Sunday, January 13, 2008

Your Body Belongs To The State


Not even the People's Republic of China goes this far. True, 95% of all their transplant organs are taken from executed prisoners. But so long as you don't get condemned to death, your organs are safe.

Here in Bottler's Britain, having abolished you know what, the commissars are thinking much more expansively. And today the Supreme Leader tells us the state should own your body organs. He wants to change the presumption of body ownership from you to the state health commissariat.

At present, in the event of your kicking the proverbial, state doctors can only help themselves to your bits and pieces if you've previously registered consent on the National Donor Register.

But in Bottler's New Order, the presumption will flip round. When you die, state doctors won't have to go through the tiresome business of searching through the Register. As soon as they reckon you've probably gone, they can dive straight in to strip you down to your chassis.

Of course, theoretically your family would still be able to opt you out after your expiry. But does anyone seriously believe the typical NHS hospital would be capable of managing such a process? Plus, we punters find it hard enough to grip NHS bureaucracy at the best of times, so filling in a 200 page opt-out form in the depths of family grief is a virtual non-starter. And what about all those who die in hospital with no family around?

Bottler says it's for the best of all possible reasons in the best of all possible healthcare systems:

"There are currently more than 8,000 people in the UK awaiting organ donation but only 3,000 transplants are carried out each year. Sadly, that means that more than 1,000 people die each year waiting for transplants... That is an avoidable human tragedy we can and must address."

Statistics and tragedies: they've always been uneasy bedfellows, ever since Uncle Joe came up with his famous principle. And when you scratch Bottler's stats you notice something rather odd.

It turns out that one quarter of the UK adult population have already registered for organ donation, on an entirely voluntary basis (Tyler being one of them). Yet "in terms of actual donors (not just people willing to give, but those whose organs are actually used) we have a rate of about 13 donors per million in our population" (just over one thousandth of one percent).

Why such a massive apparent difference? Undoubtedly much of it is down to the difficulty of matching model numbers, and there are some statistical apples and pears, but over and above all that, NHS hospitals are just not much good at customer relations: you may have signed up for voluntary donation, but all too often the hospital then mishandles your grieving relatives. The Department of Health's own "taskforce" reckons:

"... there could be a 50 per cent increase in donated organs if hospitals became better at dealing with the highly sensitive conversations that take place when a patient has been confirmed braindead. At present, around one-third of families refuse to give consent for organ retrieval, and even when a patient carries a donor card, many families still refuse."

No wonder the commissars want to switch things round: how much easier for them if the presumption becomes automatic donation unless the relatives manage to jump through some impenetrable opt-out hoop.

Yes it's true that the donation rate is higher in countries like Spain and France, which have already established these "presumed consent" systems. But the donation rate is also higher in the US, where there is no presumed consent.

And while we all understand this a tricky area, there is always that Other Approach- the one nobody likes to talk about.

According to the Economist:

"IF THEY were just another product, the market would work its usual magic: supply would respond to high prices and rise to meet surging demand. But human kidneys are no ordinary commodity. Trading them is banned in most countries. So supply depends largely on the charity of individuals: some are willing to donate one of their healthy kidneys while they are still alive (at very little risk to their health); others agree to let their kidneys be used when they die. Unsurprisingly, with altruism the only incentive, not enough people offer.

Kidneys are the subject of a quietly growing global drama. As people in the rich world live longer and grow fatter, queues for kidneys are lengthening fast. Doctors are allowing older and more sluggish kidneys to be transplanted. Ailing, rich patients are buying kidneys from the poor and desperate in burgeoning black markets. One bigwig broker may soon stand trial in South Africa . Clandestine kidneysellers get little medical follow-up, buyers often catch hepatitis or HIV, and both endure the consequences of slapdash surgery.

In the face of all this, most countries are sticking with the worst of all policy options.

Governments place the onus on their citizens to volunteer organs. The way to encourage this is to legalise the sale of kidneys. That’s what Iran has done. Having a kidney removed is as safe as common elective surgeries and even beauty treatments (it is no more dangerous than liposuction, for example), which sets it apart from other types of living-organ donation. America already lets people buy babies from surrogate mothers, and the risk of dying from renting out your womb is six times higher than from selling your kidney."

And the Economist isn't alone in calling for us to be allowed to sell our organs in an open fully regulated market.

Because whatever we may think of it, in these days of international health tourism, the transplant market is booming. But being unregulated and largely clandestine, standards are all over the place. And the danger for all concerned is immense.

The market's Wild West nature is underlined by the huge variation in prices. Here's an indicative price list:

  • Kidney- sourced in Manila: $1000-$2000
  • Kidney- sourced in urban Latin America: $10,000
  • Kidney- sourced in South Africa: up to $20,000
  • Kidney transplant operation- US: $100,000; China $70,000;
  • Heart transplant- US: $311,000 plus $40,000 annual maintenance; China $120,000
  • Liver transplant- China: $160,000; US: $250,000

According to Sue Roff at the Dundee Hospital Medical School, offering £22 grand apiece for homegrown British kidneys would soon bring forth plenty to go round.

Wonder why Bottler hasn't mentioned that idea?

PS I've been trying to work out what the Major might be worth as scrap. Using the price list above, I figure £44 grand for a pair of kidneys, maybe £50 grand for the liver (nicely run in), perhaps £100,000 for the heart (although that would definitely need a full rebore), eyes... well, a tad bloodshot, but maybe they'd scrub up... gearbox... hmm... pretty well shot I fear... let's say £250 grand the lot. No tax, no MOT, buyer collects.

PPS As regular BOM readers will recall, the official value of a British life is £1,311,490 all in. So if we're worth £250 grand as physical scrap, that must mean our intangibles are worth just over £1m. Or to put it another way, the total value of us 60 million UK citizens is around £80 trillion (60m times £1.3m). With about £15 trillion being the value of our body parts, the other £65 trillion must be the value of our human capital. And of course, our souls.

Update: I heard Lib Dem Dr Evan Harris on C4 News last night telling me that Bottler's proposal is the "ethical" way forward. He says "more lives would be saved and grieving relatives will be spared the experience of making the wrong decision at the worst time". That's very thoughtful of him, and we should be grateful that we have such omniscient people to spare us from making unethical choices. The only question is why such a man is a Lib Dem rather than a fascist?

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