The Instigator
PervRat
Pro (for)
Winning
17 Points
The Contender
Realist
Con (against)
Losing
16 Points

Living Organ Donors Should Be Allowed to be Compensated

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Voting Style: Open Point System: 7 Point
Started: 10/3/2009 Category: Health
Updated: 5 years ago Status: Voting Period
Viewed: 11,957 times Debate No: 9597
Debate Rounds (5)
Comments (13)
Votes (6)

 

PervRat

Pro

A lot of Americans check the box when getting their driver's license renewed to be an organ donor so that, in the event of their own death, their organs can be used to save the life of someone else in need or in research.

A lot of Americans also donate blood and get some compensation for this.

A lot of Americans also volunteer to participate in experimental research trials of new medications, before risks and side effects of the medicines are known.

There are a few Americans who volunteer to become living organ donor, giving up a part of their body -- such as one of their two kidneys -- for which such a sacrifice does not bring serious long-term harm, but someone else on, say, dialysis faces much lowered quality of life and may die from their failing kidneys.

The ratio of those in need of organ donation to willing donors has been getting steadily worse. In 1980, those in need of transplant were on waiting list for organs on the order of 1 year. Today, the average wait time is 6 years with many having to wait more than a decade. Eight percent -- about one in 12 -- patients die waiting for a needed transplant. Clearly, the supply has been dropping relative to demand.

There has been some very despicable activity going on human organ trafficking. Some people are outright abducted and their organs taken without their knowledge or consent, especially from third-world countries. Many more are coerced or forced into it, and many more still are never educated about the costs and risks and do not know what it is they are getting into. Because of abuses like these, the United States currently has a complete and total ban on any form of compensation to living donors. No one who volunteers to donate an organ may receive even a small cash payment. The donor recipient's insurance coverage is required to pay for the donor's operation itself in giving up the kidney and a little after-care for, at most, a few weeks, but beyond that any risks or lasting consequences are entirely at the risk of the donor. Often, the donor is also responsible for paying their own travel and lodging expenses to get to and stay in the city with the recipient to actualy donate, though technically the law does not ban recompense for those specific expenses.

I argue that, while well-intended, this ban on compensating organ donors is an obstruction that reduces the supply of much-needed living donors and very regulated but navigable paths should be created in law to allow willing donors of sound mind and body to be offered and provided compensation for sacrificing their organs that someone else needs to survive with a decent quality of life.

CON will need to argue the contrary.

I do not follow any formal format, CON is free to use any debate format for his/her arguments.
Realist

Con

Hi there,

Thank you for posting this debate. I commend your choice of topic, as it is far from one-sided and quite controversial. I anticipate, and hope for, an interesting exchange. I plan on using this round for more of a rival opening statement similar to my opponent's, and going into detail and focusing on more detail in later rounds.

I'll start out by saying that I agree with my opponent that it is alarming how much demand there is for organs verses how few donations are available. I also agree that it would certainly be in everyone's best interest to encourage a higher rate of donorship within the general community. Where we differ, however, is in our approach to what the best method is of encouraging better donorship and helping to alleviate the shortage of supply of organs. My opponent suggests that an effective way would be to allow the compensation of living donors by financial or some other means. I want to argue not only that this is a flawed method of solving the mutually recognized problem, but that there are also better and more ethical solutions.

Just for the sake of clarity, by the way, is it your position that allowing compensation for living donors is the best way to address the problem of organ donor shortage, or merely that it is a suitable method among other potentially equal or superior options?

My opponent rightly states that at present there is a ban on compensation being offered in exchange for organ donation, due to the National Organ Transplant Act (NOTA) of 1984 [1] in the United States. The reason for the ban on the sale of human organs, which is also my own main objection to the practice, is that it would likely create a market for organs which will only serve to exploit the poor. It concerns me that the poor will be the ones who are coerced into selling off their organs as if their body were a walking marketplace.

The primary purpose of the NOTA was to set up a system of fairly distributing organs to donors in need. Under this act recipients are not discriminated against based on gender, ethnicity or financial status. Patients in need of a transplant are placed on a National Health Service (NHS) waiting list and receive organs accordingly when they become available. To the best of my knowledge there is no significant evidence from academic studies or other official means that would suggest that allowing compensation for organs would greatly decrease deaths of patients while waiting on transplants. At this point it's anybody's guess, but I would assume that implementing financial compensation would only serve to shift the demographic of organ recipients away from a currently equal distribution and towards the more wealthy. I would think that while some people would certainly be encouraged to donate organs who otherwise would not have, the already existing donors and prospective donors would be discouraged from doing so. The demand for organs will always likely remain higher than the supply also, so prices for organs will become competitive, thus eliminating the poor from being likely to receive a transplant.

At present, there are around 30% more organ donations received in the U.S. each year from deceased organ donors than from living [2]. As well as constituting a higher number, there are a larger variety of organs able to be obtained from cadaver donations than living, the latter contributing only a kidney 90% of the time [1]. It seems to me that the best strategy to alleviate the problem of donor shortages would be to attempt to encourage more people to sign documentation giving permission for their organs to be removed and transplanted in the event of their death.

In the U.S. there are only around 25% of people willing to donate their organs in the event of their death, whereas in many European countries there are 90% who are willing [3]. What's the difference? Are Europeans more generous than Americans? In fact the main difference is that in these European countries you are automatically considered a donor unless you sign paperwork to indicate otherwise while in the U.S. it is the other way around; You are considered to not be a donor unless you specifically indicate otherwise. The biggest similarity between America and Europe is that they both have a comparable proportion of people that don't tick the box concerning organ donation on their driver's license application. This seems to indicate that the majority of people in both Europe and America probably just don't give it much thought or don't wish to make a special decision either way.

My first alternative to my opponent's proposal of financial compensation is for America, as well as my country of Australia and any other countries that have a similar policy, change their deceased donor permission form to adopt organ donation as a default unless specifically indicated otherwise. As simple and even laughable an idea as it is, this seems like it has the greatest potential to alleviate organ donor shortages if these statistics are anything to go on.

