Our Deadly Organ Donation System

by on May 26, 2006 · 36 comments

We mostly focus on computer technology here at TLF, but there are other types of technologies that are arguably more important. For all my railing against the DMCA, I have to concede that, as far as I know, it’s never gotten anybody killed. The same can’t be said, unfortunately, of our organ-donation system. AEI’s Sally Satel writes:

When Rob Haneisen, a reporter at the MetroWest Daily News in Framingham, Mass., who has written about people in situations like hers, asked Lisa if he could interview her for a story, she jumped. Perhaps former colleagues, long lost friends, or a Good Samaritan would read about her and volunteer to donate. Lisa had even begun coordinating with Beth Israel Deaconess Medical Center to prepare for a transplant, should a donor come forward as a result of the News article that ran on April 16. Enter Dr. Douglas Hanto, head of the transplant division at Beth Israel. He had heard about Lisa’s circumstance when Haneisen called him for an interview as part of the story. Before speaking to the reporter, Hanto had his staff phone Lisa right away to deliver shocking news: Beth Israel would flatly refuse to do her transplant if the only donor she could find was a kind-hearted stranger who responded to the article. “We are in favor of donors coming forward and donating to the next person on the waiting list,” Hanto told Haneisen. And how many have done that so far over the years, the reporter asked? “Just a couple,” Hanto admitted. Also puzzling is Hanto’s assertion: “We have hundreds of people on the waiting list. If we support some favored status for one patient, how can we really say we are being fair and looking out for all our patients?” The fact is that Lisa harms nobody if a stranger responds to her story and comes to her aid. In fact, she helps people on the list because she is taken out of the cadaver-waiting queue and others can move up.

Transplants in this country are handled by the United Network for Organ Sharing, a non-profit organization with a government-granted monopoly on the distribution of organs. The “bioethicists” at UNOS are obsessed with ensuring that organs are distributed “fairly,” even if fairness leads to fewer donations and more people dying. The system is arbitrary, it’s stupid, and–most importantly–it’s deadly

Obviously, we’d like the distribution of organs to be as fair as possible. But a far more important objective is to increase the number of donors so that fewer people die. Death is never fair, and I doubt it’s going to be any consolation to the family of somebody who died on a waiting list that no one was allowed to cut in line ahead of them.

What’s to be done? The best solution would be to allow financial incentives to organ donors. If we’re too squeamish about a full-blown free market in organs, we could at least allow some tightly regulated rewards to those who choose to become donors.

In the meantime, you should check out LifeSharers. It’s a network of organ donors who have specified that their organs should go preferentially to other LifeSharers members. This has two beneficial effects. First, if you should ever need a transplant, your odds are increased because you’ll get priority should any LifeSharers members’ organs become available. But more importantly, you increase the incentive for others to become LifeSharers members (and therefore, organ donors) too.

People respond to incentives. It’s an obvious point, but it’s one that seems lost on the “bioethicists” who are currently standing in the way of creative solutions to the organ shortage.

  • http://sethf.com/ Seth Finkelstein

    You say: “The best solution would be to allow financial incentives to organ donors”

    Just to confirm, you support organ-selling, correct? A billionaire can offer someone some cash for their … liver? kidney?? HEART???

    How does this interact with parental rights, by the way? Can said billionaire offer the money to a parent to make the parental decision for their child to donate the organ? How about the money if the parent will attempt to “convince” the child to donate the organ?

    Is the financial “incentive” to donate organs part of the rights which can be sold for a debt? (adds new meaning to the phrase “the credit company owns me”)

    Inquiring minds want to know!

  • http://www.techliberation.com/ Tim

    Seth,

    Sure, allowing organ sales is one type of incentive that I would support. I don’t think the horror stories you suggest are realistic. I don’t think it’s very likely that anyone would voluntarily sell someone else their heart, and if it would make you happy we could explicitly prohibit organ sales that endanger the life of the donor. And no, obviously parents wouldn’t be able to sell their childrens’ organs, any more than parents can sell their children into slavery. That’s ridiculous. And no, we wouldn’t allow children to sell their organs, any more than we allow them to smoke or join the military. Similarly, we aren’t going to make people sell their organs to pay off debts, any more than we make them sell off their wedding rings during bankruptcy proceedings.

    But more to the point, there are lots of ways we could introduce beneficial incentives without moving to full-blown organ markets. We could, for example, have a tax credit for organ donations, or allow non-profit organizations to offer rewards for organ donations. We could pay people to sign their organ donor cards.

