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Keeping the poor from wealth and the sick from health

“Bulgarian authorities bust gang suspected of illegal organ trading”, reports the Chinese state news agency Xinhua.

Bulgarian law enforcement authorities have dismantled a four-member organized criminal group suspected of illegal human organs trading, an official said here on Friday.

Two of the gang members were arrested on Tuesday evening when they were trying to leave the country at the Kapitan Andreevo checkpoint on the border with Turkey, and the other two were detained later, Siyka Mileva, a spokesperson for the Specialized Prosecutor’s Office, said at a press conference.

The evidence gathered so far indicates that the gang has been active since Feb. 2019, recruiting donors and recipients of kidneys, and transporting them to a clinic in Turkey where transplantations were performed, Mileva said.

All the criminals, donors and recipients are Bulgarian citizens, she said.

The recipients paid the gang between 50,000 euros and 100,000 euros (55,500 to 111,000 U.S. dollars) for a kidney, of which from 5,000 euros to 7,000 euros were paid to the donors, and the surgery cost between 20,000 euros and 25,000 euros, Mileva said.

The donors were of low social status, she added.

Thanks to the splendid work of the Bulgarian authorities their low social status will now be lower still, as in “criminal”. The people who needed the kidneys will have their status changed from “sick” to “sick and in jail”.

I first heard this story on the radio. Unfortunately I cannot remember which station I was listening to, but I do remember that the report specifically said that all the participants, including the would-be donors, were willing participants in the exchange of kidneys for money. Both sides were better off in their own judgement; the poor wealthier, the sick healthier. This evil had to be stopped.

21 comments to Keeping the poor from wealth and the sick from health

  • They were all consenting adults. If they’d only been consenting to something more PC-fashionable then the European court of human wrongs might have helped them, but I feel no certainty these particular consenters will get any joy there.

    On the figures (if I have understood them), the ‘gang’ (as opposed to donors and clients) were looking to a minimum 36% transfer fee and a maximum 75% transfer fee. Making something illegal does of course increase its overheads.

    Anyone who has read a Larry Niven SF book (in his future society, a preliminary adverse judgment can see you lose a few organs before you are cleared of the charge) will allow there can be slippery-slope discussions. It might not be too hard to recast my post on Humanitarian Combat Fatigue to be about donors in a fictional future time instead of migrants today.

  • This evil had to be stopped.

    The ultimate in supply and demand. The only thing I’m offended by is the huge wedge that the scrotes acting as middlemen are getting.

  • Ian

    The only thing I’m offended by is the huge wedge that the scrotes acting as middlemen are getting.

    It does seem quite a lot, but besides covering the risk of arrest, one has to assume they had a number of overheads too. You’ve got travelling costs and months of accommodation to pay for, as well as the initial time/effort in finding the donors and donees (how long did that take?), not to mention finding the hospitals and doctors willing to do the procedures (probably involving a number of backhanders along the way), plus all sorts of sundry costs for operating such a shady business. I’d also note that there’s no mention of costs for post-operative care, which might have had to be done secretly for a while — was that included in the price?

    It sounds like it’s a full-time job, and clearly they’re only making what the market will bear. When you divide that by the time they’ll be spending in prison, I’m guessing the hourly rate will turn out to be reasonable.

    It’d be interesting to compare it with NHS costs per successful kidney transplant, including pre-op dialysis and workforce non-participation costs. Dialysis was £30K per year in 2009, and the average wait time is about three years, so assuming waiting times could be eliminated (see below), we’re talking about a saving of roughly £100K just for the dialysis. Tack on the cost of the operation and the workplace non-participation costs, and this gang’s prices seem eminently reasonable at the €50-100K level.

    Of course this is a simplistic calculation, but I think even if the taxpayer were footing the bill then it’d be worth it not just for the patient but financially for society at large, even with them taking up to 75%. Quite frankly, I think these guys were operating a lot more efficiently than the NHS would.

    Incidentally, doing a little online research just now garnered an interesting fact that I wasn’t aware of: the only country that allows commercial organ transplants is Iran. According to The Guardian, two years after introducing the scheme in 1997, waiting lists “had almost disappeared”. And prices for kidneys are surprisingly low.

    All in all, if what these guys did was criminal, it was a very benign form of criminality. I wonder if the “victims” will speak up for them at the trial.

  • Ted Schuerzinger

    The only thing I’m offended by is the huge wedge that the scrotes acting as middlemen are getting.

    How much are the government scrotes who want to make organ “donation” opt-out, thereby claiming they own your body, getting?

  • Ted Schuerzinger

    I wonder if the “victims” will speak up for them at the trial.

