged for the organ. n145 Perhaps
more importantly, current jurisprudence recognizes a legal interest in the organ of each of these
players in each transaction - again with the exception of the first - and has validated sales contracts
for human tissue. n146 Thus, both markets and the law itself treat organs as a commodity in all but
one of the series of transactions from donor to recipient.
The ban is limited to organs. Tissue can be sold.
Calandrillo 4 Steve P. Calandrillo, Associate Professor, Univ. of Washington School of Law. J.D., Harvard Law
School. B.A. in Economics, Univ. of California at Berkeley. George Mason Law Review Fall, 2004
L. Rev. 69 ARTICLE: Cash for Kidneys? Utilizing Incentives to End America's Organ Shortage lexis
13 Geo. Mason
The objections to human organ sales detailed above all contain some merit, but lose some of their
force upon closer analysis and further ignore the reality that markets in human body parts and
products are, for all practical purposes, unavoidable. n176 Morality concerns opposing
commodification of the human body are somewhat hypocritical when one considers that we allow
the explicit payment of cash for human tissues, blood, semen and ova. n177 We also have no moral
qualms about requiring individuals to pay for medical care in general, without which their health and
lives can be expected to suffer. The argument regarding the distributive justice impact of allowing
sales (i.e., that the poor would be sellers, and only the rich could be buyers) ignores the fact that
organ transplants are still rationed on the basis of ability to pay today. n178 Further, distributive
inequity could be partially cured by providing government subsidies to enable the poor to have equal
access to available organs. n179 [*106]
The ban is limited to organs for transplant. Sales for research are not prohibited.
Boyer 12 J. Randall Boyer, J.D. candidate, April 2012, J. Reuben Clark Law School, Brigham Young University.
2012 Brigham Young University Law Review 2012 B.Y.U.L. Rev. 313 COMMENT: Gifts of the Heart ... and Other
Tissues: Legalizing the Sale of Human Organs and Tissues lexis
n150. As mentioned previously, the price for a kidney has reached $ 90,000. Steinbuch, supra note
96, at 1562. Further, research institutions pay large sums of money for fresh and frozen cadavers or
parts thereof. Cheney, supra note 12, at xv. For an interactive display based on the same information,
see Body Parts Pipeline, USA Today,
http://www.usatoday.com/money/graphics/body_parts/flash.htm (last visited Jan. 18, 2012). Also,
one website has set up a cadaver calculator whereby, after answering a series of questions regarding
lifestyle, one can find out how much her body would be worth in the event of her death. The Cadaver
Calculator: How Much Is Your Body Worth?, Cadaver Calculator,
http://www.oneplusyou.com/bb/cadaver (last visited Jan. 18, 2012).
Contention 4 is risk calculus
Evaluating risk with a one percent doctrine makes life impossible – everything
could theoretically cause extinction
Meskill 09 (David, professor at Colorado School of Mines and PhD from Harvard, “The "One Percent Doctrine" and
Environmental Faith,” Dec 9, http://davidmeskill.blogspot.com/2009/12/one-percent-doctrine-and-environmental.html)
Tom Friedman's
piece today in the Times on the environment (http://www.nytimes.com/2009/12/09/opinion/09friedman.html?_r=1) is
one of the flimsiest pieces by a major columnist that I can remember ever reading. He applies Cheney's "one percent doctrine"
(which is similar to the environmentalists' "precautionary principle") to the risk of environmental armageddon. But this
doctrine is both intellectually incoherent and practically irrelevant. It is intellectually
incoherent because it cannot be applied consistently in a world with many potential disaster scenarios.
In addition to the global-warming risk, there's also the asteroid-hitting-the-earth risk, the
terrorists-with-nuclear-weapons risk (Cheney's original scenario), the super-duper-pandemic risk, etc.
Since each of these risks, on the "one percent doctrine," would deserve all of our
attention, we cannot address all of them simultaneously. That is, even within the one-percent
mentality, we'd have to begin prioritizing, making choices and trade-offs. But why then should we only make
these trade-offs between responses to disaster scenarios? Why not also choose between them and other, much more cotidien,
things we value? Why treat the unlikely but cataclysmic event as somehow fundamentally
different, something that cannot be integrated into all the other calculations we make? And in fact, this is how we behave all the
time. We get into our cars in order to buy a cup of coffee, even though there's some chance we
will be killed on the way to the coffee shop. We are constantly risking death, if slightly, in order
to pursue the things we value. Any creature that adopted the "precautionary principle" would sit at
home - no, not even there, since there is some chance the building might collapse. That creature would neither be able to act, nor not
act, since it would nowhere discover perfect safety . Friedman's approach reminds me somehow of Pascal's
wager - quasi-religious faith masquerading as rational deliberation (as Hans Albert has pointed out, Pascal's wager itself doesn't add up: there may be a
God, in fact, but it may turn out that He dislikes, and even damns, people who believe in him because they've calculated it's in their best interest to do
so). As my friend James points out, it's
striking how descriptions of the environmental risk always describe
the situation as if it were five to midnight. It must be near midnight, since otherwise there would
be no need to act. But it can never be five *past* midnight, since then acting would be pointless
and we might as well party like it was 2099. Many religious movements - for example the early Jesus
movement - have exhibited precisely this combination of traits: the looming apocalypse, with the
time (just barely) to take action.