Another innovate step towards alleviating donor shortages which I believe is also morally and ethically superior to my opponent's proposition is giving some sort of priority of organs to patients who have previously indicated that they themselves are willing to donate their organs in the event of their death. Around half of all organs transplanted each year in the U.S. go to people who themselves are not willing organ donors because they are earlier on the NHS list while willing organ donors die waiting for a transplant [4]. This seems grossly unfair in my mind. In fact, a non-profit organization has been set up with this same idea in mind called Lifesharers.org [4]. They are an organization that requires compulsory organ donor status upon joining and gives priority to its own members in the event that a member dies and another member requires a transplant. At present, the organization has over 13,000 members and is steadily growing. It is my belief that if such priority ideals were put into practice on a larger scale it would prompt a large amount of people to become organ donors in the event of their death who otherwise wouldn't have because doing so would be a sort of free insurance for themselves.

In summary, I believe I have shown the negative implications of my opponent's suggested course of action and have provided multiple alternatives which I believe would not only be more effective, but are more morally and ethically sound.

I look forward to your next argument,
Rob.

References:

[1] http://cme.medscape.com...

[2] http://www.ustransplant.org...

[3] http://www.nytimes.com...

[4] http://www.lifesharers.org...
Debate Round No. 1
PervRat

Pro

I thank my opponent on accepting my challenge and posting his response.

I disagree that establishing alternatives, even preferable ones, to allowing compensation for living organ donors is not sufficient to win Con's case; I stipulate Con must establish that not only is compensation for living donors not the best option, but it causes so many problems without providing sufficient benefit such that it should not be allowed as an option at all.

I respect Con's referencing his statements to back up his claims, but it is apparent some information eludes him regarding the difference to the recipient of a receiving a live organ donation as opposed to one from a similar organ from a recently deceased person, and it is apparant Con also lacks information on the effects of compensating living donors on the waiting list.

On this first point, regarding whether organs donated from the recently deceased are just as good as live donors, a number of medical professionals disagree. [1] [2] [3] The outcome of the donation for the recipient is, generally, better for a live donor than one who has passed on. This is likely due to the fact that a live organ donor is generally brought to the hospital where the needy recipient is (unfortunately at their own expense, including travel, meals and lodging!) so the removal of the organ and transplant into the recipient happens all at once, with very little time the organ is dead and subject to decay. In a transplant from a deceased person, the organ has died the moment the donor has, and time spent finding what recipients the donor is most compatible with, removing the organ from the dead body, securing it for transport and then getting the organ to the recipient takes many hours during which the organ is decaying, suffering permanent damage before it can get to the recipient.

On the second point, there is in fact one nation that has authorized financial compensation of donors: Iran. In 1988, Iran began to allow live organ donors to be compensated, and the waiting list for recipients needing renal (kidney) transplants plummetted to zero in 1999 -- since 1999, no one needing a kidney transplant in Iran has had to wait for a donor. [4] In all other countries (no other permitting donors to be compensated), waiting lists are years long -- in the United States, waiting lists for kidneys range from 5 to, in some cases, more than 10 years. While Iran may not seem like a model for social justice, this medical practice I believe proves that compensating living donors definitely reduces the time those needing transplants of live-donatable-organs such as kidneys must wait to receive a transplant. This reduces deaths, since those waiting for an organ transplant can die as a result of the failure of that organ (renal failure, for those whose kidneys are failing).

[1] http://cme.medscape.com...
[2] http://www.kidney.org...
[3] http://www.mayoclinic.org... (see "The Pros and Cons of Living Donor Liver Transplant" about 2/3 down the page)
[4] http://cjasn.asnjournals.org...
Realist

Con

Hi again. I thank my opponent for his prompt response in the previous round.

Firstly, you said: "I disagree that establishing alternatives, even preferable ones, to allowing compensation for living organ donors is not sufficient to win Con's case".

Whether or not it was your actual intention, I feel that here you're making out that I'm dodging the primary issue and attempting to "win" the debate by establishing better alternatives. I never stated, nor implied, that I felt merely pointing out better alternatives was sufficient to win the debate. Clearly you're misinterpreting my question of whether or not your position happens to be that compensation for organ donors is the BEST (I'd use italics rather than caps, but the feature doesn't seem to be available on this site unfortunately) solution, or whether it is a viable solution among other potentially superior solutions. Also since you, either deliberately or inadvertently, failed to answer my question, I'll assume that you concede that your proposal is the inferior option in both an ethical and practical sense to other proposals but still feel it is viable. If this is not your position please correct me, as I do not wish to go on knocking down straw men.

I'm sure any fair-minded reader would agree that I did in fact begin to demonstrate problems with your proposal before offering alternatives. My reason for even proposing alternatives at all was to show that, apart from being grossly unethical, your proposal is also far from the only solution, or even from being the best solution to attempt at this point. I wanted to ensure that when assessing this debate readers wouldn't agree your proposal is flawed but consider it a necessary evil, so to speak. However, I grant that it may very well be the case that your proposal could be trailing several others in practicality (as I would say is certainly the case) but still be worth implementing. Therefore, as well as describing superior alternatives, I will address the problems with your proposal also.

You go on to say: "On this first point, regarding whether organs donated from the recently deceased are just as good as live donors, a number of medical professionals disagree."

Again, I feel this is an obvious caricature of my opening statement. And again, I appeal to the fairness of the readers: did I in fact claim that cadaver kidneys are "just as good" as those from live donors, or did I merely propose that various strategies to make better use of cadaver organs was a better strategy than financial compensation? However, since you brought it up, cadaver organs are only slightly less reliable than those obtained from living donors. At present, patients obtaining kidneys from living donors have a 97.9% survival rate after one year versus a 94.5% survival rate afte one year from cadaver donors [1]. I'd say that's more than an acceptable difference given that cadaver donations do not inflict massive negative effects on donors, since they are coming from the recently deceased, which I'll discuss shortly.

