Wednesday, February 06, 2008

Would Paying for Organs Help--a review of Michelle Goodwin's terrific book

iThis is a link from my collegue Gerry Beyer's trusts and estates blog to an abstract of a book review/essay I just published in 33 J. Health Pol. Pol’y & L. 117 (2007) discussing Michele Goodwin's terrific book: I am trying to get a non-proprietary full text copy.
Professor Goodwin-who is a rock star in the field of law and organ donation- has written a compelling, well researched book which I would recommend for use in a college or graduate school class (as well as leisure reading (non-required reading?) ) as the starting place for someone who wants to understand the current legal state of the organ procurement and distribution system both in the United States and globally.

After the overview, Professor Goodwin builds her argument that people should be paid for donating their organs from the premise that African-Americans are a disproportionate share of the donor pool and, in the case of kidneys, have receive less than their share of donor organs. She then confronts and rejects the argument that this fact strengthens the argument that paying for organs is unethical because it would constitute slavery.
She thinks it would not and further thinks it is racist to deny African-Americans the choice to sell their organs. In reading her book, I did a lot of thinking about why people don't donate and started reviewing the medical literature on this topic. What I found looked to me like a very classist picture of non-donating families as selfish people -unmotivated by altruism-who would be motivated by money.
In this essay, then, I question whether paying people for organs really would increase the supply or whether we are mischaracterizing the motives of families who choose not to donate. I wonder if there isn't something at least classist if not racist in how the medical community views families who choose not to donate. Professor Goodwin has done her own research to delve deeper into the African-American community's reluctance to donate and not suprisingly, found a distrust of the medical system and a fear of being used as a research subject. I urge you to read her book and stay tuned as I rework into a real article the parts of this review which strayed from her book.

"In Black Markets: The Supply and Demand of Body Parts, Michele Goodwin (Everett Fraser Professor of Law, University of Minnesota Law School) examines the problems that arise because of a shortage of organs.
Here is a description of her book:
In direct response to indefinite delays on the national transplantation waitlists and an inadequate supply of organs, a growing number of terminally ill Americans are turning to international underground markets and brokers for organs. Offering a contemporary view of organ and tissue supply and demand, Michele Goodwin explores the legal, racial and social nuances of current altruistic institutionalized procurement schemes. It is understandably not publicized that Chinese inmates sitting on death row and the economically disadvantaged in India and Brazil are the most often compromised co-participants in the negotiation process and supply kidney and other organs for Americans as well as other Westerners willing to shop and pay in the shadow of the law. Goodwin suggests that the best alternative model for organ procurement is a market approach or one based on presumed consent and provides an alternative way of studying how to increase the supply of organs and other body parts as well.
Jennifer Bard (Alvin R. Allison Professor of Law and Director, Health Law Program ) has recently published a somewhat critical review of this book in 33 J. Health Pol. Pol’y & L. 117 (2007). Here is an excerpt from the review's abstract:
Black Markets: The Supply and Demand of Body Parts is an important contribution to the body of scholarship and policy analysis about one of the most difficult problems facing contemporary health policy, public health, and bioethics: the fact that the demand for donor organs far outstrips supply. In this book, Michelle Goodwin systematically reviews the general ways in which the United States' current organ-donation and transplantation system negatively affects potential donors and recipients, particularly African Americans. She proposes solving these problems by changing the current system that prohibits payment for organs to one that allows it. However, I argue that the entire discussion of a market-based solution to the problem of a shortage in supply in donor organs suffers from a flaw far greater than the inability to predict how such a market would work, because of a lack of reliable evidence that an offer of compensation would be effective in changing the minds of people who currently decline to donate the organs of their loved ones. "

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