COLLAPSE You might have heard not too long ago about a case involving a New Jers

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COLLAPSE

  You might have heard not too long ago about a case involving a New Jersey company called Biomedical Tissue Services, which was accused of selling processed body parts from stolen cadavers. Bone and tissue from some of these bodies turned up in Joplin, Missouri, and were used in surgeries performed recently in both of our local hospitals. They have of course turned up in many other places also.   

The body parts processing industry is a largely unknown but very lucrative –and usually legal – industry that takes tissue, bone, tendons, ligaments, heart valves, corneas, and various other body parts, processes them, and turns them into products that can be used in various kinds of surgery. Some 20,000 bodies are “ processed” in this way in the U.S. each year. Typically, a family will consent to the donation, and the body is then taken by a non-profit body harvesting foundation. This foundation then passes the body on to various specialized companies for a token price, and these companies then harvest the different body parts, and process and sell them to medical supply companies, which then sell them to hospitals. Every one makes a profit in these transactions except the donor and the donor’s family. It is estimated that a single donor body can generate the raw material for products that sell for up to a total of $220,000.00. If vital organs are included, the body might generate up to a $1,000,000.00 worth of products. The ethical dilemma I would like you to discuss here concerns the question of whether families of donors should be paid for body parts donations? Is it fair that others make a handsome profit from the sale of body parts, but those who “donate” them don’t? If you think people or their families should be paid when they donate, do you feel the same way about vital organs like hearts, lungs, kidneys, etc.?

For your information – and at risk of making this posting overly long – here is some more information about what body parts can be donated and how they are used. Cadaver skin is used both for burn victims and in cosmetic surgery, and skin from a single donor can be turned into product that can be sold for several tens of thousands of dollars. Tendons and ligaments are of course used in knee and joint surgery and they can cost patients thousands of dollars each. Corneas can fetch $2400.00 per pair. A heart valve costs around $7000.00. One catalogue lists 650 body parts products that can be purchased. Separate bones are harvested, and bones are also fashioned into various sizes and shapes, and ground down to powder form and used in bone paste, screws, wedges, and putty. Products are typically freeze dried or frozen so that they can remain useable for up to five years after harvesting.

U.S. law requires that body parts be harvested only from donors who have signed consent forms. There is also rigorous medical testing that is required, including screening for HIV, Hepatitus B and C, and syphilis. Needless to say, none of this testing was done on the cadavers stolen by Biomedical Tissue Services. This company is now out of business and its former owner, Michael Mastromarino, is in jail. Surely, we all agree that what Mastromarino’s company did was wrong, but what do you think of the larger question? When companies make hundreds of thousands of dollars from donated body parts, is it fair that the donors and their families get nothing?

Explanation / Answer

Since some people actually end up losing money when they give an organ, one idea is to take away any financial obstacles that might hinder someone from making a living donation. While some people who favor these types of incentives will not go as far as to say donors should benefit financially, they do agree that donors should not be put at a monetary loss for their altruism. For example, in the rare case that donors experience complications from the procedure, they may have to pay for lifelong medical treatment. Others may have to pay for their travel to and from the hospital, or they may lose money when they take time off work after the procedure. The main reason we support reimbursement is that it’s the right thing to do for the living donors. But one would hope that it would alleviate some concerns that potential living donors might have. Providing initiatives to remove financial disincentives may increase living donation. And providing them with reimbursements for medical care or even health insurance in case they change jobs and are not covered due to a preexisting condition may ease their worries about being a donor. Imagine if people were not just reimbursed, but actually paid for their kidneys. Some people think that a regulated system could be put in place in which true financial incentives — ones that result in financial gain — are provided to donors. This incentive could be a cash payment, or something less direct, like lifetime health insurance. One of the biggest fears with introducing financial incentives is that it might lead to an organ market and create a situation in which the rich could exploit the poor for organs. Once you insert monetary gain into the equation of organ donation, now you have a market. Once you have a market, markets are not controllable, markets are not something you can regulate. The problem with markets is that rich people would descend upon poor people to buy their organs, and the poor don’t have any choice about it. However, a system could be overseen by transplant professionals who would screen donors and decide if they are healthy enough to donate. This system would be drastically different from the organ trafficking schemes which are unregulated systems where the middleman who purchases the organ for a recipient has no interest in the health of the donor. Extremely poor people could also be excluded from the system. Poverty is associated with a high risk of kidney disease, and thus an exchange involving a very poor donor would not benefit either party. Removing poor people from the system would also prevent this group from being exploited by those with more money. However, the fear of exploitation as a reason to omit the poor from this system with incentives. I don’t think the mere fact of being poor renders poor people incapable of making decisions that materially affect their lives.There wouldn’t be any discrimination [regarding] the recipients’ socioeconomic status; organs would really be allocated according to medical criteria and not by how much money the recipient has. However, those opposed to financial incentives argue that the risk of slipping from incentives into a market is too big to take. And there’s no reason to think a market in organs would work any differently. Additionally, there is a concern that certain religious groups would be turned off by the idea of financial incentives. If individuals in these groups stopped donating organs, the organ supply could actually decrease. And even if incentives are put in place, they may still not persuade many people to provide their organs for transplant. “There’s not a lot of evidence that what is stopping people from giving organs when they’re alive or when they die is money. While almost everyone is in agreement that the disincentives need to be removed, there is great debate about whether or not to provide financial incentives, with people passionate on both sides. If financial incentives were ever put in place, they would most likely first need to go through pilot trials to test out different systems. They could be carried out in a few regions in the country and conducted like research studies, with both a trial and follow-up period. However, before any studies could take place, the National Organ Transplant Act would need to be lifted for that area. “Right now we’re not even close to there yet. Meanwhile, the waitlist problem remains. “As we have these debates about what to do, the waiting list gets longer and the waiting times get longer. We need a radical change to our approach.I believe it is time for disruptive innovation, It is time to test incentives, to reward people who are willing to save the life of a stranger through donation…Altruism is not enough. Pilot trials of incentives are needed. Ethicists worry that an organ donation market would pressure poor people into selling their organs to make rent, while allowing rich people who are in need of a spare kidney to jump the line by offering bigger payouts.

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