BLOODY LAWS!

The Indian Government has now slapped a punishment of imprisonment for professional blood donors. Anyone who sells his blood for money will be sentenced to three months imprisonment. What is more, the license of the blood bank will be forfeited. Full story here.
The rationale is that professional blood donors often are the worst sources of blood. They donate repeatedly, within days of the previous one, with their own body running short of the life-source. They do this simply because they need the money for sustenance. Many a time, they need the extra cash for drugs or alcohol. Blood from these people is liable to be tainted with HIV or hepatitis viruses.
So, all in all, this looks like one good move by the Indian Government, doesn’t it?
Not really, no. I think this is another idiotic act.
Professional blood donors may contribute as much as up to 30-40% (figures of uncertain veracity) of donated blood. India is chronically short of blood. People die because of lack of blood, following blood loss in accidents, shootouts, and surgeries. Is attacking the existence of these people going to do Indians any good when they need blood?
Around 6% of HIV and hepatitis cases are said to be due to transfusion of tainted blood. Is donation by professional donors the problem? Or is the failure of the Blood Banks in detecting these infected samples the problem? It is clearly the latter. The failure of the State in enforcing its own laws and the judgments of the Supreme Court have led to this mess. As it is, the country suffers from a major shortage of blood products. How has the decade-old ban on professional blood donors helped the problem? Have transfusion-related complications come down?
The problem with tainted blood is underlined by several other major deficiencies of Indian society. One is the abysmal standards of education, resulting in a huge lack of trained technicians to man the Blood Banks. Another is the poor state of the legal defence system, because of which unscrupulous private blood banks are left scot free even after failing in their duty to provide for safe transfusion.
A trade is a voluntary activity between individuals. One’s body and its components are one’s own property. If one cannot dispose of them or treat them as per one’s conscious choice, then who has the right to do so? The Courts? Whom are the courts protecting, and why? From the looks of it, this ban on organ trade seems to be a case of the Law deciding to protect the citizen from his own self!
Not surprisingly, countries the world over are squeamish in acknowledging the property rights of the individual to his organs. Take the recently publicised case of donor eggs in the ‘surrogate motherhood’ issue. It is illegal in the US and UK to sell your egg, though you are free to donate it.
Here is a Wikipedia entry on organ trade:

In compensated donation, donors get money or other compensation in exchange for their organs.
In the United States, The National Organ Transplant Act of 1984 made organ sales illegal; regulation by the OPTN has probably eliminated organ sales. In the United Kingdom, the Human Tissue Act 1961 made organ sales illegal.
Recent development of web sites and personal advertisements for organs among listed candidates has raised the possibility of selling organs once again, as well as sparking significant ethical debates over directed donation, “good-Samaritan” donation, and the current U.S. organ allocation policy.
Two books, Kidney for Sale By Owner by Mark Cherry (Georgetown University Press, 2005); and Stakes and Kidneys: Why markets in human body parts are morally imperative by James Stacey Taylor: (Ashgate Press, 2005); advocate using markets to increase the supply of organs available for transplantation.
In 2006, Iran became the only country to allow individuals to sell their kidneys, and the market price is US$2,000 to US$4,000. The Economist and the Ayn Rand Institute approve, and advocated a legal market elsewhere. They argued that if 0.06% of Americans between 19 and 65 were to sell one kidney, the national waiting list would disappear (which, the Economist wrote, happened in Iran). The Economist argued that donating kidneys is no more risky than surrogate motherhood, which can be done legally for pay in most countries.
Two European conferences in 2007 recommended against the sale of organs. In Pakistan, 40 percent to 50 percent of the residents of some villages have only one kidney because they have sold the other for a transplant into a wealthy person, probably from another country, said Dr. Farhat Moazam of Pakistan, at a World Health Organization conference. Pakistani donors are offered $2,500 for a kidney but receive only about half of that because middlemen take so much. In Chennai, southern India, poor fishermen and their families sold kidneys after their livelihoods were destroyed by the Indian Ocean tsunami two years ago. about 100 people, mostly women, sold their kidneys for 40,000-60,000 rupees ($900-$1,350). Thilakavathy Agatheesh, 30, who sold a kidney in May 2005 for 40,000 rupees said, “I used to earn some money selling fish but now the post-surgery stomach cramps prevent me from going to work.” Most kidney sellers say that selling their kidney was a mistake.

Clearly, vultures exploit the miseries of the poor people who are cheated in this transaction. That, in itself, does not mean the trade is unethical. The cheating of the donor is what is unethical. However, these examples are often the reasons public sentiment is stirred up to implement bans of the kind in question.
David Holcberg argues in The Economist article:

If the law recognises our right to give away an organ, it should also recognise our right to sell an organ (as long as there is no coercion involved). Those who could afford to buy organs would benefit at no one’s expense but their own. Those unable to pay would still be able to rely on charity, as they do today. If the government upheld these rights, many of the thousands of people now waiting for organs would be spared hideous suffering and an early death. How many? There is only one way to find out: set these people free.

