Thursday, February 23, 2006

Culture: Is is moral to sell organs for transplantation?

The other day, I heard an NPR news report about the growing concern over the black market for organ donations.

The reality is that there are far more people who need life saving transplants than there are organs for them.

If no family or friend is an immunological match (or willing to be a donor), then the patient must wait for someone who dies who has indicated their desire to be an organ donor and who is an immunologically compatible donor. While on these waiting lists some will die.

The news item said that there is a growing black market for organs and the discussion is beginning about making the whole process legal and fully transparent.

Being an organ donor is not a simple thing. As good as medical technology is, it is not risk free for the donor. In estimating how much a donor would be paid, the report said the following factors need to be considered: How much medical care the donor will need in making the donation and in possible future medical expenses? How much in lost wages will the donor incur for participating? How much additional money should be provided for them to do the donation since they are not "giving" the organ to a family member or friend?

One of the persons being interviewed said this, right now, if I wanted to, I could go out and sell my eggs to a couple who want children. I could also "rent" out my womb because I've had children in the past and my womb "works." This is completely legal in America. People can debate whether it is moral but it is totally legal. So why not make the selling of organs legal?

My gut reaction to listening to this news story is revulsion. There just seems to me something viscerally wrong with auctioning eggs and renting out wombs and selling organs.

We allow people to sell their blood for making medically important products.

For instance, there is Rh hemolytic disease when the baby inside mom is Rh+ and mom is Rh-. The mom could develop antibodies to the baby's Rh+ blood which in turn destroys the baby's blood and causes the baby problems.

To counter act this, an Rh- mom can receive a small amount of antibodies to Rh+ collected from donor blood which is bought in the free market to manufacture these products. These exogenous Rh+ antibodies destroy the small number of the baby's Rh+ blood that has mixed with mom thus preventing the mom from mounting a full scale immunological attack on the Rh+ blood from baby.

This seems to me to be completely legal and moral.

But what is the moral difference between selling blood and buying organs, renting out a womb or putting a woman's eggs on the free market for childless couples?

And now, there is the embryonic stem cells research issue. Advocates say, there are all these frozen embryos left over from in vitro fertilization, why not use them for research? They are going to either decay in storage or be thrown out. Why not use them for research?

Most people think, okay, makes sense. But, my guts are wobbling. It doesn't sit right with me.

Let's say the research proves moderately successful. Let's say the collection of left over embryos are running out. Researchers then are in the position of having to say, well, we need more, we are THIS CLOSE to a breakthrough, we need more embryos. At that point, we will be faced with people deliberately going to IVF clinics to generate embryos to donate them to be consumed by research or paying people to donate sperm and eggs to make embryos to destroy them for the progress of research.

My gut reaction to this scenario is revulsion.

Is there or is there not a moral difference between:
1) paying for blood for medical products
2) paying for organs for transplantation
3) paying for eggs for childless couples
4) paying for a womb for a childless couple who can't carry their own to term
5) paying for embryos for research?

Currently 1, 3 and 4 are legal.

Some people will say all 5 should be legal and consider all 5 moral.

Some will say all 5 should be legal but may consider some immoral and acknowledge that not all legal things are moral.

My "guts" send a steady "red light" with 4 and 5. My "guts" have a "yellow light" with 2 and 3. And my "guts" give me a "green light" on 1.

Am I wrong?

And why are my "guts" telling me different things while others are giving a green light to all 5 things?

UPDATE: Dr. Sally Satel is a resident scholar at AEI and she is getting a kidney from her friend, Virginia Postrel, a blogger I read fairly regularly. Surgery is scheduled for Saturday, March 4. All the best to both of them!


Anonymous Hugh D. Cox said...

Second Thoughts about Dr. Sally Satel’s Personal Kidney Transplant:

On November 22, 2005, Dr. Sally Satel, M.D., issued a deeply personal account of her need of a kidney transplant because of the “no-fault” failure of her own kidneys. She wanted a normal life rather than dialysis due to convenience and she was not critical of any potential donor. Her writing was very moving. All can empathize with her and wish her a speedy recovery now that she has a new kidney. See: .

