Human Nature: Science, Technology, and Life.

Selling Organs in the Recession

Will the global recession push more people to sell their organs? Apparently, the answer is yes.

Here's the question as I posed it two months ago:

You don't normally think of selling your body's parts or products. But bad times can make you think hard. One reason you might not have thought of selling something from your body is that the idea felt unnatural or somehow made you uncomfortable. But for $5,000, with bills to pay and no other income prospects, you decide you can get over those feelings. ... The next question is whether money can persuade you to donate not just a body product, but a body part.

And here's an initial answer, courtesy of Agence France Presse:

The economic crisis has forced dozens of "desperate" people in Spain to put their organs up for sale on the Internet, a consumers association said Tuesday. The association, FACUA, told Spanish authorities it has detected "31 announcements of organ sales" on 13 Internet sites by Spaniards and Latin American immigrants. "These are offers of kidneys, lungs and bone marrow, by persons who say they are going through economic difficulties and asking for sums ranging from 15,000 to one million euros (19,000 to 1.3 million dollars)," FACUA said.

The trend is all too logical: As the recession takes away the external assets of more and more people, they'll be forced to sell what's left.

Organ Rewards in Singapore

Two days ago, I mentioned Frances Kissling's proposal to reward organ donors by offering them "comprehensive long-term health insurance" as well as "life and disability insurance." Kissling framed the offer not as an incentive but as "the basic safety net that a just and giving society should provide people who offer to risk their own lives to save the lives of others."

She's not alone. Singapore has just "passed a law allowing cash payments to organ donors," according to Agence France Presse. "Previously, it was illegal for a living donor to be financially compensated." But now "an organ recipient can voluntarily pay the donor if he wishes to help cover expenses like hospital and surgery fees."

And how did proponents of the legislation present it? "This is a bill about fairness, being fair to donors who do suffer financial consequences as a result of their act of donation," Singapore's health minister told parliament during the debate. "I know the controversial nature of paying donors. But we also realize that it is unfair to allow genuine donors to bear all the financial consequences of their altruistic acts."

Coverage of transplant-related medical expenses is already legal in the United States. But it'll be interesting to see whether the message from Singapore—fairness to altruists—becomes an effective argument, here and elsewhere, for more extensive compensation.

Organ Rewards

If financial incentives for donating a kidney are wrong, what about financial rewards?

Frances Kissling offers that idea in a beautiful piece at Salon. She writes:

Appropriate concern for the international organ trafficking problem ... has so distorted the concept of altruism and eroded the principle of mutual respect that potential kidney donors are denied the basic safety net that a just and giving society should provide people who offer to risk their own lives to save the lives of others. ... [W]e financially abandon the donor almost immediately after we take their kidney. There is no provision for comprehensive long-term health insurance for donors, or for life and disability insurance. Opponents of any form of compensation or benefit to donors beyond costs directly attributable to the transplant itself fight efforts to provide these benefits.

What worries compensation opponents is that such benefits, framed as incentives to increase the organ supply, will economically coerce poor people to surrender body parts. But what if we don't frame the benefits as incentives? What if we present them, in Kissling's words, as what "a just and giving society should provide [to] people who offer to risk their own lives to save the lives of others"? And could we make this difference real, not just a matter of spin, by designing the reward system without regard to its effect on the organ supply?

Kissling argues that we should

treat potential donors with the same generous spirit with which they have offered their kidneys. No donor should spend a single dollar in the process of giving an organ. And donors should have the safety net they need to stay healthy, to support their family if they cannot work and life insurance should they die. ... One member of Congress who gets it is Arlen Specter, who is circulating the Organ Trafficking Prohibition Act of 2009. The bill increases the penalties for really buying and selling organs, but makes clear that state and federal government can provide the kind of benefits donors deserve without going to jail. Anyone disagree?

Well? Do you?

Creativity and Body Parts

Drawn by payments of up to $10,000, an increasing number of women are offering to sell their eggs at U.S. fertility clinics as a way to make money amid the financial crisis. ... The Center for Egg Options in Illinois has seen a 40 percent increase in egg donor inquiries since the start of 2008. New York City's Northeast Assisted Fertility Group said interest had doubled and the Colorado Center for Reproductive Medicine said it had received 10 percent more inquiries.

