Commercial Fishing and Paid Organ Provision:

I'm revising my Medical Self-Defense article, and adding some statistics that I should have added before. I had already pointed out that the risk of providing organs is modest:

Giving a kidney carries a 0.03% risk of death or irreversible coma, a less than 2% risk of complications, and some unknown but not high increase in susceptibility to kidney disease. Giving part of a liver (livers regenerate, so giving part is possible) has been associated with a 0.25% incidence of provider death, plus some risk of nonfatal complications. Marrow donation is safe, though temporarily painful.

But I hadn't mentioned the specific occupational danger statistics, which report (see page 13 of this PDF) that working in fishing or logging for a year carries a 0.1% risk of death from occupational hazards. Working for a year as a truck driver or a delivery driver carries a 0.03% risk of death.

So let's think again about the argument that organ sales should be banned because allowing organ sales would unduly pressure poor providers to put their health and their lives at risk. We let people become professional fishermen or loggers, and we'd consider a ban on those occupations to be no service to the poor. Yet these occupations, with their modest return on investment and risk, likely appeal especially to the poor, and thus may (by analogy to the organ argument) unduly pressure poor workers to put their lives at risk.

Why not let people run a comparable risk (somewhat higher for liver providers, somewhat lower for kidney providers, though perhaps offset by the unknown extra risk of kidney disease in the future) to provide organs? Why protect people from their own supposedly foolishly life-threatening decisions when it comes to providing organs, and not when it comes to providing their labor?

Or consider this hypothetical: A fisherman grows tired of working in this dangerous occupation. Each year he saves only (say) $5000 per year, given that his yearly income must be offset by the usual yearly expenses for housing, food, and so on; not a good deal, he concludes. Instead, he'd much prefer to sell a kidney, put the $30,000 aside as savings (or spend it on education for himself or his children) and take a desk job that pays somewhat less than his fishing job but that is quite safe — oh, and incidentally save someone's life in the process.

"I'll probably decrease my risk of death, and I'll certainly save myself a great deal of physical discomfort and make more money," he says. "No, no!," the critics of compensation for organs say. "We must protect you from the risk that you will be unduly pressured into this unwise transaction by the prospect of economic gain. If you simply wanted to stay in a dangerous business like fishing, you'd be free to choose that; but when you try to provide a kidney for money, we have to step in to save you." How can that possibly make sense?

I realize that this particular argument doesn't confront some of the other arguments against compensation for organs, but I've dealt with them (or will deal with them) in other posts. Here I just want to confront the "protect poor pressured providers" argument.