But this Dr. Satel is the same anti-veteran physician on the payroll of the neoconservative American Enterprise Institute (AEI) who openly criticized military veterans making claims for disabling PTSD after they were assigned to duties in Iraq, Afghanistan and past wars. Satel accused veterans of using “an underground network [that] advises veterans where to go for the best chance of being declared disabled.” See: . Once veterans are declared disabled, they retain that status indefinitely, Satel said in the Washington Post on December 27, 2005. Recently, the VA announced that certain PTSD claims already granted would be reduced by 50%. See: .

Dr. Satel believes that PTSD is not a medical diagnosis of any social consequence. Those who seek VA benefits for PTSD were recently labeled by Dr. Satel in a New York Times op-ed of March 1, 2006 as, “[b]ut it's also very likely that some of the veteran baby boomers who have filed claims in recent years did so not out of medical need but out of a desire for financial security in their retirement years.”

In the same op-ed, Dr. Satel stated, “it is often hard to know which applicants can be helped with short-term psychiatric care, which are seeking a free ride and which are truly deserving of the diagnosis of post-traumatic stress disorder and thus long-term care and payments of up to $2,300 a month for life.

Dr. Satel appears to view many disabled veterans as “welfare queens” seeking a “free ride” and unjustified “financial security”.

There is more disturbing information about Dr. Satel to consider.

Dr. Satel works for the AEI, and appears to be the Bush administration's "go-to" physician for denial and reduction of rightful health care and veteran benefits.

Satel is also a "go-to" physician for the tobacco industry. See: where Satel stated that second hand smoke is not as harmful as most medical experts think.

Likewise, Satel is also the "go-to" physician for the silicone gel-filled breast implants industry. See: in which Satel assures women that breast implants are quite safe. Interestingly, breast implants are linked to kidney failure. See: .
Her credibility as an expert was once demolished in a reported court case. In the case of Farmer v. Ramsay, 159 F.Supp.2d 873, D.Md. [2001] (the case is a reverse racial discrimination case seeking to allow white applicant into medical school over minority student applicants with lesser MCAT scores. Satel was expert for the white applicant), the court found:
"The Defendants have filed a motion to strike Dr. Satel's report on the grounds that it lacks the necessary indicia of reliability required under FRE 702. The Court agrees and will, by separate order, grant the motion. Satel offers little more than her personal opinion of Farmer's application and the weight that UMSM should have placed on his MCAT scores. Satel has no familiarity with UMSM; she lacks an extensive background in medical school admissions; she reviewed a total of only five applications; her work has not been subjected to any peer review; and her opinions are not based on a methodology that can be tested. Accordingly, her views lack the indicia of reliability required under Daubert v. Merrell Dow Pharms., Inc., 509 U.S. 579, 113 S.Ct. 2786, 125 L.Ed.2d 469 (1993). See Samuel v. Ford Motor Co., 96 F.Supp.2d 491, 493 (D.Md.2000).
Even if Dr. Satel's report were admissible, the Court could not accord it much, if any, weight. As stated, the report consists entirely of Satel's personal evaluation of the applications. A plaintiff's (or his expert's) personal evaluation of his own qualifications is, however, irrelevant. Courts have repeatedly held that such subjective personal judgments do not raise a genuine issue of material fact. See Smith v. Flax, 618 F.2d 1062, 1067 (4th Cir.1980); Bradley v. Harcourt, Brace and Co., 104 F.3d 267, 270 (9th Cir.1996); Williams v. Cerberonics, Inc., 871 F.2d 452, 456 (4th Cir.1989). Applications of Minorities Not Interviewed".
The Court found that Dr. Satel’s credibility and so called expertise was so unreliable that her findings had to be stricken by law without waiting for opposing evidence or cross-examination. Dr. Satel appears to be a “mouthpiece” for sale to any neoconservative cause.

In her New York Times op-ed dated March 1, 2006, Satel stated, “[Veterans] have made use of a system that has coalesced around the idea that combat is the root of all anguish. [Veterans] deserve treatment to the extent that it can help, but rarely long-term disability payments.” See: .