    This isn’t a black-and-white issue. Surely we could certainly come up with some way to reward donors without it leading to credit card companies seizing peoples hearts. Right now, people are dying due to a lack of donors. Surely it’s worth trying out some alternative approaches to see if we can save some lives, isn’t it?

  • http://sethf.com/ Seth Finkelstein

    You say: “The best solution would be to allow financial incentives to organ donors”

    Just to confirm, you support organ-selling, correct? A billionaire can offer someone some cash for their … liver? kidney?? HEART???

    How does this interact with parental rights, by the way? Can said billionaire offer the money to a parent to make the parental decision for their child to donate the organ? How about the money if the parent will attempt to “convince” the child to donate the organ?

    Is the financial “incentive” to donate organs part of the rights which can be sold for a debt? (adds new meaning to the phrase “the credit company owns me”)

    Inquiring minds want to know!

  • http://sethf.com/ Seth Finkelstein

    Err, even today, in certain parts of the world, children get sold into slavery. Or look up “baby farming”. Or the issues with organ-harvesting in China, that’s a horror story which is quite real and not a Libertarian thought-experiment.

    Though I’m glad to see you admit there’s other values besides “a full-blown free market in organs”.

    But, really, do you believe nobody has every thought of the wonders of organ-selling? That is, “It’s an obvious point, but it’s one that seems lost on the “bioethicists” who are currently …”. If that’s just political rhetoric, then all it deserves in reply is counter-rhetoric. More seriously, the fact that people do respond to “incentives” is exactly why bioethics want to guard against the perverse incentives in organ-selling.

    Riding ideological hobbyhorses is not a viable “alternative approach”.

  • http://www.techliberation.com/ Tim

    Sure, we want to “guard against” possible perverse incentives. But how is that an argument for flatly prohibiting anyone from being rewarded for donating an organ? Are you telling me that there’s absolutely no way to reward people who choose to become organ donors without leading to people selling their children’s kidneys on eBay?

  • http://www.techliberation.com/ Tim

    Seth,

    Sure, allowing organ sales is one type of incentive that I would support. I don’t think the horror stories you suggest are realistic. I don’t think it’s very likely that anyone would voluntarily sell someone else their heart, and if it would make you happy we could explicitly prohibit organ sales that endanger the life of the donor. And no, obviously parents wouldn’t be able to sell their childrens’ organs, any more than parents can sell their children into slavery. That’s ridiculous. And no, we wouldn’t allow children to sell their organs, any more than we allow them to smoke or join the military. Similarly, we aren’t going to make people sell their organs to pay off debts, any more than we make them sell off their wedding rings during bankruptcy proceedings.

    But more to the point, there are lots of ways we could introduce beneficial incentives without moving to full-blown organ markets. We could, for example, have a tax credit for organ donations, or allow non-profit organizations to offer rewards for organ donations. We could pay people to sign their organ donor cards.

    This isn’t a black-and-white issue. Surely we could certainly come up with some way to reward donors without it leading to credit card companies seizing peoples hearts. Right now, people are dying due to a lack of donors. Surely it’s worth trying out some alternative approaches to see if we can save some lives, isn’t it?

  • http://sethf.com/ Seth Finkelstein

    Err, even today, in certain parts of the world, children get sold into slavery. Or look up “baby farming”. Or the issues with organ-harvesting in China, that’s a horror story which is quite real and not a Libertarian thought-experiment.

    Though I’m glad to see you admit there’s other values besides “a full-blown free market in organs”.

    But, really, do you believe nobody has every thought of the wonders of organ-selling? That is, “It’s an obvious point, but it’s one that seems lost on the “bioethicists” who are currently …”. If that’s just political rhetoric, then all it deserves in reply is counter-rhetoric. More seriously, the fact that people do respond to “incentives” is exactly why bioethics want to guard against the perverse incentives in organ-selling.

    Riding ideological hobbyhorses is not a viable “alternative approach”.

  • http://www.techliberation.com/ Tim

    Sure, we want to “guard against” possible perverse incentives. But how is that an argument for flatly prohibiting anyone from being rewarded for donating an organ? Are you telling me that there’s absolutely no way to reward people who choose to become organ donors without leading to people selling their children’s kidneys on eBay?

