Friends And Organs

Online Organ Linkups Spur Debate, Alarm ... Patients and [organ] donors are incredulous that doctors might refuse them simply because they met on a website. They point out that family members and friends are permitted to donate. Doctors acknowledge that defining what is meant by friends can be difficult. For example, Dr. Douglas Hanto, chairman of the transplant surgeon society's ethics committee and chief of the division of transplantation at the Beth Israel Deaconess Medical Center, says he would probably perform a transplant on a patient taking an organ donation from a member of his or her church, if they fit other medical criteria for donations. But if the patient approached him with a donor he met on the tennis court a few weeks ago? "Probably not," Hanto said. ... Critics have objected that public solicitation of organs is easier for those who have money or who are computer-savvy. ... "People who contact us say, if it weren't for Cynthia's story, they wouldn't have considered donation at all," said Irma Woodard, speaking on behalf of her niece, Cynthia Gallardo. "Everyone assumes we're taking from someone else, but the fact is that a lot of these people wouldn't donate if they didn't feel a personal connection."

I can understand the modernist viewpoint that underlies defense of the waiting list system. It's hard to argue that certain people deserve an organ more than others, and to the extent that they do (e.g. if they lost their liver due to irresponsible drinking), that desert doesn't align with differences in ability to locate a willing donor. The solution, then, is to create a universal and formally fair system to allocate organs. If people are less willing to donate to the waiting list than to a particular person they have some connection to, that's just a sign of moral weakness -- after all, saving a life is saving a life -- and a price we must be willing to pay to make the system fairer.

But allowing donations by family and close friends undermines the modernist argument. It seems bizarre that one would be allowed to donate a kidney to a stranger or to a parent, but not to an acquaintance. It may perhaps be justifiable as a compromise, since people affected by severe illness are notoriously unwilling to accept the dictates of a system that is unable to validate and respond to their personal anguish. But there's a real philosophical inconsistency.

The inequality argument raises some issues as well. In our current health care system, there are countless advantages that the rich can get. But economic inequality is not the only form of equality that's relevant to health care. Social inequality -- differences in the amount, breadth, and strength of one's social network -- can be critical as well. Social connections can facilitate finding treatment, as in the case of getting a friend to donate a kidney. They also provide emotional support to people dealing with illness or recovery. I would suspect that there are real benefits to both parties when the donor and recipient know each other and can share the experience, rather than simply interacting individually with a bureaucracy.

As it happens, economic inequality is relatively easy to deal with (at least from a technical standpoint). The government can give poor people vouchers for donation websites, or even set up its own free organdonation.gov. Social inequality is more difficult, because you can't give someone welfare friendships. However, the internet offers the promise of leveling the playing field somewhat. My own anecdotal experiece suggests that people who would otherwise have the thinnest social networks -- introverts, members of geographically dispersed subcultures, those who are stuck at home -- benefit disproportionately from the social networking that the internet makes possible.