A thought

One that isn’t fully fleshed out you understand. But, as here:

It’s also possible to invert the entire discussion and point out that we all already agree with this thought anyway. Exactly those who tell us that, say, blood must be donated voluntarily, are likely to be those who also insist that we don’t solely rely upon charity to solve poverty and inequality.

We must instead tax and then use government to hand out that forcibly acquired revenue to solve that problem. No, this doesn’t mean I think we should use force to gain kidneys for transplant. But by insisting that voluntary action, charity, won’t solve the problem we have just agreed that voluntary action, charity, won’t solve the problem. We thus have to use some other method to do so.

We must use only voluntary donation to provide organs for transplant. OK, fine, fair enough, but that does leave some people dying.

We cannot leave it purely to voluntary and charity to alleviate poverty because some will die. OK, fair enough.

Where this falls down is that it’s only in Poul Anderson novels that forcible transplants take place. Or maybe Chinese prisons.

But it is interesting, at least I think so, that most people on one side of either of those statements will be on the other side of the other. Those who would insist that we cannot use paid markets for body bits would be, in my experience at least, those most vehement against relying purely upon charity to deal with poverty.

30 thoughts on “A thought”

  1. “only in Poul Anderson novels”

    Which are those? Or are you thinking of the Larry Niven ‘organ-legger’ series with Gil Hamilton of the ARM?

  2. Paid blood donation didn’t work out well, not sure paid kidney donation would either and for similar reasons. (And you can analyse what the problem was economically, that’s not just “one more nail in the coffin of homo economicus” as left-wingers sometimes make out, but rather a sign you need to take second-order and higher effects into account too.)

    Now I’ve lost a relative who died before the transplant could come so I appreciate there’s a real problem here. But I don’t know what the solution is. I wonder how viable would be a social/cultural change that makes voluntary donation more common, whether you can shape that kind of social response via advertising, education or similar. Certainly not all countries have the same donor rates which suggests there’s an element of cultural malleability but perhaps not one that’s straightforward to direct and control.

  3. Paid plasma donation works very well indeed. The world relies upon it in fact. Iran has compensation for kidney donors and doesn’t have people dying on dialysis…..

  4. The Meissen Bison

    we cannot use paid markets for body bits would be, in my experience at least, those most vehement against relying purely upon charity to deal with poverty

    Perhaps you’re seeing a problem where none exists. Both the donation of organs and the payment of taxes need to rely on consent although the level of tax and what it is spent on may be a matter for dispute.

  5. The idea that you must use the state to cure social problems that charity does not has got the cart in front of the horse. Charities are, and have been longer than there has been a legal definition of charity, filling in gaps in the state system (or lack theroef).
    Buying blood plasma from diseased and/or drug-addicted Americans was an error of judgement – buying it from American College students might (probably would) have been a good idea. In a free market a better and/or quality-controlled product will attract a premium price. The NHS did not seek a quality-controlled product.

  6. Now that it’s universally agreed, at least among the woke, that society ought to be run along racial/ethnic lines we could just adopt a law that says if your racial/religious group hardly ever donates blood or organs, you don’t get to receive them.

    Who could say fairer than that?

    P.S. Just in case I haven’t drawn your attention it:

    “Hundreds of people with haemophilia in England and Wales could have avoided infection from HIV and hepatitis if officials had accepted help from Scotland, newly released documents suggest.

    A letter dated January 1990 said Scotland’s blood transfusion service could have supplied the NHS in England and Wales with the blood product factor VIII, but officials rejected the offer repeatedly.

    Large volumes of factor VIII were imported from the US instead, but it was far more contaminated with the HIV and hepatitis C viruses because US supplies often came from infected prison inmates, sex workers and drug addicts who were paid to give blood but not screened. …

    Scotland’s factor VIII supplies were also contaminated, but to a far lesser degree than those from the US.”