  • http://sethf.com/ Seth Finkelstein

    When “reward” means “pay money”, it should be obvious how that can very quickly become problematic. “Rewarding” people in ways which don’t translate into immediate profit are one thing – cash-for-kidneys quite another.

    Look, it wasn’t all the far back in history when people were bought and sold in this country, and again, there’s still a market in slaves in some parts of the world. I think organizations which are aware of existing slave trades, and the killing of prisoners for organ transplant material, have every reason in the world not to want to see a financial market in organs created in rich countries.

  • http://www.techliberation.com/ Tim

    It’s not obvious to me how it could “quickly become problematic.” We’re not talking about heart futures being sold on the Chicago Mercantile exchange. Perhaps you can elaborate on how, say, a $1000 tax credit for donating a kidney can lead to the reintroduction of slavery?

  • http://www.withoutbound.net Amanda

    The organ selling/slavery comparison is lost on me. They look to me like complete opposites. Allowing people to get financial compensation for their organs recognizes that people own their own bodies, and (if competent) can choose what to do with them. In stark contrast we have slavery in which people’s bodies are not their own at all.

    Further note that the ability to sell plasma, eggs, and sperm has not led to any human rights losses I’m aware of in this country.

    I would certainly support restrictions as mentioned in this thread, but when thousands of people are dying every year because we’re burying usable organs, I think it’s time to take a hard look at what we can do to make more organs available.

    If nothing else, there are plenty of options for increasing cadaver donation – paying people to sign organ donor cards, as Tim mentioned; giving credits to the estates of donors, etc.

  • http://sethf.com/ Seth Finkelstein

    When “reward” means “pay money”, it should be obvious how that can very quickly become problematic. “Rewarding” people in ways which don’t translate into immediate profit are one thing – cash-for-kidneys quite another.

    Look, it wasn’t all the far back in history when people were bought and sold in this country, and again, there’s still a market in slaves in some parts of the world. I think organizations which are aware of existing slave trades, and the killing of prisoners for organ transplant material, have every reason in the world not to want to see a financial market in organs created in rich countries.

  • http://sethf.com/ Seth Finkelstein

    Amanda: In both cases, money is paid for a human body (part). Now, if this is a replaceable body part, it’s not a problem – there’s a market in human hair, for example. If it becomes an irreplaceable body part, that produces an incentive to irrepairably exploit others (if you sell your hair, well, it grows back – eggs, sperm are generally useless, blood regenerates – but internal organs don’t).

    I’m trying to make this simple:

    1) Do you know about China and organ-harvesting of prisoners?

    2) Do you know about historical “baby-farming”?

    3) From 1) and 2), can you see that cash-for-kidneys could be a problem?

    [Tim, do you see this also?]

    If we don’t even get past the basics, there’s no point is anything else.

  • http://www.techliberation.com/ Tim

    It’s not obvious to me how it could “quickly become problematic.” We’re not talking about heart futures being sold on the Chicago Mercantile exchange. Perhaps you can elaborate on how, say, a $1000 tax credit for donating a kidney can lead to the reintroduction of slavery?

  • http://www.withoutbound.net Amanda

    The organ selling/slavery comparison is lost on me. They look to me like complete opposites. Allowing people to get financial compensation for their organs recognizes that people own their own bodies, and (if competent) can choose what to do with them. In stark contrast we have slavery in which people’s bodies are not their own at all.

    Further note that the ability to sell plasma, eggs, and sperm has not led to any human rights losses I’m aware of in this country.

    I would certainly support restrictions as mentioned in this thread, but when thousands of people are dying every year because we’re burying usable organs, I think it’s time to take a hard look at what we can do to make more organs available.

    If nothing else, there are plenty of options for increasing cadaver donation – paying people to sign organ donor cards, as Tim mentioned; giving credits to the estates of donors, etc.

  • http://sethf.com/ Seth Finkelstein

    Amanda: In both cases, money is paid for a human body (part). Now, if this is a replaceable body part, it’s not a problem – there’s a market in human hair, for example. If it becomes an irreplaceable body part, that produces an incentive to irrepairably exploit others (if you sell your hair, well, it grows back – eggs, sperm are generally useless, blood regenerates – but internal organs don’t).

    I’m trying to make this simple:

    1) Do you know about China and organ-harvesting of prisoners?

    2) Do you know about historical “baby-farming”?

    3) From 1) and 2), can you see that cash-for-kidneys could be a problem?