Blood donation for pay is one example of trade in body parts. The larger ethical issues seem to be all solved, and the world seems to have embraced the philosophy of control of the individual’s rights to his own decisions. Therein lies a deep malady!

Lateral reading:
1. Nita’s article on autotransfusion.
2. Mine on Immaculate Conception.

28 responses to “BLOODY LAWS!

  1. A great subject rdoc! I wouldn’t trust the blood from any bank and if I ever needed blood (God forbid) I would prefer it from family or if possible, autologous blood. I agree that the state of our blood banks is not good and there is inefficiency, shortage of staff as well as corruption which allows infected donors to donate. The ideal thing would be to cleanse our blood banking system…but it looks like that is too difficult for the government to do.
    But when you say that only cheating is unethical (when it comes to selling body parts), the fact is that if there is no cheating and duping very few people will actually sell their body parts! Not in sufficient numbers anyway.

  2. How is it that the government failed to overlook the option of testing the blood, rather than banning it altogether, during a national blood shortage?

    Can I expect to see, sometime in the future, spam e-mails from Nigeria demanding I send them one of my kidneys?

    By the way (you would know this), what are the physical effects of having only one kidney? I’ve heard 1/2 a kidney can do the work of two (is this correct?) but I was wondering what kind of negative side effects might be associated.

  3. Nita:
    “the fact is that if there is no cheating and duping very few people will actually sell their body parts!”
    Untrue! Most people know what they are doing when they sell their kidneys. Even if we assume what you say is true, so what? That is a voluntary decision by people not to sell (you or I wouldn’t normally), which should be just fine!

  4. Bancheese,
    Hahaha! Trust you to come up with something like that!
    You heard right, you can live with half a kidney. You need to be lucky not to damage that (infection, stones, surgeries), or else you need to find a Good Samaritan or a sister who would give her kidney for you. Maybe Nigeria is not a bad place for you to be in if that happens!
    🙂

  5. I can’t decide which is more painful selling your body organ for money or selling your son(like Budhia of Orissa) or your daughters(in Hyderabad young girls are being sold to rich Sheikhs) or kids being sold for camel racing in the middle east.
    If a parent decides to sell his body part to feed his family somewhere our govt is responsible. Instead of commiting suicide if the farmers in Vidarbha could survive a drought by donating one kidney it is not a bad bargain. In UP the state govt has started a Vridhavastha pension scheme of Rs 300 per old woman per month. You would be shocked to see the long queues of old women standing outside public sector banks in the beginning of every month. Quite a few of these women can’t even stand straight. In a condition of such poverty I don’t know how the govt can prevent professional donors. I agree with you failure of the Blood Banks in detecting these infected samples is the problem and not the donation by professional blood donors.

  6. rambodoc wrote:

    Clearly, vultures exploit the miseries of the poor people who are cheated in this transaction. That, in itself, does not mean the trade is unethical. The cheating of the donor is what is unethical.

    Recently, I saw a movie, Lilya 4-ever, the story of a 13-year Russian girl, abandoned by her mother, and cheated by her boyfriend into becoming a sex slave in Sweden. She eventually commits suicide. Informed consent is tough to establish in any trade that involves physical violation. You are more of an expert in this, but I suspect if physical or biological violation of any conscious life form could ever be considered as totally voluntary. The instinct will be to resist such violation.

    Having said that, one may consent to lose some to gain more – definition of trade – but a necessary condition is complete information. The sordid stories on drug trial outsourcing – see here and here – are not very reassuring, not for a market for organ trade, antime soon. I would be particularly wary of “informed consent” in totalitarian countries such as Iran and China!

    p.s. This is a very interesting post, an I have linked it in my blog trail section [certainly not because I am your long separated twin 😉 ]. I hope you don’t mind.

  7. TRF,
    Thanks for the comment. And for linking here.
    What you say is definitely true: markets should operate freely, but laws protecting individual rights should be severely implemented. This (strict legal system) surely does exist in the West. However, laws come in with a lot of Me-Big-Dad accessories that do more harm than good.
    China is another blog post, hopefully not too far away.
    However, I notice you use the term [‘violation’ of life form].
    I am not condoning those violations at all. I am merely placing the case for what should be a legal transaction, with all the necessary informed consent, etc.

  8. That was a very eye-opening article Doc. I had no idea that you can “donate” your body parts… but cant “sell” them! How gross is that?

    Moreover, I say, we should probably have a control board which takes care of these things… to ensure that the person willing to sell his body part, should not be under potential damage coz of it…. Thats where the role ends!

