Friday, August 18, 2006

Another body parts scandal. What should we do about the ghouls?

I am an organ donor. It was very easy to do, I just had to tell them when I got my driver's license and they put the little sticker on the back. And I've also made it very clear to my wife that if she ever has to make that decision, that I would love to be able to save someone else's life before they pull the plug.

And I fully believe that being an organ donor is a very important thing to do. It is a simple fact that people die waiting for an organ, simply because other people don't take a few moments to make that decision, or for whatever unknown reason want their liver, heart, or kidneys buried or cremated with them (hey, I'm a believer in Christ and therefore I believe in resurrection, but does any one really believe that if your body is missing a liver, you will die again, from blood poisoning caused by the failure of the liver to clean your blood when you reach heaven?)

I have a personal reason as well for being an organ donor. I had a friend named Rob Oliver quite a few years ago. Rob ruined his liver with alcohol. When I knew him, he was clean and sober, but his liver had already been destroyed. Rob died when it finally gave out altogether, like so many others, on the transplant list waiting for an organ donor who had a liver that matched his. So being an organ donor is the least I can do, too late for him but perhaps in time for somebody else if I have an unfortunate early demise.

My father had also wanted to be an organ donor. When he died in 1991, his body was too riddled with pharmaceuticals to be useful for transplants, but his eyes were donated to a medical school. He would have been happy that they at least used that part of him, and perhaps to train the next generation of doctors (he was a doctor.) And many people will their bodies to medical research. That is a good thing. It is true that many doctors today are trained by software programs that simulate human anatomy. And in some ways this is good, in that it is a lot cleaner and in some cases can be made clearer than a cadaver. And the software is much better than it was a few years ago, when the ADAM program only allowed one version of a male and one version of a female. Random differences between individuals can now be written into the software program. However, no matter how good a software program is, it is only like having a very good flight simulator or a very good program that simulates driving. Ultimately the only way a medical student will learn is by actually doing some work himself or herself on cadavers. Either that, or have a live patient the first time. I much prefer a cadaver be used before the young intern operates on me.

On top of that, cadaver tissue has been found to be useful in many other cases than just organ transplants. Burn victims are now routinely given skin transplants from cadavers, and just last year a French medical team even did a face transplant from a cadaver for a woman whose face had been mauled by a dog. Bones from cadavers have been used to create natural replacements for joints, and also in reconstructive surgeries.

It is for that reason that I find stories like the one out today, that a company in North Carolina in order to make a buck may have allowed tissue infected with HIV or hepatitis to be cleared for medical use, to be very disturbing.

And this isn't the first time. Because there is big money involved with body parts, we saw recently a gang in Brooklyn charged with the theft of body parts for sale, including some belonging to the late Masterpiece Theater host Alistair Cooke, who died at the age of 95 (clearly they were just looking to make a quick buck from people who were equally unethical and would be willing to transplant or otherwise use 95 year old body parts). We also saw for example, that St. Vincent Hospital in Los Angeles in 2003 violated the most fundamental precept of organ transplantation, the waiting list, by bumping a Saudi national who flew in from Saudi Arabia (and who remains anonymous), and who was at the time at number 52 on the list for a new liver ahead of two people who were there at St.Vincent hospital, including number one on the list who was an indigent black man, nine from other hospitals in Los Angeles and also 40 other people. The second article linked below gives the reason for this, as apparently the Saudi embassy paid the hospital $340,000 up front, along with a lot of under the table payments to various hospital personnel who were willing to be bought for the right price. The list is supposed to involve a combination of factors, including the immediacy of the need, the time already on the list, the goodness of the fit, and the distance from the donor, but it is absolutely NOT supposed to include wealth, social standing or ability to pay.

Then there was also the UCLA cadaver scandal-- in which cadavers donated for medical research were apparently 'parted out' to sleazy underground dealers who sold the parts for as much as $200,000 per cadaver to pharmaceutical and medical industry representatives. On top of that, we have since learned that hundreds of homeless people, mostly blacks, have 'disappeared' from a skid row near the UCLA medical center over the years. Police are investigating whether some of them were murdered and sold either to the medical school there or to other body parts traders. Meanwhile, earlier this year up to a hundred people in the Atlanta area have been informed that they may have received diseased tissue that was stolen from corpses in funeral homes and never properly screened for a variety of diseases.

I believe that before any more stories like today's come out, we should seriously look at the profit that is being made in the sale of body parts. Then we should either nationalize the whole industry (I know conservatives cringe about this, but frankly this is an industry where perhaps no profit SHOULD be made), and that is the solution I would favor, or if we don't do that, then allow the people themselves to be able to share in what are now obscene profits. Do I believe that people should be able to simply sell their own organs, even if it is with a clause which is only effective at death? Well, I have serious concerns about how this could be abused, but since apparently the system is being abused anyway, it seems the lesser of evils. I mean, if you are really worth $200,000 doesn't it stand to reason that you should be at least as able to access it as some 'used parts' dealer?

If you want to be really crass, consider an option to allow insurance companies to give people an option when they purchase a life insurance policy to get some exchange on the medical value of their body, perhaps by agreeing that if they are willing to give the control over their body (perhaps after the removal of a few nonvital parts that could be buried or cremated for the benefit of loved ones) to the insurance company in exchange for either lower premiums or a higher payment at death. An alternative would be to include a clause allowing their loved ones to consider this option after death (though that is probably the worst idea-- given a choice between, say, burying the body or giving it up for a hundred thousand dollars, would undoubtedly lead to a great deal of regret and second guessing no matter which option was chosen.)

I don't pretend to have the answer to any of this, but I do know that the system we have now is enriching unscrupulous and greedy profiteers to the detriment of both the quick and the dead.


Anonymous said...

I don't like either of your ideas.

Nationalizing it won't stop black marketeering.

I do think you can make a case for regulation (this is an industry that has to be regulated).

If you really want to curb the abuses then why not give everyone an incentive to be an organ donor? Like a refundable tax credit. Increase the supply legally and force the price down and the bottom drops out of a black market.

Anonymous said...

And the reason I don't like the insurance proposals are that I don't think that this is ethical. It could be used to pressure people. And besides all that, what would your insurance company do with a dead body anyway? Keep the insurance companies out of this.

Karen said...

wow, eli, lots of useful info to digest...

shrimplate said...

The wonderful Canadian movie "Jesus of Montreal" ends with the "christ" character dying and donating his various organs.

The scene in which the blind woman now sees through his donated eyes is very moving.

I too will be an organ donor. It's like the ultimate way of being a conscientious objector.