Based on Dr. Satel’s current lobbying and speculation, the VA now places great emphasis on “combat” exposure supported by almost non-existent documents because VA officials know that it is a convenient method to deny or lower PTSD benefits. If there is no confirmed documentary combat stressor – the veteran is denied the claim for PTSD. As a civilian, Dr. Satel apparently believes that military clerks are taking detailed notes on wi-fi computers right there on the battlefield during a firefight or IED explosion.

Dr. Satel advanced that “civilian” theory in her March 1, 2006 op-ed: “As the department tries to distinguish among these groups, verification of exposure to trauma is vital. The inspector general's office found that for one-quarter of Vietnam veterans claiming post-traumatic stress, the department could not confirm any incidents of traumatic stress. A study in a leading psychiatric journal last year could not verify such history in 59 percent. True, military personnel records are not perfect — a cook who endured a terrifying rocket attack on an airbase at which he was stationed may be unable to produce documentation of it. However, such records could indeed disprove the fabrications of a cook who claimed he was traumatized by a firefight on infantry patrol.”

Now Dr. Satel believes that if there is no confirmed documentary combat stressor – the veteran should be denied benefits. The infantry battalion cook who holds a dying fellow soldier killed by a suicide bomber in a Baghdad mess hall and then must put the body in a body bag receives no “sympathy” from Dr. Satel.

The latest of Dr. Satel’s malice against disabled veterans on March 1, 2006 in the New York Times occurred since she received her kidney. See: .

Perhaps it is time for Dr. Satel to walk in a veteran’s boots. Had Dr. Satel been subjected to the kind of hostile inquiry she believes ought to be used in the VA claims process, she might never have received a kidney transplant. Her own positions could subject her to the following insulting and outrageous questions from the VA suggested by her own anti-veteran positions:

“Dr. Satel, why do you say your kidneys ‘retired early’ and ‘mysteriously’? Have you ever used controlled substances or abused alcohol or had breast implants? Do you have a tattoo? Why should we give you a ‘free’ kidney if you abuse your body? We need documentary proof that you did not engage in reckless behavior causing your kidney failure.”

“Let me understand your position, Dr. Satel, do you want us to give you a free kidney for your convenience, I repeat, convenience? There are thousands of people in the U.S. waiting for kidney transplants. Why should you break in line in front of them? Your kidney ‘problem’ did not seem to halt your prolific writing and speaking engagements, did it? Tell me again, where is the financial ‘inconvenience’?”

“Dr. Satel, did anyone on your behalf use any form of ‘influence’ to obtain your kidney match so soon? Did you use an underground network to advise you on the best chance of finding a kidney?”

“Dr. Satel, Haven’t you made use of a system that has coalesced around the idea that deprivation of convenience is the root of all devastation and victimization. Certainly, you deserve continuing dialysis treatment to the extent that it can help, but rarely should long-term or expensive payments or gratuities be justified. Don’t you agree?”

* * * * *

Fortunately, this kind of “Satel-suggested” outcome determinative interrogation will never take place for Dr. Satel and all can wish her a speedy recovery.

There are many kinds of support for our enemies in the war or terror. Most are obvious. One of the most insidious attacks on our military troops and our combat veterans is from Dr. Satel, M.D. who apparently believes that combat trauma must be proven with almost non-existent documentary evidence at the expense of battlefield common sense and traditional medicine. Unlike many other non-profit, well-financed corporate propaganda machine “experts”, Dr. Satel is leading the AEI into an alarming anti-military and anti-veteran culture. The concept that combat PTSD is of little consequence or is quickly and easily cured by quick medical intervention, by return to combat, or by a good hard day’s work at Wal-Mart borders on treason. That potential treason is evident every day at our military recruiting offices when potential recruits reject military service when they sense that neoconservatives might exploit and abandon brave warriors and patriotic veterans using Dr. Satel’s “credibility”. Our brave troops in Iraq and Afghanistan deserve the protections of a solemn and sacred contract that our nation will care for “him who shall have borne the battle and his widow, and his orphan.”

Submitted by:

Hugh D. Cox
Greenville, North Carolina

7:59 PM  
Blogger Marshall Darts said...

No. I think it is immoral. If they were for sale, neither Dr. Satel nor you would ever be able to outbid Madonna, Paris Hilton or some other, richer person.

Just like there was always a faster gun in the west, there will be a richer person than you or Dr. Satel.

11:23 PM  

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