One clinic's egg donation manager explains that the bad economy "encourages women to find creative ways to make money." It's an interesting use of the word creative. In this case, two kinds of creativity seem to be involved. One is the invention of egg donation in the first place. Selling eggs was impossible until doctors learned how to extract, preserve, fertilize, and transfer them for successful implantation. These breakthroughs made eggs transferrable and commercially valuable.

The second kind of creativity goes hand in hand with the first. You don't normally think of selling your body's parts or products. But bad times can make you think hard. One reason you might not have thought of selling something from your body is that the idea felt unnatural or somehow made you uncomfortable. But for $5,000, with bills to pay and no other income prospects, you decide you can get over those feelings.

Economics clearly drives the donation market. Two years ago, Reuters notes, a study found that the average payment to an egg donor in the United States was $4,216. But the average sperm donor in New York City gets only $60 per deposit. And sperm banks, unlike egg donation programs, are reporting no recent increase in donations. The money's not good enough.

The next question is whether money can persuade you to donate not just a body product, but a body part. In principle, half the world's kidneys are expendable. People are already buying and selling them on the global market, regardless of laws. Some reformers are proposing to replace this black market with a regulated system of incentives ranging from $15,000 to $40,000. If $5,000 is enough to make people think creatively about donating their eggs, $15,000 might well be enough to do the same for kidneys.

Seven Ways To Sell Your Body

As economies around the world continue to shrink, how many people will start thinking about selling their bodies?

Two years ago, the global market in human flesh looked like a humanitarian issue. It was a problem for those poor people in developing countries, not for us. But global capitalism doesn't care what color your skin is, as long as you've got some to sell and you need the cash. And, increasingly, people need the cash.

The idea starts with superficial rentals. Last month, according to the New York Times,

FeelUnique.com, an online beauty products store, paid 10 men and women to apply temporary tattoos with the company's Web address on their eyelids and then wink at strangers. Chosen randomly from more than 6,000 who applied online, participants were paid 100 pounds (about $149) to wink at people 1,000 times, or 10 pence a wink, an allusion to pay-per-view Web advertising.

Harmless, right? So let's move around to the back of the head. Thirty people have hired themselves out to Air New Zealand as "cranial billboards," the Times reports. "For shaving their noggins and displaying the ad copy for two weeks in November, they received either a round-trip ticket to New Zealand (worth about $1,200) or $777 in cash."

A bit tacky, but who are we to judge? They need the money. And if people are willing to wear temporary tattoos for pay, why not permanent ones?

Since 2005, Dunlop Tires has hired tattoo artists to work at its booth at the annual Specialty Equipment Market Association show in Las Vegas, geared to motorists who modify cars. Volunteers who agree to be permanently tattooed—either with Dunlop's logo or its trademarked tire tread—while onlookers gawk receive a set of tires worth $500 to $1,000, said Jim Davis, a Dunlop spokesman. About 200 people have been tattooed so far.

If it's OK to sell permanent advertising on your skin, it's hard to see why we outlaw temporary prostitution, especially in view of current financial pressures:

Signs of the economic free fall have cropped up in many of Nevada's 25 or so legal brothels. The Mustang Ranch, for example, has a steady stream of customers, but the number of women vying for work has soared.

Should women who resort to this line of work in other states continue to be arrested? Do you have some other employment opportunity to offer them?

And if extra cash to women who need it is a good thing, what about the increasing use of undeveloped countries as testing grounds for drugs not yet approved in the West? According to an article in the New England Journal Medicine, "Pharmaceutical and device companies can realize substantial cost savings by conducting trials in developing countries, so they are increasingly moving phase 2 and phase 3 trials to places such as India and South America." In these countries,

There may be a relative lack of understanding of both the investigational nature of therapeutic products and the use of placebo groups. In some places, financial compensation for research participation may exceed participants' annual wages, and participation in a clinical trial may provide the only access to care for persons with the condition under study. Standards of health care in developing countries may also allow ethically problematic study designs or trials that would not be allowed in wealthier countries. In one study, only 56% of the 670 researchers surveyed in developing countries reported that their research had been reviewed by a local institutional review board or health ministry. In another study, 90% of published clinical trials conducted in China in 2004 did not report ethical review of the protocol and only 18% adequately discussed informed consent.