    Will they even be allowed to?

  • Ian

    Will they even be allowed to?

    Maybe not, since it’s a different legal system over there. But they are key witnesses.

  • Patrick Crozier

    I knew that this was the subject of an EconTalk podcast a few years ago. When I went to find I discovered that it has come up no fewer than 11 times. There is no way I am going to be able to figure out just which one of these I listened to.

  • Mr Ed

    The criminals’ slogan: ‘Stand and de-liver‘.

  • CaptDMO

    “Voluntary”. Maybe even eventually “In loco parentis”?
    You know, like bio-harvesting of aborted “tissue” for minor schoolgirls.
    Ultimately, see “Coma”.
    Once money for middlemen, custodians,and rent seekers is involved…….
    As sure as night follows day.

  • Gavin Longmuir

    “Once money for middlemen, custodians,and rent seekers is involved…….”

    Come on, CaptDMO. Politicians and government employees can’t all be evil, surely! 🙂

  • Phil B

    Once the technology and medical science is sorted and transplanting organs is as easy as swapping an engine in a car, then the death penalty will be brought back toot de sweet. Except you won’t be hung by the neck until dead but essentially dissected organ by organ until you die. Why do you think that governments worldwide are compiling a DNA Database? Solving Crime? Don’t be daft. The powers that be can’t be bothered to prosecute criminals right now even with overwhelming evidence or if prosecuted, the criminals get ridiculously short sentences. BUT the law abiding are harassed so that they can have their DNA sampled too. Got to have a database so a perfect match can be selected.

    You reckon that the politicians and our “betters” will forgo the chance of immortality? I have a bridge for sale …

    Robert Silverberg wrote a short story called Caught in the Organ Draft back in 1972. It can be read/downloaded here:

    https://lexal.net/scifi/scifiction/classics/classics_archive/silverberg3/silverberg31.html

    If you reckon that it WON’T happen then that bridge is still for sale.

  • Fraser Orr

    A lot of people are concerned about the exploitation of the poor, and, although I think that infantalizes the poor I think there are far less iky intermediates we could try that would aleviate the very real problem of replacement organ shortages:

    1. For replaceable things like blood and livers there should be no barrier within the limits of what is medically sensible. (I used to work for a company that made machines for collecting blood plasma, the liquid containing your blood cells. It contains many substances that are extremely valuable medically. It can be collected much more frequently than whole blood because your body can regenerate it completely in a couple of days, whereas RBCs take eight weeks. However, where I live in Illinois selling, or donating, your blood plasma is against the law. So we had to go to Wisconsin where there is a small industry in it. Students could make $80 three times a week (and this was twenty years ago — for donating this plasma which was then used to save many people’s lives. What possible justification could there be for not allowing this? The biggest complaint? The donors were cold afterward, so they warmed up the replacement saline and all was well.)

    2. For people who have died with viable organs allow their estate to sell the organs. This is no more iky than the present system, with the exception that the family can get substantial reward in a time when the death may well put them in deep financial straits. Imagine a family of four — dad, the sole breadwinner with no life insurance — dies in a car crash. How outrageous to ask this family who are in deep financial trouble, to make a donation to a stranger worth hundreds of thousands of dollars? Especially so since all the medical staff, hell even the courier, are getting paid handsomely for their efforts. Imagine, Dad’s heart is flying on a private jet to some other hospital to save a rich older dude’s life, while mom, destitute, can’t figure out how to buy groceries that week.

    3. People could sell futures contracts on their organs. So, some insurance company is given the right to harvest your organs when you die (in a respectful manner with medical declaration of death, or course), in exchange for which they send you $250 per month for the whole of your life. How much is a full set of organs actually worth? It is hard to say, but it is not unreasonable to say $500,000 when you consider cornea, middle ear, heart (or heart valves), lungs, two liver lobes, two kidneys, pancreas, spleen, intestines, connective tissues, skin bone, bone marrow and blood vessels. I think a lot of people would go for something like that, and there are absolutely no losers in this scenario. Even the poor family left behind is benefited since they don’t have to make a really difficult decision about donation at the worst possible time in their lives.

    So, much as I agree people should have a perfect right to sell unreplaceable parts of their own bodies should they so wish, these three steps seem to me to be much more politically viable, and would go a HUGE way to alleviating the shortage or organs that leads to many tragic deaths each year.

  • Ian

    @Fraser,

    I agree with a lot of what you say, although I find the idea of someone selling irreplaceable body parts about as ugly a notion as I find suicide to be, if not more so. Maybe I’m not an orthodox libertarian, but I think the harm principle applies equally to oneself.