Prefer the affirmative’s impacts to highly specific long term disadvantages –
cognitive bias means you will think their impact is better than it really is
Yudkowsky 06 [Eliezer, 8/31/2006. Singularity Institute for Artificial Intelligence Palo Alto,
CA. “Cognitive biases potentially affecting judgment of global risks, Forthcoming in Global
Catastrophic Risks, eds. Nick Bostrom and Milan Cirkovic, singinst.org/upload/cognitivebiases.pdf.
The conjunction fallacy similarly applies to futurological forecasts. Two independent sets of professional
analysts at the Second International Congress on Forecasting were asked to rate, respectively, the probability of "A complete
suspension of diplomatic relations between the USA and the Soviet Union, sometime in 1983" or "A Russian invasion of Poland,
and a complete suspension of diplomatic relations between the USA and the Soviet Union, sometime in 1983". The second set of
analysts responded with significantly higher probabilities. (Tversky and Kahneman 1983.)
In Johnson et. al. (1993), MBA students at Wharton were scheduled to travel to Bangkok as part of their degree program. Several
groups of students were asked how much they - 6 - were willing to pay for terrorism insurance. One group of subjects was asked
how much they were willing to pay for terrorism insurance covering the flight from Thailand to the US. A second group of subjects
was asked how much they were willing to pay for terrorism insurance covering the round-trip flight. A third group was asked how
much they were willing to pay for terrorism insurance that covered the complete trip to Thailand. These three groups responded
with average willingness to pay of $17.19, $13.90, and $7.44 respectively.
According to probability theory, adding additional detail onto a story must render the story less
probable. It is less probable that Linda is a feminist bank teller than that she is a bank teller, since all feminist bank tellers are
necessarily bank tellers. Yet human psychology seems to follow the rule that adding an additional
detail can make the story more plausible.
People might pay more for international diplomacy intended to prevent nanotechnological warfare by China, than for an
engineering project to defend against nanotechnological attack from any source. The second threat scenario is less vivid and
alarming, but the defense is more useful because it is more vague. More valuable still would be strategies which make humanity
harder to extinguish without being specific to nanotechnologic threats - such as colonizing space, or see Yudkowsky (this volume)
on AI. Security expert Bruce Schneier observed (both before and after the 2005 hurricane in New Orleans) that the U.S.
government was guarding specific domestic targets against "movie-plot scenarios" of terrorism, at the cost of taking away resources
from emergency-response capabilities that could respond to any disaster. (Schneier 2005.)
Overly detailed reassurances can also create false perceptions of safety: "X is not an existential risk and you
don't need to worry about it, because A, B, C, D, and E"; where the failure of any one of propositions A, B, C, D, or E potentially
extinguishes the human species. "We don't need to worry about nanotechnologic war, because a UN commission will initially
develop the technology and prevent its proliferation until such time as an active shield is developed, capable of defending against all
accidental and malicious outbreaks that contemporary nanotechnology is capable of producing, and this condition will persist
indefinitely." Vivid, specific scenarios can inflate our probability estimates of security, as well as
misdirecting defensive investments into needlessly narrow or implausibly detailed risk
scenarios.
More generally, people tend to overestimate conjunctive probabilities and underestimate
disjunctive probabilities. (Tversky and Kahneman 1974.) That is, people tend to overestimate the
probability that, e.g., seven events of 90% probability will all occur. Conversely, people tend to
underestimate the probability that at least one of seven events of 10% probability will occur.
Someone judging whether to, e.g., incorporate a new startup, must evaluate the probability that many individual events will all go
right (there will be sufficient funding, competent employees, customers will want the product) while also considering the likelihood
that at least one critical failure will occur (the bank refuses - 7 - a loan, the biggest project fails, the lead scientist dies). This may
help explain why only 44% of entrepreneurial ventures3 survive after 4 years. (Knaup 2005.)