So, the standards overseas are lower, and the people recruited to test the drugs have fewer choices. But isn't that how capitalism works? Aren't these people getting value in exchange for supplying their bodies at lower cost? As Ezekiel Emanuel, chairman of bioethics at the National Institutes of Health Clinical Center, puts it: "More places outside the United States are participating in research—is that a bad thing?"

And what about the sale of human eggs, sperm, and surrogacy? Driven by the recession, women are lining up to sell their eggs and rent out their wombs. It's fully legal. Do you want to stop them or their clients? Do you think you can?

If it's OK to sell your eggs and skin—and to rent out your body for pregnancy or drug testing—why not let people sell expendable organs? Thanks to the progress and spread of transplant technology, every healthy person with two good kidneys or a splittable liver now has a fungible asset. Earlier this month, for instance, the Asahi Shimbun reported:

Amid the serious shortage of available organs in Japan, a nonprofit organization admitted to helping 17 Japanese receive transplants in China even after Beijing banned such operations for foreigners in 2007. A deputy chief of the NPO [said] the group paid doctors in China, in addition to treatment costs, for the kidney and liver transplants there. ... Cases have already emerged of Japanese traveling to Southeast Asia for new organs.

I'm not saying all of these practices are acceptable or unacceptable. Some are more worrisome than others. But they're all happening, and they're all being driven by money. And as the recession takes away the external assets of more and more people, we're going to face increasingly difficult questions about letting them sell what's left.

A Kidney Stimulus Package

The other day, I was reading about a new procedure in which a kidney was extracted for transplant through the donor's vagina. And it got me thinking: If kidney donors deserve special surgical benefits—which is what doctors argued in this case—then what other benefits should they be offered? How about free medical care? How about cash?

The Johns Hopkins doctors who performed last week's vaginal kidney delivery describe several special benefits. "An organ donor, in particular, is most deserving of a scar-free, minimally invasive and pain-free procedure," says one Hopkins surgeon. The natural-orifice procedure supplies these benefits. According to Dr. Robert Montgomery, head of the Hopkins transplant division, "Removing the kidney through a natural opening should hasten the patient's recovery and provide a better cosmetic result."

The doctors see these benefits not just as a special reward but as an inducement. "This approach could have a tremendous impact on people's willingness to donate," argues Montgomery. The shorter recovery time "greatly reduces the inconvenience of donating and we're hoping that will encourage more people to donate."

I've written before about the horrors of the international black market in organs from living donors. Federal law goes further, banning the provision of any "valuable consideration" in exchange for an organ. But the law adds that this term doesn't apply to "the expenses of travel, housing, and lost wages incurred by the donor."

So it's OK to compensate donors for lost income opportunities. And it's OK to make sure that they, of all people, get the most pain-free procedure with the best "cosmetic result." What else?

Sally Satel, a friend of mine and a frequent Slate contributor, points out that other countries have taken further steps. In When Altruism Isn't Enough: The Case for Compensating Kidney Donors, she reports that last year, "the Dutch health minister directed health insurers to reduce annual fees by 10 percent for registered organ donors."

Sounds good, right? If you do a good deed for your fellows, don't you deserve a reward? You're supplying a medical benefit to the community. Doesn't the community owe you, at a minimum, a discount on your health insurance?

And why stop at 10 percent? Satel notes that Saudi Arabia's Cabinet recently "passed a law to compensate unrelated living donors with lifelong medical care."

Still onboard? Let's keep going. Satel proposes to amend the definition of "valuable consideration" in U.S. law so that states can offer "incentives" for organs. The incentives, she explains,

could take many forms, perhaps as simple as an offer of lifelong Medicare coverage or a credit on the federal income tax. States could, perhaps, implement their own creative incentive ideas, such as the utilization of tuition vouchers, state income tax credit, loan forgiveness, or contributions to retirement accounts.

