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Comment by uptown | Hacker News Reader

I'll admit I haven't read the case you references, but once you build a financial marketplace around something, it will get controlled, manipulated and exploited. Why stop at bone marrow? Everybody's got a couple kidneys ... why not let people sell one? What about the donors who regularly give blood donations today? Would they stop doing so without being paid? I believe it's an oversimplification to just say that the current system kills people by design and that adding money will make it operate more effectively.

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Not to fight this battle with you in the comments, but a) you only get two kidneys but bone marrow is, like blood cells, a replenishable resource and b) it is absolutely, unequivocally the case that paying people for blood, plasma, and gamete donations (all of which we do, but we're circumspect about saying so) increases the amount of people who are willing to participate in blood, plasma, and gamete donation.

The biology of plasma is different than the biology of bone marrow, which complicates things considerably, but the biology of plasma did not solve the plasma problem. We used to have plasma shortages, too, because plasma donation is inconvenient and strikes some people as "icky." So we increased people's willingness to engage in it by using our traditional method of encouraging inconvenient, icky things: we paid them money.

> it is absolutely, unequivocally the case that paying people for blood, plasma, and gamete donations (all of which we do, but we're circumspect about saying so) increases the amount of people who are willing to participate in blood, plasma, and gamete donation.

This is the only problem. It's false. Well ... it might be false. Extrinsic rewards ($10) tend to displace intrinsic rewards (I saved someone's life!).

If the reward is high enough, you will certainly get lots of donors. But if the reward is too high, poor people may get shut out.

Because of the intrinsic reward, it might be better if blood was donated. I'm not so sure about bone marrow though - if there's enough of a shortage (due to it being much harder to donate than blood), then it might be worth it. Poor people won't be able to afford it (or will be really screwed by the costs), but at least some people will get it. And donors won't feel the warm glow of having saved a life, but they will feel the warmer glow of a big fat cheque (as I'm assuming the extrinsic reward will be higher than the intrinsic reward it displaced).

As for organs, you could end the shortage now if you mailed out donation forms, and said that anyone who didn't sign on as a donor (after they don't need the bits, of course) would be shunted to the bottom of the list if they needed one later on.

I'm not a huge fan of the idea of paying people for bone marrow, but "poor people won't be able to afford bone marrow" is fairly irrelevant as an argument. Poor people already cannot afford to pay for any of the costs associated with a bone marrow transplantation. You have to destroy the patient's immune system to allow the donated blood cells to grow - which means at minimum, if everything goes very well, six weeks in a high-tech isolation room, being treated with extremely expensive antivirals, antibiotics and antifungals, getting all sorts of expensive diagnostics, highly paid specialists taking care of your around the clock, etc.

The last number I heard was, I believe, about 100,000 Euro if everything goes well. If things go wrong, you're looking at the ICU for ~10,000 Euro a day for a month or two, or maybe ten years worth of intense, state-of-the-art immuno-suppressive treatment...

> Why stop at bone marrow?

I would draw a very clear line: Renewable tissue and organs can be sold, non renewable ones can't.

Blood, sperm, marrow: All sellable.

Kidneys: Nope, donation only.

Liver, skin: On the fence. (They renew, but only with scarring, and can be taken only a limited number of times.)

Liver is renewable, but living donation is extremely risky to the liver donor.

I'm not worried about risk, that's for the donor/seller to decide. Higher risk, higher money. It's no different than hazard pay for dangerous jobs.

But my understanding is that someone can only donate a liver once, even though it regenerates. Perhaps that just because doctors are uncomfortable with the risk of a second donation?

I don't agree that tissue renewability is the correct sole factor in determining whether said tissue should be for sale. I think that donor risk is much more important. I consider this to be a bioethical issue but I think it's also pretty political so I'll probably refrain from making much of an argument here.

I don't do liver transplant so I'm at the limit of my knowledge re: number of liver donations, but I would guess that it has to do with the fact that the donated segments do not regrow; the liver regains function, but not form.

> I think that donor risk is much more important.

It would be important to me certainly, if I was considering donating.

But at the end of the day each person much decide for themself. Just like people decide on a level of risk when accepting a job.

If people are allowed to risk their life on a job to make money, they should be allowed to risk their life to donate tissue to make money.

For donations though, any significant risk is probably not acceptable, which is the current situation.

This is actually the wrong way round.

Blood has a low cost to the donor, so the "feel good" intrinsic reward is high enough to keep the supply going. Adding a price will just make it more expensive for poor people who need transfusions.

Because kidneys are so expensive to donate, you can't rely on people's goodwill, so both poor people and rich people miss out. Of course, you would have to ensure that they wouldn't be sold to clear debts.

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