    Thanks for bringing this up! 🙂

  9. Rdoc I didn’t say that no one would sell their body parts…I said few people would. Maybe I should say fewer. True there is a lot of poverty in this country but not all poor people go in for this method of earning money. I would say a small percentage do.
    This kidney selling and blood selling racket is surviving because of the duping and the cheating. Many do not even have the complete information. Millions are being made at the expense of poor people who are lured and tricked into it. If there was no duping and cheating, the number of blood units or kidneys or other body parts available would go down drastically.

  10. Rambodoc: The reason why selling is not allowed but donating is because the latter requires more reflection on the donor’s part and the whole thing does not become only a ‘free market transaction’. If selling were a free-for-all, many more people – not just the poor – might be tempted.

    Secondly where is the line to be drawn? A student in the west recently wanted to auction her virginity to pay for her tuitition fees and a businessperson requested her to pull that ad out and donated a large sum of money to pay for it. If everything is a market transaction, fine. Shall we sell body parts of our old but now economically-unproductive relatives because that way we can pay for the costs we incur on their upkeep and well-being? Why not? We can always convince them of the benefits. While we are at it, how about selling the mothers-in-law that men so despise most of the time? After all a body part is a step up from a tissue and a person is a step up from a body part, no?

    I think you are missing a vital point. Philanthropy – of the kind donating tissues or money – cannot really be explained in a satisfactory way through principles of transaction economics just as transaction economics cannot explain why a democracy keeps working.

  11. “pay for it” means pay for her education, not her virginity.

  12. Rambodoc:

    I said: “If selling were a free-for-all, many more people – not just the poor – might be tempted.”

    I should have added that the ones that will queue up will not normally be the healthiest. They probably need money for crack!

    Now the question to ask is how tight is the screening in blood banks for HIV, Hepatitis and other problems emerging from shared/ dirty needles and other paraphernalia in this sub-group?

  13. Shefaly:
    Transaction does not preclude philanthropic donations at all. It is a matter of individual choice whether to donate your organs or sell them.
    The ownership of body parts rests not with one’s relatives but with oneself. Therefore, the question of selling the body parts of relatives does not arise. Unless that relative gives you a power of attorney to sell her kidney or blood.
    Similarly, selling people is way out because there is no concept of contractual ownership of a person’s body. I suppose theoretically a person can sell off his entire body to another person, but I don’t think this is probable. Theoretically, maybe, yes.
    Where does one draw the line, you ask?
    You draw the line between the voluntary, consensual, free decisions on one side and the duping, forcing, cheating on the other.

  14. Nita:
    I don’t think that cheating and duping are largely responsible for people donating their organs. Even if what you say were true, the ethical issues would not be different, viz., does a human being have the right of ownership over his or her body parts? The issue of cheating and thuggery involved is largely a law-and-order issue, and should be dealt with accordingly.

  15. I’m sure this is gonna be ‘yet another law’. The enforcement of this law is very difficult in India. How are they going to find out if a person is a professional donor? No doctor can dare to say to the patient’s relatives in an emergency, ‘I’ll not let this person donate blood since his a professional donor.’

    Relax! 🙂

  16. To answer your question as to whether a person has a right over his body parts to do whatever he wants with it…well, after he is dead maybe! Somehow this whole business of selling one’s body parts for money makes me sick to the core. And my instinct tells me that no one does it voluntarily, they do it out of desperation and also because they are being cheated. to do it for love, that’s different. That i can understand.
    also people who do it for money can easily forge papers in India to prove they are healthy and harm a lot of other people. I think the government has taken the right decision…but as Harsha says implentation is going to be difficult!

  17. Good grief, imprisoning blood donors! Wrong tactic.
    Here, professional blood banks advertise and target the poor via newspaper ads with the lure of quick cash. These same donors could give blood to nonprofits such as American Red Cross–who do not pay their donors.
    Testing of blood and blood products are tightly regulated, but in reality many folks who sell their blood fall into high risk categories. There may be as yet diseases transmitted for which there is no testing for yet.
    At the Red Cross, you are interviewed to at least screen out some potential problems (a while ago, recent travelers to UK were turned away due to CJD-mad cow fears; another example: recent travel to malarial prone regions). This screening phase is very thorough and will exclude many potential donors, and the screening/interview questions change often.
    At least blood is a renewable resource. The sale of organs just doesn’t seem right – too much potential to exploit those least informed or consenting.
    There is never enough blood and organs to go to all who need. Our high tech medical heroics have not caught up with the need for good artificial blood products and lab grown tissues/organs we require.

