Any reason you shouldn’t be able to sell your blood, or buy a kidney? Not really, say guest posters Zac Gochenour & Peter Jaworski. And it would save lives.
How to Get a Spare Kidney
The good news is that you already have one
by Zac Gochenour
A common complaint about a market in kidneys is that the sick poor would not be able to get kidneys as easily as with a first-come, first-serve system. Even the lowest estimates of the price of kidneys in a free market is a
significant sum for many of the world's poor. But this argument ignores one of their biggest assets — their healthy kidney before the onset of failure.Most underlying causes of renal failure affect both kidneys, so keeping a reserve kidney in case one fails will usually not work. Also, kidneys can only be stored outside the body for about 30 hours, so storing your healthy kidney for future transplant is impossible.
In a sense, though, it is possible to store your kidney: in a market for organ transplants, your healthy kidney can be sold and the money earned from the sale used for another purpose, such as the purchase of another kidney in the future.
One way to help ensure you will have the market value for a kidney in the future is to sell one now at current market value and save the money. Prohibition of the sale of kidneys takes away the one asset that most of the poor have that could potentially save their lives.
Why We Should Let People Sell their Blood
There's nothing special about human blood
by Peter Jaworski
Many people think blood is special in a way that means it shouldn’t be “commodified,” or bought and sold on a market. It is a basic human need. It’s not like the latest gadget or a pair of shoes; it is to be revered, not remunerated.
I’m glad we don’t think food is special in this way. If we did, imagine how many people would die of starvation, or would suffer from hunger.
But Canada is just one place that thinks this way about blood. This past December, the Ontario legislature preserved the sanctity of the exchange of blood through Bill 21, entitled the “Safeguarding Health Care Integrity Act.” Schedule 1 included provisions from Bill 178, the “Voluntary Blood Donations Act,” which prohibits paying and receiving payment for blood, either directly or indirectly.
With this bill, the legislature has made the giving and receiving of blood a sacrament.
Canadian Blood Services does not have to kneel before the Act, by the way, since they are exempt from the requirements of holy sanguinity. Subsection 3 of Schedule 1 exempts them, and only them, from the subsections that make it a heresy to buy and sell blood. So they could, without being subject to an inquisition, engage in blood simony.
Is this way of describing the Act unfair? It would be, if the provisions of the Act were not based on magical thinking and were consistent with contemporary studies about the relationship between compensating donors and the quantity and quality of the blood supply. But the Act is not.
Opponents of a blood market cite worries about the safety and quantity of the blood supply. They also claim that selling blood “expresses” the wrong attitude to something sacred.
The latter worries I wrote about with Jason Brennan in a recent issue of Ethics, and explore at length in our book Markets without Limits. In short, no symbolic arguments against markets work.
The right response to worries like, “if we buy and sell blood, doesn’t that mean that we have the wrong attitude towards blood?” is, first, to point out that attitudes are independent of markets. We buy and sell cats and dogs, for example, but think of them as members of our family, not “commodities.”
And, second, that if a market in blood would save lives, as it would, then we should criticise the social practice of attaching these symbolic meanings to these kinds of exchanges. We don’t have to think that the buying and selling of blood is profane — we could, instead, think it a wonderful thing. And we should.
The former worries about the safety and quantity of blood were most prominently raised by Richard Titmuss in his ground-breaking 1971 book The Gift Relationship. Titmuss argued that we can expect poorer quality blood, and maybe even fewer donations, if we compensate donors in cash.
He thought that many of us donate blood out of concern for others. But no one will think you’ve done a ‘good deed’ out of the goodness of your heart if they know you pocketed a few Wilfrid Lauriers [ed. note: guy on the Canadian five dollar bill] in the process, and this will turn many of us off of donating blood. And who will give blood? People who need money, people whose blood is a little bit more dangerous.
Indeed, Ontario and the rest of Canada had a significant problem in the 1970s and 1980s. The Canadian blood supply, which included blood and plasma taken from U.S. prisoners who were compensated for donations, was tainted. Many Canadians who had blood transfusions ended up with HIV and Hepatitis-C because of it. This historical fact is a significant reason raised by many opponents of a market in blood, like in this Globe and Mail opinion piece.
If this is a reason to prevent compensated blood donations, why doesn’t it apply to tomatoes or blueberries?
Every year, about four million Canadians get a food-borne illness, with 11,600 hospitalizations and 238 deaths.
Despite this, no provincial government has yet proposed a bill entitled the Voluntary Tomato Donations Act, making it illegal to buy and sell tomatoes. There are no commercials urging us to replace our lawns with tomato gardens (“Tomatoes. It’s in you to grow.”).
And of course they haven’t. If anyone were to seriously suggest it, we would all laugh. We all understand that if we don’t permit farmers and grocery stores to profit from a basic human need, the basic human need will basically go unmet. We still romanticise the idea of a family farm, but we’re not prepared to see our friends and neighbours starve or go hungry for the sake of a pastoral romance.
Instead, we respond to food-borne illnesses with improved methods of testing foods, improvements in farming techniques and machinery, and certification of farmers and agricultural workers by both regulatory agencies as well as by grocery stores, neither of whom want anyone to get sick.
That’s also precisely what we’ve done with our blood and plasma supply. While no tests are perfect, modern donor assessments as well as screening and processing methods have made the worry about the quality of that supply basically moot. In the past 20 years, for example, there have been no cases of HIV or hepatitis transmission by any member of the Plasma Protein Therapeutics Association, an association representing private-sector plasma-derived therapies. And many of them pay donors.
We don’t eliminate or try to neutralise the profit-motive from our food production. We recognize that money can help to encourage people to direct their energy toward food production rather than some other endeavour. We recognize that paying people is an effective way to encourage them to provide us with things we value.
And without the added incentive, hardly anyone bothers. Lots of Canadians will support the idea of charitable blood donation, and endorse this legislation that prohibits payment. But when it comes to showing up and giving blood, it turns out it’s just a lot of worthless talk, since only a lousy four per cent of us show up.
In fact, there exists no jurisdiction in the world that gets its entire blood and plasma supply from voluntary donors. That includes the Ontario supply, which will be topped-off with blood and plasma purchased from jurisdictions that do compensate individual donors.
That means, of course, that Ontario participates in paying individual donors. If you buy a product from a third party that you know gets the product by paying individual donors, then, morally speaking, it is the same as you paying those donors. Paying a third party is not a magical moral cloaking device, it’s just obfuscation.
Claims that compensating donors lowered the supply of blood and plasma had some purchase based on a few early studies following Titmuss’s book. But those studies were small, non-representative, depended on survey data, or were not controlled. More recent, large-scale studies have shown that compensating for blood and plasma does not crowd-out charitable giving.
Economic incentives — whether in the form of a day off work, a lottery ticket, a gift card, t-shirts, coupons, or free medical tests (with the sole exception of a free cholesterol test which had no effect) — consistently increased donations in all countries studied so far, with larger effects from items of greater monetary value.
The simplest solution to the blood and plasma shortage is to desacralise blood and plasma. Instead of bowing our heads to this idol, we should see it as the false idol it is, and get back to having a market in blood.
Peter Jaworski (right) is an Assistant Teaching Professor teaching business ethics at Georgetown University. He is a Senior Fellow with the Canadian Constitution Foundation, and a Director of the Institute for Liberal Studies. He has also been a Visiting Research Professor at Brown University.
These posts first appeared at Anything Peaceful.
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