The case of Iran's waiting list for kidney transplant being reduced to zero certainly seems impressive at first glance, no doubt about it. However, it's not so clean cut. Sure, everyone needing a kidney transplant got one, and everyone who donated was compensated for it, albeit only a petty and insufficient sum of approximately $1,200, according to my opponent's sources. The mistake my opponent makes is that he looks at this scheme, notices that the waiting list has been abolished, and stops investigating there, concluding that this is a win-win situation. As I mentioned in the previous round the primary concern is the exploitation of the poor.

The poor are clearly the ones that will be pressured into selling off their organs for money. In Iran, for example, of those who participated in the kidney donation compensation scheme, only 13% were employed full-time [2]. The World Health Organization (WHO) shares my opinion that organ markets are vehicles to exploit the poor. They conclude that "research shows that the underlying motivation of most paid kidney donors is poverty, and that lasting economic benefit after donation is limited or even negative because of the limited employability of such patients and the perceived deterioration of their health ... Paid kidney donation is also associated with depression, regret and discrimination. Paid kidney donors do not receive follow-up care, due to financial and other reasons"[3].

Following donation, 65% of donors suffered negative effects on employment status [2], and over 70% suffered significant depression and feelings of isolation. Most donors felt ashamed, 94% of whom not wanting to be publicly recognized as donors [4]. 68% of the families of donors strongly disapproved of the organ sale, leading to domestic complication, and 21% of families getting divorced shortly after the procedure [4]. 80% of donors were greatly dissatisfied with their level of physical stamina following the donation [4], and given that the majority are unskilled labourers this is immensely significant.

In fact, even the Iranians that my opponent holds up as proving his case would disagree with him! Given the choice again, 85% of Iranians surveyed say they would not have sold their kidney and a stunning 76% even say that they think the practice of compensation for kidneys should be banned, and that they'd trade 10 years of their life for their kidney back [5]. Keep in mind this is coming from the mouths of the majority of the very Iranians that my opponent is citing. Reports by the reformist Iranian press also indicate that the these samples obtained are a good representation of other Iranian donors [5]. It seems the most accurate assessment my opponent gave of his Iran case study was that "Iran may not seem like a model for social justice".

I believe I've shown that it's pretty clear that compensation for organ donation will not, as my opponent claims, properly solve the very real problem of organ shortages. It will serve to create an inevitable mechanism by which the less fortunate are exploited for the gain of the wealthy.

Even if there were no alternatives, my opponent's proposal would not only be unethical and immoral, but downright disastrous. However, fortunately there are much better alternatives. For example, the two that I mentioned in the previous round (the 'opt out' approach of having every citizen a donor by default unless they choose not to be, and a preference given to those on the NHS waiting list who themselves have opted to be an organ donor in the event of their death. As well as that, another good suggestion is to reform the waiting list to make it more balanced. For example, Nancy Scheper- Hughes, professor of Anthropology at UC Berkeley and founder of the organization 'Organs Watch', notes in a radio interview - [6] - just how imperfect the waiting list currently is. For example, younger patients should have a preference over people ages, say, 55+. Also people can be listed multiple times on multiple regional lists, as well as people deemed inoperable also being listed. Clearly, the NHS waiting list could do with some cleaning up before we consider desperate approaches such as the proposal my opponent has put forward.

References:

[1] http://www.kidney.org... (table at point 20)

[2] http://www.who.int...

[3] http://www.who.int...

[4] http://www.ncbi.nlm.nih.gov...

[5] http://www.ncbi.nlm.nih.gov...

[6] http://www.wnyc.org... (Fast forward to around 20mins in for relevant comments on organ selling). It's quite a good discussion, I recommend it.
Debate Round No. 2
PervRat

Pro

To answer the question I apparently missed earlier, I agree that altruistic live donors would be the best option, but in terms of practicality, that has failed. Every nation dependent on altruistic donors winds up with a waiting list that gets longer with each passing year. Iran is the only nation with no waiting list for organs that can be donated live, and is the only nation that allows live donors to be compensated.

In terms of whether live donors offer benefit over cadaver organ donors, I believe I did thoroughly address that with references. Cadaver-originating organs tend to be less successful and need to be re-replaced much sooner than organs from living donors, due it is believed to better screening and less time from organ-death to transplant (since a live donor's organ would be still living inside of the donor when the donor is brought to the hospital, and would need minimal time to be physically moved to the recipient when the recipient is ready, so it is 'fresher' with less decay). There is also more haste due to needing to minimize the death-time of the organ, no time to double-check things whereas much more time can be afforded to ensure everything is proper with a living donor.

The current shortage is causing deaths and increasing wait times for recipients; supply is not keeping up with demand. The worse this gets, the higher the rates of death. I am sure that any fair-minded reader would accept that allowing donor compensations would be a far less evil than the deaths of recipients-in-need.

In terms of practicality, there is no better alternative. Allowing live organ donors to be compensated has been proven, in Iran, to eliminating wait times for recipients, similarly eliminating the death rate among recipients-in-waiting. No other system has proven up to the task of eliminating the waiting lists nor wait-deaths, which is the meter I use for practicality.

Regarding the points on live vs. cadaver organs, check my sources and you will find startling differences, such as a live organ transplant showing to have twice the organ-life of a cadaver transplant; in other words, an organ received from a cadaver will only have half the life, on average, as an organ from a live donor before it needs to be replaced. And your own numbers, while impressive showing, actually do show a stark difference: 97.9% surival rate means 2.1% death rate, or 1 in 47; a 94.5% survival rate means a 5.5% death rate, or 1 in 18. I wouldn't call that an insignificant difference; live organ donation is twice that, from your source, as cadaver organ donation ... combine this with the fact that many needing organs will die on the waiting list, and it adds even more to the practicality of allowing live donors to be compensated.