After all, lifelong medical care, which we've already agreed is appropriate, is a quantifiable benefit. What if the reward you really need isn't medical? What if you need a college education or a professional degree? What if you're struggling with your student loans or your mortgage? Can't we do something for you?

Don't worry. We're not talking about cash. Under most of the proposals outlined by various authors in Satel's book, benefits would be "in-kind," with "a months-long cooling-off period prior to surgery" so that nobody rushes to donate out of financial desperation. The value of the incentives might range from $15,000 to $40,000. And according to surgeon David Cronin and economist Julio Elias, there would be one further payoff:

A smoothly functioning pilot period of in-kind rewards might, however, allow the public to adjust to the very idea of compensation so that actual payment became more socially acceptable over time ...

That's a good bet. Satel opposes cash payments, and a bill awaiting introduction in Congress, the Organ Donor Clarification and Anti-Trafficking Law of 2009, would reassert the ban on cash transactions (in fact, it would increase penalties for them) even as it legalized state-provided in-kind incentives. The question is whether such legal distinctions would hold firm in the face of the increasing social acceptability of compensation.

So here's the dilemma: If we maintain the ban on "valuable consideration," Americans with sufficient wealth will keep going abroad to buy organs from living donors on the black market. Those without sufficient wealth will wait for freely donated organs, and some will die waiting. On the other hand, if we relax the ban, we might get used to the idea of compensation and end up buying and selling organs legally.

Which is worse?

Kidneys From Vaginas

Good news: You can now get a kidney from a vagina.

More here.

Your Money or Your Wife

Can you get paid for donating an organ?

In practice, you can. All over the world, people are being paid for their kidneys. But what about the United States? Under U.S. law, can you demand compensation for such a gift?

Richard Batista of Long Island, N.Y., thinks he can. He's suing his ex-wife for $1.5 million, citing, among other things, the kidney he gave her eight years ago. He says she rewarded his life-saving generosity by having an affair, divorcing him, and keeping their children away from him.

Newsday implies the case will go nowhere:

Medical ethicists agreed that the case is a nonstarter. Arthur Caplan of the University of Pennsylvania's Center for Bioethics said the likelihood of Batista getting either his kidney or cash was "somewhere between impossible and completely impossible." Robert Veatch, a medical ethicist at Georgetown University's Kennedy Institute of Ethics, noted that "it's illegal for an organ to be exchanged for anything of value."

I'm not so sure. Batista can't take his kidney back, but that's not what he's after. He wants his ex-wife to let him visit their kids, on pain of compensating him for what he gave her. And what he gave her, according to his attorney, wasn't just an organ but a livelihood. According to Newsday, the attorney says the $1.5 million demand "reflects damages, including how much money she made as a result of being able to continue working and not having to go on dialysis." So the dollar figure isn't based on the price of an organ (which would be considerably cheaper, based on the going rate of kidneys abroad); it's based on the income one spouse accrued thanks to the other's sacrifice. And sacrifices between spouses are treated differently, under the law, from sacrifices between strangers or friends. There's a tradition and expectation of common benefit. You and your spouse become one flesh—in this case, literally.

I'm sure some of you clever lawyers can figure out how to position this claim as an extension of those divorce cases where the wife gets compensated for devoting herself to her husband's executive career. "It's not the organ itself we're asking you to value. It's the financial benefit the defendant gained thanks to the risk, the pain, and the extensive, invasive medical procedures this good man, this loving husband, endured. Yes, it was a gift of love—but no less a gift of love than the other sacrifices so many spouses make for each other's careers. Let it be acknowledged in the same way."

I'm tearing up already. Will it work? I wouldn't bet a kidney on it. But it's worth a try.

Organs, Haste, and Culpability

We have a verdict in the premature-organ-harvesting case.

Let's go to the Los Angeles Times for a summary of the case. Two years ago, the patient, Ruben Navarro, lay close to death after a heart attack.