    However, as regards your idea (3) for futures contracts, I can’t imagine this really working all that well except for the young (when organs are most valuable); but since mortality rates for the young are low it wouldn’t even work well there. At most I guess it’d allow one to get discounted medical or car insurance, especially as it’d be a good hedge for the insurance companies. It’d probably be quite good for the performance car market.

    Also I’m a bit wary of your point (2), since it would incentivize suicide. Would that not bother you?

  • Rich Rostrom

    A dies, and B gets to sell A’s organs.

    The incentive for murder is obvious.

  • Fraser Orr

    @Ian
    However, as regards your idea (3) for futures contracts, I can’t imagine this really working all that well except for the young

    That isn’t true. A lot of donated organs come from older people.

    Also I’m a bit wary of your point (2), since it would incentivize suicide. Would that not bother you?

    See below, though FWIW, your dislike of suicide is not one I share. Of course someone dying is always a tragedy, however, I can think of many circumstances in which going on living would be much worse than dying, some not even traditionally like terminal illness in six months. For example, Alzheimer’s… that is not a way I would want to live, and not something I would impose on my children.

    Maybe you can’t think of such a circumstance, but I certainly don’t think you should have a say in the matter in regards to what I do with the life that belongs to me. Any more than I have the right to tell you to not end your own life were you is such a dreadful state. If you want to cling on till your last fingernail snaps, you will have my full support.

    @Rich Rostrom
    A dies, and B gets to sell A’s organs.
    The incentive for murder is obvious.

    So I assume you are equally opposed to life insurance and wills, since you could make exactly the same argument there.

  • Ian

    @Fraser,

    That isn’t true. A lot of donated organs come from older people.

    I’m suggesting this is because there’s a scarcity of supply. In Iran, where they have a thriving kidney market from live donors, the age limit is 35.

    Any more than I have the right to tell you to not end your own life were you is such a dreadful state.

    I have a perfect right to tell you not to do something, if I think it’s in your best interests. Free speech and all that. But I think you missed my point. I was talking about the suicide of perfectly healthy people, and I would find it odd and slightly sociopathic if you think it would be an advance for liberty that a society were willing to tolerate people doing that for money. But then I suppose this may be ideological for you.

  • Mr Ed

    RR

    A dies, and B gets to sell A’s organs.

    More accurately:

    A dies, and the Chinese Communists get to sell A’s organs.

    FTFY.

  • Fraser Orr

    @Ian
    I have a perfect right to tell you not to do something, if I think it’s in your best interests.

    Sorry if I didn’t say it quite right. I didn’t mean you shouldn’t be able to express your opinion. Of course you should, in fact, you just did!! It is just that you shouldn’t be able to force your opinion on my be way of the law.

    But I think you missed my point. I was talking about the suicide of perfectly healthy people, and I would find it odd and slightly sociopathic if you think it would be an advance for liberty that a society were willing to tolerate people doing that for money.

    You may find me sociopathic, but logically speaking, if it is my body what right do you have to prevent me from destroying it? I mean obviously this is not a good situation at all, and not something I think is a good outcome. But people do kill themselves to “collect their life insurance”, for example, and, much as that isn’t a good thing, it isn’t a reason to ban life insurance.

    I suppose it isn’t totally horrible to have some sort of regulation preventing such purchases from suicides, or perhaps the AMA could deign it unethical to do so. I’d rather not, but it would be a small price to pay to deal with the horrendous shortage of organs. I’m pretty healthy, but I’m not as young as I once was, and in the next few decades I may well need such an organ transplant. So I think it would be awesome if I didn’t have to wait seven years in a hospital bed because some people are a bit icky about these sorts of solutions.

    but then I suppose this may be ideological for you.

    I’m honestly not an ideological guy. I just believe that these sorts of free market solutions are much more productive and better at sorting out the situation. I mean look at the current situation. It is absolutely horrendous. People die horrible unnecessary deaths because of the ridiculous socialist way in which organs are harvested and distributed. That isn’t ideological, it is basic human decency that we demand a better solution.

    I think liver waiting lists are perhaps the most horrendous of all. Healthy people can donate half of their liver and that liver will regrow within six weeks. How can anyone possibly justify not allowing a market in this, where, in the USA, there there are approximately 40,000 people waiting for a liver transplant, and probably a half to two thirds will die while waiting.

    Honestly, to not adopt a solution like this, for sure for livers and other renewables, is the real narrow minded ideological approach.

  • Ian

    @Fraser,

    It is just that you shouldn’t be able to force your opinion on my be way of the law. […] if it is my body what right do you have to prevent me from destroying it?