    [Tim, do you see this also?]

    If we don’t even get past the basics, there’s no point is anything else.

  • http://sethf.com/ Seth Finkelstein

    Amanda: In both cases, money is paid for a human body (part). Now, if this is a replaceable body part, it’s not a problem – there’s a market in human hair, for example. If it becomes an irreplaceable body part, that produces an incentive to irrepairably exploit others (if you sell your hair, well, it grows back – eggs, sperm are generally useless, blood regenerates – but internal organs don’t).

    I’m trying to make this simple:

    1) Do you know about China and organ-harvesting of prisoners?

    2) Do you know about historical “baby-farming”?

    3) From 1) and 2), can you see that cash-for-kidneys could be a problem?

    [Tim, do you see this also?]

    If we don’t even get past the basics, there’s no point in anything else.

  • http://sethf.com/ Seth Finkelstein

    Amanda: In both cases, money is paid for a human body (part). Now, if this is a replaceable body part, it’s not a problem – there’s a market in human hair, for example. If it becomes an irreplaceable body part, that produces an incentive to irrepairably exploit others (if you sell your hair, well, it grows back – eggs, sperm are generally useless, blood regenerates – but internal organs don’t).

    I’m trying to make this simple:

    1) Do you know about China and organ-harvesting of prisoners?

    2) Do you know about historical “baby-farming”?

    3) From 1) and 2), can you see that cash-for-kidneys could be a problem?

    [Tim, do you see this also?]

    If we don’t even get past the basics, there’s no point in anything else.

  • http://www.lifesharers.org David J. Undis

    The organ shortage is really an organ donor shortage. About 8,000 Americans die every year waiting for organ transplants. At the same time, Americans bury or cremate about 20,000 transplantable organs every year.

    LifeSharers is increasing the supply of organ donors by giving people another good reason to donate. We offer a very good trade — you agree to donate your organs when you’re dead, and in exchange you increase your chances of getting a transplant if you ever need one to live.

    Increasing your chances of getting a transplant could literally save your life. More than half of the people who need a transplant in the United States will die before they get one.

    Membership in LifeSharers is free and open to all at http://www.lifesharers.org or by calling 1-888-ORGAN88. No one is excluded due to age or pre-existing medical condition.

  • http://www.lifesharers.org David J. Undis

    The organ shortage is really an organ donor shortage. About 8,000 Americans die every year waiting for organ transplants. At the same time, Americans bury or cremate about 20,000 transplantable organs every year.

    LifeSharers is increasing the supply of organ donors by giving people another good reason to donate. We offer a very good trade — you agree to donate your organs when you’re dead, and in exchange you increase your chances of getting a transplant if you ever need one to live.

    Increasing your chances of getting a transplant could literally save your life. More than half of the people who need a transplant in the United States will die before they get one.

    Membership in LifeSharers is free and open to all at http://www.lifesharers.org or by calling 1-888-ORGAN88. No one is excluded due to age or pre-existing medical condition.

  • eric

    Seth, I can see that cash-for-kidneys can be a problem. But do you not see that our entire medical system is a problem? It is paid more for treating disease with expensive surgeries, devices, and drugs, than it is for keeping people well so they don’t need such services. That is a perverse incentive system, one that has led to tens of thousands of preventable deaths from prescription drugs every year, because they are overused, misprescribed, with improper patient monitoring.

    One study, designed to estimate the monetary cost of morbidity and mortality from drugs prescribed in an outpatient setting, used as the basis of their calculations a death rate of 200,000 Americans per year! This study was published a few years ago in a major pharmacology journal.

    The point is that when hospitals, doctors, and drug-makers cash in to the tune of a couple hundred thousand dollars for every transplant, why is the donor expected to literally give a pound of his own flesh on the basis of unpaid humanitarianism? Everybody else gets paid.

  • eric

    Seth, I can see that cash-for-kidneys can be a problem. But do you not see that our entire medical system is a problem? It is paid more for treating disease with expensive surgeries, devices, and drugs, than it is for keeping people well so they don’t need such services. That is a perverse incentive system, one that has led to tens of thousands of preventable deaths from prescription drugs every year, because they are overused, misprescribed, with improper patient monitoring.

    One study, designed to estimate the monetary cost of morbidity and mortality from drugs prescribed in an outpatient setting, used as the basis of their calculations a death rate of 200,000 Americans per year! This study was published a few years ago in a major pharmacology journal.