His mother had given permission for organ donation, and a team that included [Dr. Hootan] Roozrokh flew in from San Francisco on behalf of a regional transplant network.  Roozrokh ... was to supervise a donation after cardiac death ... In most transplants, the removal of organs occurs only after a patient is declared brain-dead. In donations after cardiac death, a patient's brain is irreversibly damaged but still functioning minimally. With a family's consent, the patient is removed from life support and, once the heart has stopped, the patient is declared dead, and organs may be removed minutes later. Many experts say, however, that organs are usable only if they can be retrieved within 30 minutes after the machines are turned off.
According to prosecutors, Roozrokh ordered up excessive doses of the painkiller morphine and Ativan, an anti-anxiety drug, so that Navarro would die within that crucial half-hour. As it turned out, he died eight hours later and Roozrokh did not remove any organs.

So the basic problem was that Navarro's medical care was being directed by a guy sent to the hospital to get his organs—and that the doctor's actions may have helped the organs but not the patient. The doctor was looking at a felony charge, dependent adult abuse, with a possible sentence of four years.

Verdict: Not guilty. But the jury also issued this statement (handwritten PDF here):

Ruben's case has identified that Donation by Cardiac Death (DCD) is in desperate need for further identification of prescribed policy in order to continue successfully as a viable option for organ donation in this country. Refining the nationwide protocol of DCD organ procurements will be an important part of Ruben's legacy...

In other words, Roozrokh may have crossed the line, but the jury blames the system, or lack thereof, for failing to draw the line clearly in the first place. I think the jury did the right thing. Most of us are selectively pious. We like to single out villains when bad things are done. It's harder to admit that the bad things are extensions of good ideas and that the people behind those ideas include us. What happened to Navarro wasn't a bad doctor. It was a system that has increasingly pushed boundaries to get organs that save lives. As Art Caplan puts it in the Times story:

There's a growing waiting list; there are more centers competing for donors; and it's a very lucrative procedure for hospitals. It's against that backdrop that the story of a doctor being sent out to come back with organs unfolds.

The pressure has reached the point where doctors at one hospital, as noted here,

removed hearts from infants 75 seconds after their hearts stopped. The infants were declared dead of heart failure even as their hearts, in new bodies, resume ticking.

It's a discomfiting new trend of treating people as bags of organs. But the driving force behind this trend isn't Hootan Roozrokh. It's all of us.

Eggonomics

Looking for some extra income to make ends meet during the recession? Try selling eggs. Not chicken eggs. Your eggs.

Melinda Beck has the story in today's Wall Street Journal:

Here's another sign of the tough economic times: Some clinics are reporting a surge in the number of women applying to donate eggs or serve as surrogate mothers for infertile couples.
"Whenever the employment rate is down, we get more calls," says Robin von Halle, president of Alternative Reproductive Resources, an agency in Chicago where inquiries from would-be egg donors are up 30% in recent weeks—to about 60 calls a day. "We're even getting men offering up their wives. It's pretty scary." James Liu, a reproductive endocrinologist at University Hospitals, Case Medical Center, in Cleveland, says there is no waiting now for egg donors since his roster has swelled from the usual 4 to 17. Andrew Vorzimer, an attorney who represents prospective parents in Los Angeles, says the usual six-month wait for a surrogate in California has vanished as well. "Many of these women have college loans to pay off or they want to help buy a house or provide for their own kids' education," says Mr. Vorzimer, who is also CEO of Egg Donation Inc., a recruiting agency.

So the good news is, you have an exploitable asset in your ovaries. The bad news is, you have to compete with all the other young women—and apparently their husbands—who have realized the same thing. Did I mention the daily hormone shots? The prohibition on intercourse? The needle extraction?