In terms of exploiting the poor, consider that it is a special rule to apply this to organ donation when the poor are far more likely to put their health and lives at serious risk for a little money in taking risky, relatively low-paying jobs such as that of soldiers, police and firefighters, high rise construction workers, etc. Does that mean we should eliminate paychecks for these occupations to eliminate the exploitation of the poor for these dangerous occupations? Also, in Iran, it is important to note that $1,200 goes much farther than it does, say, in the U.S.

In terms of failure to provide long-term care, that applies to uncompensated live donation as well -- no long-term care is provided for them, they must come up with the money to pay for that themselves in the U.S. I believe in not only compensating live donors with cash, but I also propose lifelong free medical and mental health care to deal with all side effects; currently, as I understand it, this too would be considered compensating a donor and is illegal!

The negative effects on employment are an obvious reason -to- allow donors to be compensated. Iran's suitability for social justice may not be ideal, but bear in mind Iran's regime is totalitarian. A better system could be worked out, but clearly Iran has at least eliminated the deaths on the recipient's side from waiting and from having live donations, the recipients are also more likely to survive well after the procedure.

Currently, the only ones who are suitable candidates to donate in the U.S. are those who are healthy, lucky enough to have health insurance to help them with the long-term side effects (the procedure itself and short-term care for the donor are handled by the recipient's health care plan), are wealthy enough to absorb the airfare, lodging and other costs of actually getting to where their organ is needed, and money to help them through loss of work and employment. Poor people have no choice -- they /cannot/ donate even if they want because the cost is too high!

My opponent's dismissal that my solution would eliminate waiting lists is false, and my opponent cannot point to any other system except Iran's that has eliminated the waiting list death tolls. Further, my opponent did not properly interpret his own data on the survivability benefits of live versus cadaver donation, resulting in his erroneous evaluation of a 1 in 18 chance of death in the first year from a cadaver donation to 1 in 47 chance of death for a live donation as not being significantly different, and he also ignores that a zero-waiting list means no deaths while waiting, meaning a lot of patients never even start their first year to be counted as among the 1 in 18!

I agree that altruistic donation is the most honorable, and do not like the fact that the poor are exploited in so many ways, putting their lives at risk just to feed their families ... but I see little difference in that between donating a live organ and enlisting in the military or putting their lives on the line in other dangerous, relatively low-paying operations. What's worse, allowing exploitation of the poor, or taking away money incentives that exploit the poor from all dangerous choices such as the life-risking professions?

I thank my opponent for continuing to contribute to this important debate, and I hope he is learning about this topic as much as I am in debating it, as well as the audience, of course.
Realist

Con

Hi again,

Firstly, it seems we're going around in circles a little so I just want to start by summarizing the argument thus far as I understand it. Please clarify anything that is out of place.

- We both agree that patients dying of organ failure is a tragedy, even more so because it is a preventable tragedy.

- We both agree that in an ideal world there would be enough volunteer donations from people who are well informed of the consequences of organ donation to cover the demand, but both realize that this is not the case.

- We both agree that an organ obtained from a live donor is of superior quality to one obtained from a person recently deceased.

- As far as I can see we both agree that allowing compensation for organ donation will almost certainly increase the amount of organs available for patients, but will also invariably lead to the exploitation of the poor.

- Where we seem to differ is that you feel that this exploitation is justified if it means more organs available for those in need. I, however, feel that this exploitation is not justified. Furthermore, it should not even be considered until all other morally superior options have been exhausted.

I hope that brings things into perspective a little more.

You seem to keep bringing up points that I've already conceded, such as refuting the idea that live organs are 'just as good' as cadaver organs. I don't believe I ever made the claim that they were just as good. What I'm saying is that, while cadaver organs are of an inferior quality, they are still good enough to save a person's life over 90% of the time. Cadaver organs also have the advantage of no negative side effects on others or society when they are being used to save a person's life. 1 in 47 is certainly better odds than 1 in 18. However, 1 in 18 deaths means 17 in 18 successful cadaver transplants. I grant that it could be better, but 17/18 is still a great success rate, hardly the problematic one my opponent makes it out to be.

Personally, I see absolutely no reason why EVERY deceased person's body should not be harvested of whatever organs would be beneficial to others. There is absolutely nothing lost by doing so since the person is already dead. Since I notice that only around a quarter of Americans are consenting organ donors [1], it seems to me that what we should be doing first of all is addressing the problem of so many potentially life saving organs going to waste. I have suggested two ways of going about addressing this problem, namely adopting an 'opt out' system of cadaver donor consent and prioritizing organs to people who are consenting donors themselves (see previous arguments for more details).

The two aforementioned alternatives have in fact been shown to increase the supply of organs and neither are being used in the United States. They both also have, as far as I can see, zero negative consequences. Another option (which isn't as effective as my two other suggestions, but is still superior to my opponent's, in my opinion) is addressing and reforming the NHS waiting list. According to Nancy Scheper-Hughes, who seems to be somewhat of an authority on organ transplantation, the current NHS waiting lists are not appropriately representative of the actual demand for organs. This is due to people deemed inoperable being included on the lists for whatever reason. Also the same people are apparently listed on several regional lists at once. Furthermore, prioritizing organs for people under, say, 55 or 60 seems a very reasonable approach also.

I assume, at this point, that Pro agrees with me that the alternatives I've listed would result in an increase in organ supply and efficiency, and that they are ethically superior to his own suggestion. I also assume that his reason for persisting with the notion that live organ donations should be compensated is due to one of, or a combination of, two things: 1. failing to realize the negative impact that his proposition will have; and 2. not accepting that the alternatives presented will make any significant difference.

I don't agree that allowing people to take on high-risk jobs is the same as allowing them to sell off their organs under the apprehension that their body is a potential marketplace waiting to be tapped into. As I mentioned in the previous round, a whopping 85% of Iranians surveyed who sold their kidneys and were compensated regretted the decision and said that, given the choice again knowing what they know now, they wouldn't have sold their kidney. I know people that have become, or are working towards, becoming fire fighters, policemen, etc. and they are motivated to do so by their desire to help people, not out of a false belief that they can make easy money. These people are to be commended, not insulted by representing them in the same category as compensated, unsatisfied and disgruntled poor Iranian organ donors who have clearly been exploited. Why not ask some local fire fighters, soldiers or policemen yourself if they regret their decision to pursue their respective career? I doubt 85% of them will say yes.

