Saturday, July 30, 2005

Organ Donation

This is a subject overwhelmingly fraught with emotion. There is a very thoughtful and intense discussion of it going on over at the Belmont Club. Scan for comments by Cedarford, who is a grimly logical person, very tough to counter, and a person who works on organ acquisition named TheNewGuy. It is a problem in the US, but was famously a greater problem in Italy when the son of some American tourists died there in 1994. Italians were astounded when the parents donated the boy's organs. For myself, I am listed as an organ donor on my driver's license and I have told my wife that I don't wish to be resuscitated if I am in a persistent vegetative state with no hope of recovering a decent quality of life.

The issue boils down to the fact that there are not enough available organs to meet the needs. If that could be changed, the emotional issues would disappear. I know this, because years ago the US went through exactly the same kind of crisis with kidney dialysis. I remember that the shortage of dialysis machines was used in Socratic classroom discussions modeled on the Fred Friendly seminar style, pushing the necessary decisions ever closer to the emotional stress points, turning the issue into Sophie's Choice. Who gets to choose, who goes first, who dies?

My recommendation would be that people should get points to move up places in the line for every year they have been on the organ donor list. Their children would also benefit from this choice. I think that would be enough incentive to eliminate the problem.

7/30/2005 11:19 PM

The issue relates to the Schiavo case, which I have discussed here and here.

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At Sunday, July 31, 2005 7:53:00 PM, Blogger mal said...

JJ, organ transplantation is a technology that is still not well developled. I have a feeling that as medical technology develops and improves the need for transplants will fall to a point where they can meet the available supply.

As a parallel case, I would point out the improvements in angioplast and stent technology that is drastically reducing the need for Coronary Artery Bypass surgery

As a topic for your consideration, Heart transplants, does having medical insurance pay for it make sense? Some real ethical quandries involved in that topic

At Monday, August 01, 2005 12:31:00 PM, Blogger jj mollo said...

I accept your argument that the whole organ transplant issue may eventually become moot due to other advances in technology. Certainly, the whole dialysis argument became moot when the equipment became cheap enough and sufficiently distributed to allow most Americans access. Both of them reduce to the basic poverty argument. How do we help people who can't afford medical care?

Addressing your question on heart transplants. I don't understand why this would be any different than angioplasts, stents, bypass surgery, or beta-blockers except for the acquisition issue. Are hearts any more important to a dead person than a liver or a kidney or corneas? If the doctor prescribes it as the appropriate solution, shouldn't the insurance cover it? The only ethical problem that I see is the possibility of pressure for premature harvesting. The definition of death is an ethical debate well worked over, without direct relationship to the funding issue. Please elaborate!

At Tuesday, August 02, 2005 8:17:00 AM, Blogger mal said...

JJ, I raised the issue of heart transplants because a recipient costs do not end with the surgery. There was a local company with 30 employees where one had recieved a transplant paid for by insurance ($130K) the ongoing follow up costs exceeded $40K per year. The insurance company was losing money. Guess what happened when the policy came up for renewal? Rates quadrupled for everyone on the policy.

I am not a fan of insurance companies but sometimes we all have a tendency to view insurance as a "pool" of money that is just out there. It is not. The question here is it fair for everyone else to pay huge premium increases for an individual who if lucky will last 5 more years? These increases can cut significantly into funds for kids college, new homes etc.. I just do not know, and if so where is the divding line?

At Sunday, August 07, 2005 3:34:00 PM, Blogger jj mollo said...

What is it you want insurance to do? Personally, I want it to come to my rescue when my medical needs become too much for me to handle. I don't want to be ruined financially because of an expensive illness.

The problem with insurance in small business is that it doesn't really accomplish the purpose of insurance. It doesn't spread the burden far enough or fairly. Small businesses always want to do things on the cheap, for which you can't blame them, but cheap insurance can be useless insurance.

Theoretically there must be a financial upper limit on what an insurance company can ethically be expected to bear. I don't think life saving heart surgery falls anywhere close to that limit, but rather represents the reason we all want insurance.


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