    The point is that when hospitals, doctors, and drug-makers cash in to the tune of a couple hundred thousand dollars for every transplant, why is the donor expected to literally give a pound of his own flesh on the basis of unpaid humanitarianism? Everybody else gets paid.

  • http://www.withoutbound.net/blog/ Amanda

    Seth, I’m aware of your (1) and (2). Those are obviously terrible problems. But it seems to me that they stem NOT from allowing people to sell their own organs, but from not stopping people from selling other people’s organs! Those are two totally different things, and I don’t see how the second follows from the first.

    For example, it’s currently legal for women to sell their eggs in the US. It’s pretty lucrative, too. And yet, I haven’t heard any stories of people having their eggs forcibly extracted and sold against their will. Surely, if the causation you suggest were realistic, this would be happening.

    More likely, we’d have stringent requirements for organ donors, just like we currently have for egg donors. They’d have to go through extensive psychological and medical counseling, with opportunities to back out at any point. There would probably be laws regulating the money transfer; for example it could only go into a bank account owned by the organ donor. All of this might be required to be vetted by an independent agency.

    I really don’t see China-type abuses happening in a country that generally respects its citizens’ human rights.

  • http://www.withoutbound.net/blog/ Amanda

    Seth, I’m aware of your (1) and (2). Those are obviously terrible problems. But it seems to me that they stem NOT from allowing people to sell their own organs, but from not stopping people from selling other people’s organs! Those are two totally different things, and I don’t see how the second follows from the first.

    For example, it’s currently legal for women to sell their eggs in the US. It’s pretty lucrative, too. And yet, I haven’t heard any stories of people having their eggs forcibly extracted and sold against their will. Surely, if the causation you suggest were realistic, this would be happening.

    More likely, we’d have stringent requirements for organ donors, just like we currently have for egg donors. They’d have to go through extensive psychological and medical counseling, with opportunities to back out at any point. There would probably be laws regulating the money transfer; for example it could only go into a bank account owned by the organ donor. All of this might be required to be vetted by an independent agency.

    I really don’t see China-type abuses happening in a country that generally respects its citizens’ human rights.

  • Anton

    I am VEHEMENTLY in favor of compulsory organ donation.This is really the ONLY practical solution ot relieving the organ shortage here in the US. For those who think that its unethical, consider THIS: DEAD PEOPLE DO NOT NEED THEIR ORGANS! LIVING PEOPLE DO! WHY ON EARTH SHOULD THE NEEDS OF THE DEAD HAVE PRECEDENCE OVER THE NEEDS OF THE LIVING?!?!?!?!?!?!

  • Anton

    I am VEHEMENTLY in favor of compulsory organ donation.This is really the ONLY practical solution ot relieving the organ shortage here in the US. For those who think that its unethical, consider THIS: DEAD PEOPLE DO NOT NEED THEIR ORGANS! LIVING PEOPLE DO! WHY ON EARTH SHOULD THE NEEDS OF THE DEAD HAVE PRECEDENCE OVER THE NEEDS OF THE LIVING?!?!?!?!?!?!

  • Teal

    For consideration….there are roughly two systems for organ acquirement 1) cadaver, and 2) living/healthy person who donates/sells an organ to another (ie)kidney. It’s a choice. Peoples choices reflect their knowledge and/or lack thereof. The systems referred to above is also reflective of the people who are making attempts to control how the 2 present systems work (which is not working out to it’s best potential).

    Think about it….I am an organ donor but that’s upon my eminent death. However, I would also be willing to sell a healthy organ (ie) my kidney to the highest bidder. It should be a choice, but ‘someone’ wants to regulate this.

    There’s already a list for those needing/seeking transplants, and these transplants/organs generally come from a previously healthy person who has recently died. That’s system 1. And those needing transplants have their name on the system 1 plan waiting list. What if one could have their name on the present system 1 plan but in addition they could also afford to purchase an organ from a healthy person willing/wanting to sell their organ (ie)kidney. Whatever organ match comes up first, the present system 1, or if a match occurs in the buying system, a person needing a transplant has a choice. We don’t all have the some choices made available to us, and those trying to make the system completely fair are completely making less options making it less fair. Think about it….those who could afford or who opt to purchase an organ match takes them off the previous waiting list (system 1) and moves the next recepient up on the list.

    There are implications to everything…but to simply focus on what could go wrong sometimes keeps what’s right from happening.