You seem to be missing the point entirely when you say things like "The negative effects on employment are an obvious reason -to- allow donors to be compensated." I want to stress again that the World Health Organization (WHO) concluded that "...the underlying motivation of most paid kidney donors is poverty, and that lasting economic benefit after donation is limited or even negative because of the limited employability of such patients and the perceived deterioration of their health. Results from other more qualitative research are consistent with these quantitative surveys in other countries." [2]. In short, the money incentive lures the poor into making a decision that they will most likely (85% of the time) regret making. The money they receive is like putting a band-aid on a broken leg, it doesn't go very far and they suffer for the rest of their life. Legalizing organ donor compensation is about as ethical as placing a poker machine in the lounge of an institution for recovering gambling addicts.

This is a real problem that we're facing that needs real solutions. For goodness sake let's investigate some solutions that are not moral and ethical abominations. It's no coincidence that systems of compensating organ donors have all been almost universally rejected worldwide as well as condemned by organizations like the WHO [2] and the Transplantation Society's ethics committee [3].

References:

[1] http://www.nytimes.com...

[2] http://www.who.int...

[3] http://www.transplantation-soc.org...
Debate Round No. 3
PervRat

Pro

I thank my opponent for continuing to respond, but despite asserting that he had conceded the point that live organ donations are superior to those from cadavers, he continues to insist the difference is minor, though I pointed out from his own statistics that a recipient has more than double the survival rate from receiving a live organ than one from a body, and that means extra deaths result if the only focus for organ donations are post-death donations. While dead organs are better than none, live are even better. Further, while it seems logical that everyone will die and thus there should be virtually unlimited organs from dead bodies, only paid compensation for live donations has been proven to be up to the task of eliminating organ donation waiting lists. That means its the most practical means.

My opponent has also ignored my points that compensating the poor for donating organs is no different than compensating the poor for taking deadly-dangerous occupations such as that of a soldier, police officer or highway worker. By and large, people from wealthy families do not put their lives at risk for others carrying out essential duties to protect others.

A compensation system could operate in different ways ... instead of a lump-sum, for instance, donors could be given a special allowance for life, say $200/week. As it stands, anyone who donates an organ is incurring not only the brave sacrifice of a piece of their bodies, but they incur extra costs and expenses for life that current law prohibits compensation for. Comparing the need of the impoverished for money to a gambler's addiction is utterly ridiculous; the poor do not suffer because they over-indulged in income! Having no money ails their health in the United States and causes emotional and mental strife to boot. What if donating an organ could allow a degree of independence to the donor as well as giving life to a recipient? That's win-win in my book.

If a person is allowed to have a lucky break in life because their daddy was rich and they inherited that wealth, why not allow anyone willing to give up a piece of themselves to save another's life a reward of not having to worry quite so hard about where their next meal, rent check or HMO premium comes from? I can find no logic nor reasoning at all to the notion that giving a poor person an opportunity to have a better life while at the same time helping an ill person to have a new chance at life is so evil that it is worth letting the sick just die.

To me, there is no worse a moral or ethical abomination than standing in the way of saving lives. If there is a less evil option that will get the job done, then let's do it. A poor person should have the right to choose to sell a bit of themselves to help themselves as well as a person whose life is in danger. There are a lot more people struggling with bills than those who never have to worry about them, so making the choice to donate hard or even impossible for them because they would be expected to absorb extra financial burdens associated with donating their organs by themselves keeps the supply of organs needlessly low, and by extension leads to unnecessary deaths. Is allowing a poor person to get by through life a little easier really such a terrible evil that its worth letting someone in need die on a waiting list or from a dead donor's organ when a live donor would have more than doubled their chance for survival?

Live donors save lives, but the personal financial costs of uncompensated donation make a lot of people who might otherwise save a life through live donor donation instead decide against it. Deaths from waiting lists and below-half survival rates from cadaver-originated organs are unnecessary and a much worse evil than the win-win situation of allowing a poor person to receive monetary assistance to help them get through life in exchange for giving up a part of their bodies that someone else has greater need of.
Realist

Con

You said "[my opponent] continues to insist the difference is minor, though I pointed out from his own statistics that a recipient has more than double the survival rate from receiving a live organ than one from a body". Maybe my math is a little rusty but I didn't think a 97.9% survival rate was "...more than double..." that of a 94.5% survival rate. You seem to be confusing a case of half the death rate with double the survival rate. Suppose you have two cubes. Cube A has 1 green side and 5 red sides while cube B has 2 green sides and 4 red sides. While the number of red and green sides add up to 100% of the sides of the cube, saying that cube A has half as many green sides is NOT the same as saying that it therefore has twice as many red sides.

I noticed this error in round 3, but figured it was just an honest mistake and let it go. However, my opponent seems to be deliberately misrepresenting statistics to back his argument as he repeatedly brings it up to try and slander the credibility of cadaver transplants. The fact that it is poor conduct aside, I believe that resorting to such petty tactics just demonstrates how weak your argument is better than any opposition ever could. I reaffirm that while 97.9% is the preferable survival rate, 94.5% is still impressive, and if it means people aren't exploited as a result I'd say the 3.2% difference is a small price to pay.

My opponent then go on to say that I completely ignored his claim that allowing the poor to sell off their organs is no different to allowing them to sell their labour in high-risk occupations. Apparently he decided to skip the third-last paragraph of my response to the last round. I'll say it again here and if it still doesn't take then we'll just have to hope that third time's a charm in the closing round.