  18. Ask for NAT Tested blood

  19. Jackie: In the UK, because of my annual pilgrimage to India, I am not allowed to donate blood. In India, ironically, I was a card-carrying Red Cross blood donor. It seems the more advanced the testing facilities, the fewer the risks we wish to take. Now what were you saying about high tech medical heroics?

  20. Nita wrote:

    To answer your question as to whether a person has a right over his body parts to do whatever he wants with it…well, after he is dead maybe!

    uh… who then has the right to determine what one should or should not do with her/his body parts? The State? Mother? Husband? Let’s not confuse fraudulent conveyance/appropriation of the right with its non-existence.

    The right to one’s body is absolute and inalienable. If it’s taken away, we are left with nothing. We may as well be living in the Animal Farm or the Republic of Gilead!

  21. I would like to think I can do whatever I want with my body after I am dead, legally. ahah imagine that!

    I want my skeleton to be in classrooms.

  22. @ Shefaly – well your Red Cross blood donation adventures are very odd. But at least you donate! There are all sorts of exclusions, but I suppose they can do whatever they want. Even non profit blood banks sell them to hospitals at a pretty penny, I assure
    you. My point about medical heroics is that we have not caught up to all the procedures possible with the tools to enable same.

    @RTF: I like where you were going with your comment to Nita – yes, you do have the right to your own body – as for organs, most choose to donate organs (in USA you specify this on your driver’s license). But why not donate your organ if you are still alive? Why create a market for organ sale?

  23. TRF, you have taken my remarks out of context. I am not at all confused about “fraudulent conveyance/appropriation of the right with its non-existence.” whatever that means.
    Let me repeat what I have said before as people aren’t getting it (they may not agree like rdoc, but thats fine!)
    I said no one should be allowed to right to sell his body parts and the key word is sell. I have given my reasons for the same in several comments.
    Giving away is different. and your remarks about ‘The State? Mother? Husband?” frankly went over my head. I never mentioned that anyone else should be able to sell a person’s body parts, in fact it is quite clear that I am against any commercial exploitation of a person’s body parts.
    At least to me this not a conceptual discussion,
    I am talking about particular instances of selling body parts like kidneys in India. That was purely in response to rdoc’s post.

  24. Nita,
    You don’t give a moral defence of the ‘why’: why are you against a man being free to sell his body parts? You have outlined some practical scenarios that TRF calls ‘fraudulent conveyance/appropriation of the right’ to do what you want with your property. However, there has to be a moral defence. The practical issues keep changing in life, but the moral core has to be solid and consistent.

  25. rdoc 🙂
    I do not believe in anything such as ‘moral cores’ and do not even understand the concept. I talk in relation to actual happenings, incidents, situations. I am the wrong person to engage in this type of discussion.

  26. The issues involved in the right to sell one’s body, are not only ethical/moral, but pragmatic, too. They impinge on everything involving from donating/selling sperm to euthanasia. More than a few have got their Ph.D.’s in medical and bio-ethics, dissecting these issues [no pun, intended]. Believe it or not, I am less concerned about the moral stuff than the practical problems here.

    Nita,
    It’s one thing to say that “I am personally repulsed by the idea of selling one’s body parts”, and quite a different one to say, “no one should be allowed [the] right to sell his body parts and the key word is sell.” The key word is not sell, imho, but allowed. What is the authority that disallows the selling here?

    Think about this in a different context – abortion. Certainly, one has the right to be abhorred at the idea of abortion, and resolve to never consent to one. If the same person asserted that no one should be allowed to have an abortion, she’d be calling for a law, a social contract if you will, with deterrent punishments for deviation. That infringes on the woman’s right to her body, wouldn’t you agree?

    Continuing with the abortion context, forced abortions (of female fetuses, say), or where a woman is fooled into an abortion – for e.g., she’s told that if the fetus were not immediately aborted, it’d pose a grave danger to the mother’s life – must clearly be illegal. That does not in itself support the idea of making all abortions illegal.

    Jackie,

    Sure, anyone can gift his/her property to another, in most civil societies. That the IRS may come after me in some cases is, unfortunately, a reality too, unless I am holed up in Montana or thereabouts 🙂

    Why create a market for organs? No visible hand creates a market. Wherever there is demand and supply, there is a market, unless a visible hand disallows the trade. I personally would like the doc to amputate that hand 😉

  27. I frankly don’t understand the connection between selling one’s kidneys and abortion. But don’t bother to explain because as I said I cannot talk in general terms/principles which are applied across the board to different issues.
    But I am not saying that it is wrong to talk of such issues. I am sure there are people far more intelligent than me who are able to. I am just an ordinary person, one who cannot engage in these type of intellectual discussions.

  28. Someone has been reading lot of Ayn Rand it seems. I completely disagree with the notion of legalising organ trade, and will be posting a case on my blog very soon.

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