  • Teal

    For consideration….there are roughly two systems for organ acquirement 1) cadaver, and 2) living/healthy person who donates/sells an organ to another (ie)kidney. It’s a choice. Peoples choices reflect their knowledge and/or lack thereof. The systems referred to above is also reflective of the people who are making attempts to control how the 2 present systems work (which is not working out to it’s best potential).

    Think about it….I am an organ donor but that’s upon my eminent death. However, I would also be willing to sell a healthy organ (ie) my kidney to the highest bidder. It should be a choice, but ‘someone’ wants to regulate this.

    There’s already a list for those needing/seeking transplants, and these transplants/organs generally come from a previously healthy person who has recently died. That’s system 1. And those needing transplants have their name on the system 1 plan waiting list. What if one could have their name on the present system 1 plan but in addition they could also afford to purchase an organ from a healthy person willing/wanting to sell their organ (ie)kidney. Whatever organ match comes up first, the present system 1, or if a match occurs in the buying system, a person needing a transplant has a choice. We don’t all have the some choices made available to us, and those trying to make the system completely fair are completely making less options making it less fair. Think about it….those who could afford or who opt to purchase an organ match takes them off the previous waiting list (system 1) and moves the next recepient up on the list.

    There are implications to everything…but to simply focus on what could go wrong sometimes keeps what’s right from happening.

  • Teal

    Goodness, you surely wouldn’t let me have the “last word” on this would you? I suppose I was in hopes that someone in this open forum would be of the mind set to get the ball rolling in the direction of making options available for those needing and for those giving….organs. This concept is neither new nor far fetched, but could very well offer benefits to all involved which includes the benefit of life.

  • Teal

    Goodness, you surely wouldn’t let me have the “last word” on this would you? I suppose I was in hopes that someone in this open forum would be of the mind set to get the ball rolling in the direction of making options available for those needing and for those giving….organs. This concept is neither new nor far fetched, but could very well offer benefits to all involved which includes the benefit of life.

  • J

    I am one of those people who would like to “donate” for compensation. I am in a dire financial emergency and have a healthy kidney to donate for proffit with A+ blood type, however, with the laws the way they are, all of my searching for someone that needs it and can pay for it is almost useless. Someone out there who might be dead in a month could have mine for a price if the government let this happen so we could have a resource to find one another. I know that it would be morrally better to just donate, but when you are in the situation I am in, that is the ony thing of value I have to offer myself to help my family. It would be helping 2 families.

  • J

    Oh, just in case someone knows of a way that I am missing and wants to let me know in private, here is my email: financequeen28@yahoo.com

  • J

    I am one of those people who would like to “donate” for compensation. I am in a dire financial emergency and have a healthy kidney to donate for proffit with A+ blood type, however, with the laws the way they are, all of my searching for someone that needs it and can pay for it is almost useless. Someone out there who might be dead in a month could have mine for a price if the government let this happen so we could have a resource to find one another. I know that it would be morrally better to just donate, but when you are in the situation I am in, that is the ony thing of value I have to offer myself to help my family. It would be helping 2 families.

  • J

    Oh, just in case someone knows of a way that I am missing and wants to let me know in private, here is my email: financequeen28@yahoo.com

  • Teal

    You’re right, what are the safe gaurds if any to prevent such a scenario? And/or, what if this very scenario is what prevents some of thinking of other alternatives and options for those needing organs and for those considering organ donation? Fear of this scenario (ie dire straights, under duress, coercion, etc.) stifles further exploration of viable options. It’s true, so now what….keep the regular system 1 waiting list plan because it’s all we have (?). Or, could it be improved upon which would be morally and ethically beneficial?

    Attention to what could wrong does need to be explored but when the focus is only on what could wrong this may very well keep further exploration of what could be helpful and beneficial from occurring.

  • Teal

    You’re right, what are the safe gaurds if any to prevent such a scenario? And/or, what if this very scenario is what prevents some of thinking of other alternatives and options for those needing organs and for those considering organ donation? Fear of this scenario (ie dire straights, under duress, coercion, etc.) stifles further exploration of viable options. It’s true, so now what….keep the regular system 1 waiting list plan because it’s all we have (?). Or, could it be improved upon which would be morally and ethically beneficial?

    Attention to what could wrong does need to be explored but when the focus is only on what could wrong this may very well keep further exploration of what could be helpful and beneficial from occurring.

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