85% of Iranian paid organ donors regretted their decision to sell their kidney. You were the one that brought up the Iranian paid kidney donor scheme as a shining success story; why won't you then acknowledge the fact that around 6 out of 7 Iranians who participated regretted their decision? When we're assessing the effect on donors, one would have thought that the opinion of the actual donors themselves would bear some significance.

Fire fighters and policemen etc should absolutely be making more money than they do in my opinion also. However, I'd hardly consider what they do make to be comparable to a one time $1,200 pay off for an organ sale that will negatively impact on you for the rest of your life. Furthermore, far from regretting their choice of occupation, firefighters score second highest on job satisfaction from all jobs in the United States, according to surveys conducted by the National Science Foundation for over 30 years [1]. Extremely poor comparison on your part.

One thing I've noticed frequently from my opponent in this debate is building up strawman arguments over and over and then knocking them down with something unrelated rather than actually responding to my points. I just hope anyone reading this debate fairly is picking that up too and considering it when voting. The current example is asserting that I'm arguing that the poor are like problem gamblers in that they are in their situation because of over-indulging in income and then calling it ridiculous and pointing out the obvious fact that lacking money has a negative effect on health. In fact, what I was comparing was the ethical similarity in unfairly tempting people who are unable to exercise sound judgment at a particular time into making a decision they will regret (at least, 85% of the time).

I'll spell it out a little further: A client in an institution for recovering gambling addicts is there precisely because they're unable to make sound judgments with respect to gambling. Therefore, placing a poker machine (for the sake of clarity, the odds of making money off a poker machine are deceptively stacked against you) in the lounge of such an institution is unfairly tempting people into making a decision they'll regret. The same is true of offering a bunch of money to people who are desperate for money. It will cause them to make a decision that they will likely regret, at least 85% of the time.

That really needs to be emphasized by the way. We aren't talking about a majority of the general public, or a majority of bio-ethicists, though they would probably agree too. We are talking about 6 out of 7 of the very people that my opponent is arguing will be better off actually regretting the decision! As well as that, most of them even think the practice of organ selling should be illegal themselves! Just keep that in mind when my opponent goes on another spiel about how the poor suffer from the inequalities of capitalism and that he's just looking out for their best interest - 6 out of 7 of them would disagree with him, and they should really be the final arbiters here.

My opponent then says "To me, there is no worse a moral or ethical abomination than standing in the way of saving lives. If there is a less evil option that will get the job done, then let's do it." Well, in fact I've mentioned three of them which my opponent refutes by deliberately misrepresenting statistics or simply ignoring them, as he did with my point about the NHS waiting lists needing reform.

He then goes on to say "I can find no logic nor reasoning at all to the notion that giving a poor person an opportunity to have a better life while at the same time helping an ill person to have a new chance at life is so evil that it is worth letting the sick just die." I have to ask myself, as should any readers, is this actually the case that my opponent really thinks he's arguing against? That he's just looking out for the poor as well as those in need of organ transplants and that the WHO, the Transplantation Society, Organs Watch, as well as every government around the world (apart from one totalitarian regime) and myself are all holding the directly opposite opinion that, as my opponent put it again, "...giving a poor person an opportunity to have a better life while at the same time helping an ill person to have a new chance at life is so evil that it is worth letting the sick just die." ? What a distorted view of reality!

His last two paragraphs aren't even worth addressing. There's more of the same emotional appeal and caricaturing of my position, as well as another misrepresentation of statistics to falsely assert that living organ donor recipients have double the survival rate of cadaver organ donor recipients.

I approached this debate trying to be civil, but was greeted with lies, deception, and strawman after strawman. My opponent rattles on about how terrible it is that the poor suffer, yet he refuses to acknowledge the implications of the very case study that he himself presented, that the poor will in fact be worse off if what he's suggesting is implemented. He has shown no evidence that would suggest the poor would benefit from his proposal at all, yet he feels justified in making an emotional appeal about their dire situation in the real world, hoping that it will help his argument. Just look at his most recent round again. All he does is emphasize a statistic that doesn't exist, falsely assert that I failed to address his points when we have my rebuttal in print above, and appeal to the readers' sympathy for the poor.

I affirm that the facts are on my side, and that my opponent realizes this, devastating as it is to him, and resorts to cheap shots to try and stay in the game. I also want to point out that his repeated claims throughout the debate that it is the donors that have to cover medical expenses is also false. It is the recipient's insurance that covers it [2].

References:

[1] http://firechief.com...

[2] http://surgery.about.com...
Debate Round No. 4
PervRat

Pro

I thank my opponent for completing this debate for me, and in this final round, I will offer final rebuttals and then a final statement.

First, the rebuttals --

The maximum rate of survival, obviously, is 100%. From the perspective of "double the rate of death is half the rate of survival," what I said was accurate, and my opponent again argues and insists that more than doubling the rate of death is insignificant ... this should be left to the reader. Is whatever harm comes from compensating donors offset by the -significantly reduced rates of death-? Cadaver-originating organs have double the fatality rate of live donors, so clearly live donation is preferred; it has not proven possible anywhere that enough live organs can be donated to meet demand (even when supplemented by cadaver-originating organs).

Compensating live donors saves lives that cannot be saved any other way. If you had two hospitals offering life-saving treatment, and in one, 1 in 18 died but in the second, only 1 in 47 died, which would be the wiser choice based on that? Would the difference be minor? I hope the readers and voters on this topic will focus on that fact and give it an appropriate weight on considering which is the lesser of two evils.

And Con, again, dodged the question of comparing compensated organ donation unduly influencing the poor with compensated dangerous occupations also unduly influencing the poor by talking about what happens in Iran, instead. That's a non-answer to the question, but to rebut his non-answer, I would point out the hardships endured by soldiers and police officers on their families. Those are very stressful occupations, and psychological problems such as PTSD are quite real, angsty divorces and low pay and difficulty taking care of one's family relative to cushy corporate jobs. Some U.S. soldiers have such low pay that they actually qualify for food stamps!