  7. So Much For Subtlety

    Tim the Coder July 5, 2020 at 10:39 am – “Which are those? Or are you thinking of the Larry Niven ‘organ-legger’ series with Gil Hamilton of the ARM?”

    I agree that Poul Anderson is unlikely. And organ transplants turn up in a lot of Niven’s work – more than just the ARM stories.

    But Robert Silverberg has the short story “Caught Up in the Organ Draft”. Which is just what it sounds like – pull a low number and they take your liver. It is, of course, a bitter satire on the Vietnam war (published in 1972) which as a Marxist Silverberg supported – just the other side.

  8. Also Fredrick Pohl’s Star Child series.

    One of the heros ends up in quite a pleasant prison camp where dissidents await until their organs are needed. They can survive with only 1 eye or kidney for a while but sooner or later they all get “totalled”.

    The inmates are kept quiet by tranks in the food so the hero tries not to eat but he is ratted out by a supposed friend. The guards inject him with tranks and send him back out to the community accompanied by one of my favourite lines in SF–“Don’t give us any more trouble Zero-Dome”.

  9. Silverberg was not a Marxist as I understand it SMFS–anti-war “liberal” but he worked far too hard writing for material gain to be much of a marxist.

  10. “The world relies upon it in fact”

    Does the rest of the world really “need need” paid plasma donations? That sense of “rely”? Or more like, has committed itself to that model so is now stuck with it because it would be hard (and involve too much uncertain) to change? Is it something special about the UK that voluntary donations work here, or just that we’ve followed that model long enough social norms have developed about donating?

  11. We rely upon paid plasma in the UK. No country without a paid collection system even supplies it’s own needs.

  12. People with a true libertarian mindset of largely letting people do what they want so long as there is no clear harm to others are pretty rare birds. I think most (or at least a lot of) people who don’t want to do something probably think other people should be constrained from doing it. And if there is money involved, watchout. The principal complaint about charity is that it allows donors to donate to what interests them as opposed to what interests the people doing the complaining.

  13. @ Tim
    But our voluntary whole blood donations are fully adequate.
    Plasma donations require more time from the donor (fortunately my employer, as a Life assurance Company, was generous about allowing time off during working hours for blood and/or plasma donors) and a lot more effort on the part of the NHS.
    I very strongly suspect that if NHS put the same time and effort into encouraging and enabling plasma donations we should be self-sufficient/

  14. There was a Harry Harrison short story where organ donation was opt-out and someone in a car accident they couldn’t find the medical tag you were supposed to wear to opt out even though they knew the person in the car

  15. “OK, fine, fair enough, but that does leave some people dying.”

    I’ve always felt that the fallacy in the logic around donation has always been that the recipiënt somehow has some “inalienable right” to someone elses’ body parts so they should live.
    They have not.

    A century ago those people would have died. Period.
    50 years ago those people would most likely, if not definitely, have died. Unless they somehow qualified for some very experimental and high-risk procedures. For Science, and all..
    It’s only in the last 25-ish years that the various procedures ( and aftercare..!) got Good Enough to reliably give results that actually result in a decent survival rate, coupled with a measurable increase in the quality of life of the recipiënt. At least until the 5-year mark..

    And somewhere in that 25-ish years the discussion (d)evolved from “You’re lucky it’s even possible” to “why is there a shortage of donors?” .
    With people forgetting that in 95% of cases someone else must die prematurely to provide the donor organ people somehow see as a “right”…

  16. only in Poul Anderson novels

    Larry Niven. But it shows up in the works of multiple authors over the years. But its Niven where its a running theme – even running a stoplight has become a capital offense on earth and its a nasty secret hidden on one of the colonies when they figure out a way to grow organs (removing the need for donors) because their social system is basically Apartheid South Africa and sentencing people for organ donation is one of the ways they keep the lower class down.

    And the UK already uses force to gain organs for transplant – that’s what ‘opt-out’ is. Its one smaller step from there to the next point on that path.