Still, it's a better deal than lots of people in the developing world are getting. They're selling kidneys; you're only selling eggs. And you can make a lot more money than they can. Beck lays out the numbers:

The going rate for a surrogate is about $25,000. Egg donors generally receive $3,000 to $8,000. But a few agencies advertise that they'll pay much more for specific characteristics. One ad running in campus newspapers promises $25,000 for a donor who is "100% Jewish with ... High SAT Scores... Attractive, at Healthy Body Weight and Free of Genetic Diseases." ... "Now that we have more donors, it's become a buyer's market," Ms. von Halle says. "Some people are looking for a 6-foot Swedish volleyball player with 39 ACTs, and they'll take their time." ... Darlene Pinkerton, executive director of A Perfect Match in San Diego, which offers up to $50,000 for egg donors with high SATs ... [has] seen a doubling of inquiries recently. The American Society for Reproductive Medicine considers compensation above $10,000 to be inappropriate; Ms. Pinkerton argues that the offer brings in donors who might not otherwise be interested.

In other words, the egg market is working like any other market. A Perfect Match is offering big bucks for exactly the same reason the ASRM opposes this practice—because money can persuade people to do things they otherwise wouldn't do. Actually, the 50 grand supplies only half the persuasion. The other half comes from the recession. You need money; you're running out of options; here's a way to get it.

But ordinary eggs won't get you the 50 grand. For that, you'll need the SAT scores, and the face, and maybe a bit more height. You'll need to be tested for the wrong genes—and maybe for the right ones, now that we can project athletic potential from specific variants.

Do you find this scrutiny degrading? Does the whole tiered pricing system offend you? Then go look in the mirror. Catering to buyers' tastes is part of selling. I know it's a lousy economy out there. But if you don't want others treating your eggs as a commodity, don't treat them that way yourself.

Heartless Pigs

Last week, during the discussion of Spain's new animal rights legislation, I pointed to an article by Donald McNeil Jr. in the July 13 New York Times. McNeil asked whether the most advanced animals, the great apes, deserved the "most basic right—to not be killed for food." My answer was yes. In fact, I'd argue—hypocritically—that it's wrong to kill animals for food, period. It's brutal and unnecessary.

But let's make the question a bit tougher for you animal lovers. Is it wrong to grow and kill animals for transplantable tissue?

I ask because a report out of England this week suggests that animals may become a rich source of tissue for repairing human bodies. "Currently, the use of animal tissue for human transplant is restricted, and of limited effectiveness," the BBC observes. The Daily Telegraph explains why:

Surgeons have been able to transplant heart valves from pigs into patients for more than a decade, but these have a limited life span as they do not become populated by the patients own cells and are unable to repair any damage, meaning they must be replaced every 10 years. For young patients this poses a particular problem as the valves do not grow with the child and so must be replaced frequently.

But scientists now think they may have figured out a solution. Professor John Fisher, a biological engineer at the University of Leeds, explains the method they've been successfully testing:

We can take a tissue from an animal, remove all the cells that carry the signals that trigger the immune system so just the biological scaffold is left. When this is implanted, the patient's own cells then grow in to replace the original cells we have removed. This has advantages as the transplant can then grow with the patient. ...

The patient's own cells then grow in. The transplant can then grow with the patient. I hope you "human dignity" fans on the right realize the import of what he's saying. He's talking about an animal tissue structure incorporating human cells and growing inside a human body. The code words are recellularization (PDF) and in vivo regeneration. In other words, interspecies integration. You can read all about it at the Web site of Fisher's company, Tissue Regenix.

But the harder question is for animal rights advocates. Fisher and his colleagues are collaborating with a British agency "to develop the technique so they can create new heart valves for children," the Daily Telegraph reports. Their research "opens the way for a range of new procedures using animal parts." So while tissue regeneration in vivo reduces the need to repeat each transplant, it will apparently increase "use of animal tissue such as blood vessels, tendons and bladders" overall, according to the BBC. The point of all this work, according to Tissue Regenix, is to "address the chronic shortfalls in donor tissue availability."

We're not talking anymore about killing animals for food. We're talking about killing them for transplantable body parts. Animal rights vs. children's lives.

Liberals often challenge pro-lifers with a dilemma: In a burning fertility clinic, you can save either a 5-year-old girl or a tray of 10 frozen embryos. The point of the challenge is to test whether pro-lifers really believe that an embryo is equal to a child. Now animal rights advocates, the pro-lifers of the left, face their own dilemma: save the girl or spare the pig?

