Why not have a system that works?

We’re really not impressed with this argument about organ donation. Not at all impressed in fact. For the actual argument is that we should abandon any thoughts of whether a system actually works or not – you know, saves lives – and instead we should concentrate upon how we all feel about it. What does our system say about the sort of society we want to be?

This does rather mean that we’ll end up with the system which kills people but makes certain dilettantes feel good. Not a useful trade off. This all starts at the ASI:

Sure, it sounds sensible. People die waiting for organ transplants, other people die with organs that could potentially be transplanted. Confiscate that second stock to feed the need, why not?

Well, the why not is, quite apart from anything else like “Our Bodies Alone” and such slogans is that it doesn’t damn well work. For near all of us die, even if with organs intact, with the organs in no fit state for transplant. There just aren’t enough of us who die healthy enough that is.

Opt out organ donations systems do not in fact solve our basic problem, a supply of organs for transplant. We know this because Wales has tried it and they got….well, how many new transplants do you think they got from this? The actual number is none. Nationalise the corpses of an entire nation and gain exactly nothing from it.

The correct answer is a paid market in live donations of course. There is only one country in the world without people dying on dialysis while they wait for a kidney. There is also only one country where live donors are paid – and paid well, something around a year’s median household income – for their kidney. It is not a coincidence that the two places are the same, Iran. Transplants are also cheaper than dialysis over time, that’s exactly why the Mullahs instituted the system. Islam can be very practical in such things, during the post-revolution sanctions they noted that they couldn’t afford to keep people on dialysis for a decade. So, they didn’t, and brought in the paid market for live donors instead. Deaths and costs fell, life expectancies rose. Good policy really.

But back to England’s recent nationalisation of the corpses:

According to the BMJ, ‘Welsh opt-out law fails to increase organ donations.’ There has been no significant increase in donation as a result of the change from opt-in to opt-out.

When you think about it (and I suspect few have), this is not totally surprising – because it’s relatively rare that a death will result in organs being available and suitable for transplant. It pretty much requires the donor to be relatively young and healthy, which typically implies being in accident, as a result of which they die in hospital, so the organs can be harvested quickly.

However, I think in terms of social benefit, the opt-out system may well be worthwhile even if it doesn’t do a lot to increase the number of donated organs. It says that we, as a society, care for each other.

That is, damn the effectiveness and let’s do it for the feelz. This is not how public policy should be made.

Leading to the important point about why not. Let’s say that we do run policy for the feelz. Many are uncomfortable with the idea of paying for kidneys. No, not for any rational reason and that’s fine, there’s no natural law which says we all must be calculating machines. It’s just icky, bringing money into this. So, now we bring that vague distaste into law making and we end up ruling out the system which works, paid live donation.

The reason we shouldn’t be doing it for Teh Feelz is because people die. And how do you feel about that then?

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10 COMMENTS

  1. I think they are hiding behind the feelz. I don’t think they really feel it. The impetus for this is coming from the doctors and the civil servants. Not people big on the feelz because their careers do not depend on re-election. Their spin doctors have just told them this is how to sell it.

    I think the real driving motive is that they really do see us as cattle rather than equal citizens. They want our organs and damn it they are going to take them. Whatever we want.

    I look forward to an apology to the doctors involved in the Alder Hay scandal. How truly ahead of their time they were:

    https://en.wikipedia.org/wiki/Alder_Hey_organs_scandal

  2. I think they are hiding behind the feelz. I don’t think they really feel it. The impetus for this is coming from the doctors and the civil servants. Not people big on the feelz because their careers do not depend on re-election. Their spin doctors have just told them this is how to sell it.

    I think the real driving motive is that they really do see us as cattle rather than equal citizens. They want our organs and damn it they are going to take them. Whatever we want.

    I look forward to an apology to the doctors involved in the Alder Hay scandal. How truly ahead of their time they were:

    https://en.wikipedia.org/wiki/Alder_Hey_organs_scandal

  3. My wife worked ICU for many years and based on what’s she’s said most Doctors don’t like asking or don’t want to ask grieving relatives about organ donation, the window to decide is very small. I can see it’s got to be a difficult conversation to have with Someone whose loved one has just died. Opt out means the doctors don’t have to ask the relatives or that’s the way they would like it to work, in reality I can’t see them getting out of it that easily

  4. My wife worked ICU for many years and based on what’s she’s said most Doctors don’t like asking or don’t want to ask grieving relatives about organ donation, the window to decide is very small. I can see it’s got to be a difficult conversation to have with Someone whose loved one has just died. Opt out means the doctors don’t have to ask the relatives or that’s the way they would like it to work, in reality I can’t see them getting out of it that easily

  5. As the ideal donor is young and braindead with organs in good working order perhaps motorcyclists should be rewarded for their choice of transport. Consent assumed with a cash consideration from a grateful NHS(corneas, heart, lungs, liver, bone) pro rata to the estate.

  6. As the ideal donor is young and braindead with organs in good working order perhaps motorcyclists should be rewarded for their choice of transport. Consent assumed with a cash consideration from a grateful NHS(corneas, heart, lungs, liver, bone) pro rata to the estate.