Alex Tabarrok of Marginal Revolution links to a very compelling case for paying organ donors, made by Alexander Berger in a New York Times op-ed. The counter-argument has always been that this will lead to the exploitation of people, especially the poor. What I find striking is that the debate, as I have seen it, has rarely if ever referenced the best example of this actually happening. In Chapter 12 of the excellent The Origins of AIDS, Jacques Pepin highlights paid plasma donors as a crucial vector in the early spread of HIV-1. A few potent excerpts:
In rural areas [of China], poor farmers were recruited by ‘plasma pimps’, to sell plasma to increase their meagre income. They received $6 per donation, which could be repeated twice a month in theory, more often if donors attended more than one collected centre. [...] In the most-heavily affected provinces [...] approximately 250,000 paid donors (a quarter of a million!) acquired HIV.
What do these stories have in common? Poor people looking for a quick source of income and willing to sell their blood repeatedly. Profit-driven blood collection centres where a small number of entrepreneurs try to make as much money as possible by cutting costs, re-using needles, syringes, and tubings, while being unaware of or not caring about the risk of transmitting blood-borne viruses. A lucrative market for these blood products, either locally or internationally. Finally, a ‘patient zero’ who introduces the pathogen.
Pepin also cites incredibly dangerous practices such as the pooling of blood from multiple (ABO-matched) donors for plasma separation, with the cell matter divided among all of them for return to the bloodstream. The system was ripe with abuses. Strikingly almost all of this appears to have been driven by blood collectors or donation centers, rather than risk-taking by actual donors. And of course all organs and blood donations are always sold, often at a substantial profit, by the extractors – we are arguing only over paying the donor him- or herself.
The lesson here is not that paid organ donation is a bad thing – all of Berger’s points are entirely valid ones, and any risks can be controlled. But we should address the strongest arguments against this option, to see how to deal with them. In particular, careful regulation of the extraction of donated organs is always important but becomes moreso the more that high prices for organs induce potential entrepreneurs to enter the market. We have a handle on HIV transmission now, but need to be on guard for the next potential disaster. The danger is that the case for paid organ donation seems so obvious that, in bringing it about, we (perhaps willfully) ignore the risks associated with it.