I pointed to the Iranian example as proof that compensated organ donation works in terms of ending the deadly waiting list and saving recipients' lives that would be lost if they relied on cadaver organs. I do not contest that Iran's actual implementation is right ... maybe an ongoing regular allowance might work better along with lifelong free medical care.

It is extremely inappropriate to compare compensating poor people with money to tempting gamblers with gambling machines. Is my opponent seriously attempting to claim that it is bad to pay money to people who have no money because having money is bad for them the same way gambling is bad for gambling addicts? He complains about this analysis of his comparison of gambling-machines-are--to-gamblers what money-is-to-poor-people when, as I am sure voters for see, that is not a valid comparison.

Nowhere in my argument did I propose Iran's compensation of $1,200 for an organ donor would be appropriate here. Considering the information my opponent found, even adjusting for cost of living differences, clearly it should be higher, and/or regular in an annuity or perhaps a weekly allowance for life.

To claim the poor are better off being poor is an even worse delusion my opponent has stated. The United States has a corporatized health care system, and with some 30 million Americans having no coverage at all, a recent Harvard university study found 45,000 people in the United States die every year because they cannot afford health care. Additionally, think of the deaths that occur due to poor people having to put up with junkers because they cannot afford newer cars that are safer, and other sacrifices poor people must make on their own personal safety and well-being because they cannot afford better options. I am not aware of any statistical analyses of the overall death toll from being poor (aside from that study on lack of health coverage), but it is not a factor to ignore in evaluating whether being given money can reduce this harm.

Con also claims to have come up with better options to compensating living donors, but they all involve ways of simply getting more cadaver organs which might reduce the growth of the waiting list, but has not eliminated it and still suffers the double-and-a-half death rate of live organ donations, so lives are still needlessly waited even if they did miraculously eliminate the waiting list like never before.

To believe my opponent and the long list of opponents to compensated organ donation, there is no serious harm in being poor. This is not true, and I do not believe this is considered in the equation. 45,000 Americans die simply from a lack of health care, and simply offering lifelong free medical care to live organ donors could greatly improve the /donor's/ chance for survival and a healthy life. Despite Con's misleading statement, the organ recipient's health insurance only covers the transplant and short-term recovery after the procedure, no more than a few weeks, leaving the donor to cover any long-term medical challenges themselves.

My opponent cries foul yet cannot even answer questions, instead pulling a Palin by switching from an answer relevant to the question to an irrelevant mention of the negative side to Iran's program without caring to acknowledge the level or type of compensation could be altered, instead implying that donor compensation could only be the paltry amount Iran offers.

In closing, I argue that Con's own statistics show a significant improvement in odds of survival for a needy organ recipient receiving the gift of life from a living donor instead of a dead body, a scale of two and a half times the death rate of the latter over the former. My opponent continues to fog and dodge the fact that a 1 in 18 death rate from dead donors is significantly worse than the 1 in 47 death rate from living donors. That is a significant and unnecessary loss of life, since there is an alternative that this entire debate is about.

Further, the assertion that money cannot help the poor's quality of life nor chance to live is similarly false. The WHO and other human rights groups that I do respect and admire have not considered that issue, I feel; my opponent clearly has not considered the fact of a degraded quality of life and increased chances of death for a person with no money nor resources to get themselves medical help in American society. Legal compensation for donors will not only help the donors and recipients, but would also put the kibosh on the black market going on right now that is, indeed, abusive and harmful to disadvantaged people. Who would abduct people in a third-world country when you could legally acquire an organ from a willing recipient at home and, with proper legal protections, the donor can make off better than they were before with health care for life and some money to live on?

I do not pretend that, even in the most ideal circumstance, there are no costs. There are long term risks and costs for the donor, and the great honor of altruistic donation may be lost; I do not consider these insignificant losses, but they pale compared to the lives that could be saved by instituting a compensation system that could leave the donors much better off than they were before donating, with their own health and well-being better than it was before donation, and how wrong is that?

I thank my opponent and thank you, voters, for reading both sides of the debate. I hope the mere discussion is enough, if nothing else, to prompt those of you who could absorb the costs associated with being a living donor to check it out. You can be a real hero and save a life ... even if you do not, I hope you do at least check that box on your driver's license so that, should the unfortunate happen, the end of your life could bring a renewed hope for life to someone barely clinging on.

Thank you, and bless you.
Realist

Con

Firstly, arguing the issue of double survival rate or double death rate etc is pointless. They are clearly not the same thing. A 94.5% survival rate is still a very hopeful survival rate in any case. Granted you'd have a better chance of survival receiving a living donor organ, but only roughly 3% better in the first year. Nevertheless, I never argued that cadaver organs were better, or even just as good, only that they were good enough and definitely workable. The difference is similar to making money by working an honest 9-5 job as opposed to stealing it. Clearly stealing it would probably be less effort, but that harms others. Therefore the 9-5 job is the better method of making money. Getting organs from living donors is better from the perspective of the recipient (not even that much better I might add), but it harms others in the process. The whole point about cadaver organs is that no one is harmed in the process.

My opponent writes: "Compensating live donors saves lives that cannot be saved any other way." Again, that's simply untrue. Cadaver donations are a very real and very viable alternative, as has been demonstrated.

I am again accused of dodging the point that compensating poor donors is no different to compensating people for risky professions, unjustly in my opinion. My opponent used the example of firemen initially. I cited a study that shows firemen as having one of the highest job satisfaction levels overall from any profession in America. Clearly this is hugely different to a massive 85% of compensated donors regretting their decision! I'll leave it to the readers to decide whether this point was properly addressed or not though.

My opponent says, again missing my point: "Is my opponent seriously attempting to claim that it is bad to pay money to people who have no money because having money is bad for them the same way gambling is bad for gambling addicts?" Clearly the situation isn't as simple as just "paying money to people who have none". The situation is such that an insufficient amount of money is being offered to tempt people into making a decision that they will regret 85% of the time. It is like the gambling machine example in that people would be unfairly tempted into making a bad decision because they are unable to reason properly at a given time.