    I’m certainly with you as regards the so-called “harm principle” (in fact that’s the cornerstone of my political thought), but whilst when it comes to suicide and self-harm generally we shouldn’t (and don’t) have laws against it in the UK or US, I do think we need to act socially to try to prevent it using all the other weapons (religion/spirituality, persuasion, therapy, meds, etc.) at our disposal.

    A lot of depression seems to arise from or are exacerbated by poor nutrition, Vitamin D deficiency (a massive problem IMO), alcohol and other relatively trivial causal factors like short-term stress (often money, but things like exams and so on can trigger it), and a lot of it is opportunistic, which suggests to me that the majority of suicides are not “rational actors”, contrary to how they are often represented by pro assisted suicide types, and so on. In fact there’s a lot of similarity to the crime of murder.

    There’s a fascinating documentary about people who’ve jumped off the Golden Gate Bridge, and I remember vividly the account of one survivor who said that as soon as he jumped, he realised all the problems in his life that he thought were insurmountable were, in fact, trivial. More recently, Greg Lukianoff was talking in The Coddling of the American Mind about his own self-destructive modes of thought that he was able to fix.

    And I do think on the basis of the “harm principle” that suicide is a kind of crime against oneself (which does affect other people too, though not physically), albeit not one we can or should punish. But it’s (perhaps more usefully) a public health issue, and I think we as a society should try as much as possible not to incentivize it. And of course with the example you give of life insurance, suicide is always excluded from the policy for obvious financial reasons, so we don’t have a problem there.

    Now coming more specifically to the topic at hand, yes I agree entirely with the sentiment of the OP and other comments here that there does seem to be a huge problem with price controls in the organ market, leading to shortages of supply. With livers, kidneys, blood, etc., there doesn’t seem any reason not to have a free market, provided it’s all done voluntarily – in fact I think the current situation is the result of a lazy irrational taboo.

    But – and this is a big “but” – I can envisage a situation where people would be offing themselves based at least partly on financial considerations, which I would abhor. Maybe that seems irrational too, but then after all if we don’t value human life and want to preserve it, why are we doing transplants in the first place? And whilst I can see the utilitarian argument that were there, say, a shortage of viable hearts for transplant, and if we allowed transplants from suicides, that that might make up the numbers and therefore be of overall benefit; but one could also argue that a lot of suicides are young men who would be valuable in the marketplace too (and probably a lot of transplant recipients would be near the end of their working lives). I think the argument can’t necessarily be won, therefore, on the basic of maximum utility – here, a completely free market might in fact be sub-optimal.

    Let me develop that a bit further and suggest there might even be something like a “tragedy of the commons” going on. Think of suicidal young men as the common land and transplant patients being the cows grazing (a bit of a strained analogy, but never mind). The cost to others of destroying that land would not be factored in to any individual private transaction. I think that free markets work best when there are rational actors involved (though obviously we recognise homo economicus might never really exist in practice), but that of course does break down when we’re talking about suicide, which is largely irrational IMO, so I’m not sure a free market argument is entirely germane.

    Of course with “common land” or public parks we have ordinances, bye-laws and all the rest to prevent overuse. I suppose my argument could be framed around there being an overriding public interest in the lives of people who might be considering suicide, however I don’t base it on that because I think that’s like the state claiming ownership of individual lives, so it only really works as a libertarian-ish argument if one accepts the notion that suicide ought to be regarded as violating the harm principle. I’d be interested in your view on that, and whether you find it convincing.

  • Jacob

    The basic question is: should people be allowed to sell their own organs (while alive or after death)?
    All agree that donating an organ is a noble deed and should be encouraged.
    But selling is considered unacceptable and prohibited by law in most countries. Why? I mean: anyone can deem it distasteful, he might find justification, but many things are distasteful, yet not prohibited.

    The question is: based on libertarian principles – can the prohibition of sales be justified while encouraging donations?

    We might dislike the fact that organ sales give an advantage to rich people over poor in a life-or-death matter. But that assumes the validity of egalitarianism, which is a wrong principle (people are not equal).

    Maybe we could devise a system where contracts are between sellers and some public body, like say the NHS, and not directly with the buyer (the donor gets paid) , and the NHS gets to decide who will benefit from the bought organ? The price to be paid either by the (anonymous, rich) receiver of the transplant or by the NHS itself. Next question: should the public (via NHS) be made to pay for organ transplants – i.e. the organ – paid to the donor (to finance life saving transplants to poor recipients)?

    That brings us to slavery – suppose a person agrees to serve as slave for some time (say 7 years) in return for a big sum paid up-front by a financier, a sum the poor man needs desperately. Can such a voluntary contract be enforced?

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