  17. @ Tim
    When did the UK start importing 100% of its plasma needs? 30 years ago National Blood service was taking plasma donations.

  18. @Agammamon “Its one smaller step from there to the next point on that path.”

    That is one of the ..fears.. of that particular slippery slope.
    Mind.. I am of a mind to present my mutilated body at the gates of Valhalla with *quite* a retinue come the day that ever happens..

  19. @Agammamon
    When did the UK adopt an “öpt out” model for organ donation? Recently? Damned glad I’ve left, now.

  20. It is not possible to pay for either sperm or egg donations for IVF treatment in the UK. In fact, for any fertility treatment it is not possible to pay the providers of the gametes. Thus the country imports sperm from Denmark

    UK imports sperm as donations collapsed when That Cnut Blair removed anonymity for the fathers

    I’d imagine same would happen if blood/organ recipients were given name & address of donor/family

    Blood: most/all blood of those with polycythaemia who have venesection is incinerated even though plasma and all but red cells could easily be used

    @dearieme
    That’s old and biased news. Someone in Scotland’s blood transfusion service did offer, but NATs higher up blocked it “Weer no heping them sassanacks”

  21. I’ve always felt that the fallacy in the logic around donation has always been that the recipiënt somehow has some “inalienable right” to someone elses’ body parts so they should live.
    They have not.

    Yup. This. The existence of medical science that enables a second lease of life with the use of body parts from the deceased does not confer a right to those body parts, nor an ethical imperative on the part of the erstwhile owner of said body parts. We do not owe the state our body parts. We give them as a gift. At least, that is how it should be.

    The decision on the part of the state to bring about the highly unethical opt out system resulted in me immediately opting out.

  22. The difference between blood/plasma and kidney/etc is the same difference between income tax and wealth tax. Once you’ve taken two kidneys you run out.

  23. Agammamon: The Gift From Earth. The ruling classes conspire to prevent newly-received knowledge from Earth of organ manufacturing as they’ve based their entire society on harvesting the lower classes.

  24. bloke in spain
    July 5, 2020 at 6:58 pm

    @Agammamon
    When did the UK adopt an “öpt out” model for organ donation? Recently? Damned glad I’ve left, now.

    March 15th this very year. I’m not sure if its in effect yet or not.

    ‘Max and Kiera’s’ bill.

  25. Dear Mr Worstall

    Larry Niven: The Patchwork Girl, A Gift from Earth.

    Lexx, a Canadian/German TV series. Chap fails to do something minor, finds the penalty is an arm and a leg. Accidentally steals a spaceship – Lexx

    Blake’s 7 has an episode where the weedy Vila is captured on a planet by ‘Hi Techs’ who prey on ‘Low Techs’ for spare parts. They treat him kindly and give him cups of tea. After being rescued, he complains about Avon’s treatment of him. Avon’s response: “so you’d rather be a load of spare parts down there than one spare part up here?” *

    I can see his point.

    DP

    * From memory

  26. When did the UK adopt an “opt out” model for organ donation? Recently? Damned glad I’ve left, now.

    Yup. Happened earlier this year and lots of us who have been voluntary donor card holders for decades tore them up and opted out. Utterly contemptible behaviour from UK Gov & co.

    You’ve got to draw the line somewhere and the idea that just because I’m somewhat terminally inclined (and not able to put up a fight), then some bastard can snatch my organs without my consent. I worked damn hard on those things, especially the liver…

    The difference between blood/plasma and kidney/etc is the same difference between income tax and wealth tax. Once you’ve taken two kidneys you run out.

    So kill two birds with one stone. Anyone that actually donates a kidney while living gets an exemption from Income Tax for the remainder of his/her life.

    Anyone who donates after death has their entire estate (irrespective of the size) completely exempt from inheritance tax.

    The organs would flood in and it’s all still voluntary (albeit incentivised).

    Job Done!

  27. “and lots of us who have been voluntary donor card holders for decades tore them up and opted out”

    Precisely!

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