My opponent then says: "To claim the poor are better off being poor is an even worse delusion my opponent has stated." I appeal to the fairness of the readers here - did I ever say that the poor are better off being poor? Of course not. I'm the one defending the rights of the poor here while my opponent wants to throw them a bone and help himself to their organs to the detriment of their health. In fact, I take that as somewhat of a personal insult to be frank. I don't know the details of my opponent's life, but I'd be willing to bet that I do more to benefit the poor and the homeless in my life than he does in his.

Clearly there are problems with our society that leaves a number of people financially disadvantaged, and clearly something should be done about it in my opinion. However, throwing them a bunch of money to take their organs will not get them out of poverty. The only place that paid organ donations have been tried is Iran and it didn't help the poor there at all.

He says: "To believe my opponent and the long list of opponents to compensated organ donation, there is no serious harm in being poor." Yeah ok, the WHO and scores of federal ethical committees all think there's no harm in being poor. The paid organ donations will very likely mean more lives saved due to more available organs. The primary objection to it is precisely that it will mean the exploitation of the poor. It's not just my opinion, it's the opinion of virtually every federal ethical committee as well as the opinion of organizations like the WHO and various other organizations with significant knowledge of this area. He then claims that "...The WHO and other human rights groups that I do respect and admire have not considered that issue...". This is absurd. These are professional ethical committees all reaching somewhat of a consensus on this issue. Sure, they're human and they're not perfect, but it's a fair stretch of the imagination to state, because they disagree with you, that they have not considered the issue!

If I get anything across in this last round I hope that it is that the position my opponent takes of fighting for the rights of the poor in society is a false one. It is a position he adopted without justification also. My opponent rattles on about studies (which aren't cited I remind you) showing the obvious fact that being poor is a bad thing. He then asserts out of nowhere that what he is proposing will benefit the poor and then accuses me of not caring. Clearly this is the sort of tactic employed by a person who is desperate.

I encourage everyone to really think about the way my opponent has argued this case. He opens by pointing at the system that Iran has put in place and holds it up as an example of a flawless way to remedy this problem. One should instantly realize that if this was really the case then many other countries would have followed suit. I then point to reputable studies demonstrating exactly what was predicted would result from a paid organ donor scheme, that the poor would be exploited.

At this point, my opponent then switches his case around. He leaves the fact that Iran's organ waiting list has been abolished alone and begins to make emotional appeals about how bad life is for the poor. From this he asserts that he's looking out for them because he just wants to give them money with no strings attached. He then asserts that I don't care about the poor, or the potential organ recipients for that matter. Any reasonable person would have to agree that what we've seen during this debate is clear evidence that the poor WILL be exploited under such a scheme, no doubt about it.

I feel my opponent would've had a much stronger case if he'd just accepted the fact that the poor would be exploited and just argue that the extra organs available outweighs the bad. However, this was not his strategy. In my mind he made somewhat of the same mistake Hitler made during WW2, he decided to fight on all fronts. My opponent refused to concede any points, even when they were made as clear as day.

In closing, I feel my opponent has not properly addressed the main objection to his proposal, but rather denied it in the face of overwhelming evidence. The reason that no countries (other than the exception of one totalitarian regime) allow organ donor compensation is for precisely the very reason that I put forth and that my opponent failed to properly address.

Thank you for the discussion, I learned a lot during these rounds, as I hope everyone reading did as well. I hope this has been an entertaining debate to follow also :)

Thanks,
Rob.
Debate Round No. 5
13 comments have been posted on this debate. Showing 1 through 10 records.
Posted by Puck 5 years ago
Puck
"so taking this on the grounds of opposing state purchase is kind of off-topic."

Haha yeah I get that which is why I haven't taken up Con.
Posted by PervRat 5 years ago
PervRat
There is one nation that does allow and pay for living kidney donation, but I'll reserve the findings of my research for my arguments. :P
Posted by Ragnar_Rahl 5 years ago
Ragnar_Rahl
If the state is otherwise prohibited from these sorts of transactions, it will be from this one, if not, it won't really matter whether it is from this one much since it won't alter the fact that the general principle is violated, so taking this on the grounds of opposing state purchase is kind of off-topic.
Posted by PervRat 5 years ago
PervRat
I didn't say it was the same, I merely pointed out its irrelevent to the debate. If either is permissible, then you would be on the PRO side of the argument.
Posted by Puck 5 years ago
Puck
"My gf donates plasma for money. Haha. I've never done it..."

In Australia no payments are made, which is why the government tends to run public service for the good type ad campaigns.
Posted by Puck 5 years ago
Puck
"And who actually pays is not relevant as to whether it is right or wrong for the donor to be paid. Consider it any one of or combination of the recipient, the government through tax dollars, or private non-profits through donations."

State paid vs. private paid is not the same (especially since you think welfare entitlements should be incentive), though if all you want to argue is the available option of sale qua sale, then doing so without reference to who is the *buyer* is quite poor. :)
Posted by PervRat 5 years ago
PervRat
I didn't invent the phrase "donate blood" to describe selling blood, but that's the standard.

And who actually pays is not relevant as to whether it is right or wrong for the donor to be paid. Consider it any one of or combination of the recipient, the government through tax dollars, or private non-profits through donations.
Posted by Danielle 5 years ago
Danielle
My gf donates plasma for money. Haha. I've never done it...
Posted by Puck 5 years ago
Puck
"You are considered to donate blood even though you are paid for it. This is the same."

That's just poor use of English. O.o

Who is paying the lump sum, the recipient or the state?

Who is to provide the health coverage?

You need to make your argument clear.
Posted by PervRat 5 years ago
PervRat
You are considered to donate blood even though you are paid for it. This is the same.

As for what sort of compensation ... any: lump sum cash (one time payment of ... I dunno, $100,000 for a kidney?), annuities (paid continually over your life ... say $20,000 per year), maybe free full health coverage for life (right now this would be worth roughly $15,000 per year in the U.S.)
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