Meat Wagons

If you're old enough to imagine your dead body being carted away, you're probably old enough to remember "Meat Wagon Action Set," the sidesplitting (oops—wrong metaphor!) parody ad that first aired on Saturday Night Live in 1977. It looked like an ordinary commercial for a kids' race-car set until one car crashed and burst into flames. That's when the flagship vehicle arrived: an ambulance that picked up the bodies and hauled them away. In the background, you could hear the manly jingle, "Meat Wagon ..."

Back then, "meat wagon" was just slang for ambulance. No more. It's about to become quite real. Here's the skinny (oops—bad metaphor again!) from Rob Stein of the Washington Post. Backed by a three-year federal grant,

New York City is working on a plan to deploy a special ambulance to collect the bodies of people who have died suddenly from heart attacks, accidents and other emergencies and try to preserve their organs. If the "rapid-organ-recovery ambulance" succeeds, officials would like to expand the unique pilot program citywide with a fleet of ambulances and eventually duplicate it in other cities.

Stein explains how the plan would work:

Once all hope for resuscitation was gone, and as long as no family members objected, the victims' bodies would be transferred to the organ ambulance team, even if the victims' willingness to be organ donors was unclear. The crew could then perform measures on the body to prevent the organs from deteriorating, including chest compressions with an automated device and pumping oxygen into the lungs through a tracheal tube to keep blood and oxygen flowing. The crew might also administer the blood-thinning drug heparin to prevent clots while speeding to Bellevue. At the hospital, doctors could take additional steps, such as inserting a plastic tube known as a cannula into an artery, usually in the groin, to infuse the body with fluids to cool and preserve the organs. Organ bank workers would then assess whether the person was a suitable donor, determine whether they had an organ donor card or were listed on an organ donor registry, and try to locate a family member to give consent.

As you can imagine, the plan is freaking some people out. One bioethicist calls it "disgusting." But let's step back and understand what's going on here: Medicine is becoming ever more efficient and rational. Thanks to improving technology, organs that were previously useful only to their owners are now useful to other people, too. This has created pressure on doctors to think about dying people as resources, not just as patients. This pressure, in turn, has driven a movement to loosen organ-collection rules so that people who aren't yet brain-dead can be prepped for harvesting.

Meat wagons are the next step. They advance the rationalization of organ harvesting from the hospital to the street. Instead of letting perfectly good innards go to waste, they go out and get them.

If this creeps you out, you're not alone. But remember Human Nature's first law: In technology, bad things don't happen because they're bad. They happen because they're good. Nearly 100,000 Americans are officially waiting for organ transplants. Just yesterday, a friend of mine disclosed that her kidneys are failing, and she needs a donor. When you think about all these people, it seems crazy that healthy organs are being routinely thrown away with their owners. Stein reports:

Currently, New York City paramedics try for about 30 minutes to revive patients whose hearts have stopped before declaring them dead, while a doctor monitors their efforts remotely. The bodies are then taken to a funeral home, morgue or medical examiner's office.

The meat-wagon plan would end this presumption of nondonation. But the shift of presumption wouldn't start at death. It would start beforehand. Things you would never do to a hopelessly dying loved one—automated chest compressions, oxygen pumping, and injections of blood thinners of preservatives—make perfect sense when you start to think of that person as a failing organ bank. Nature doesn't give you the luxury of waiting for total, irreversible death. She starts ruining organs well before that. If you want them, you have to move fast.

Meat wagons won't be the last step in the movement toward efficient organ harvesting. The next steps are already underway. As Stein points out, the compressions and injections would begin on board the meat wagon "even if the victims' willingness to be organ donors was unclear," in order to keep open the harvesting option while organ collectors hustle to locate family members and lobby them for consent.

The next barrier to go will be the five-minute rule. Under the current plan, Stein reports, "The organ team would wait five minutes after EMTs give up on resuscitation, to create a clear demarcation between efforts to save lives and those to preserve organs." But in those five minutes, lots of organs will spoil. Once we've accepted the idea that dying people are also organ banks, it's hard to see why we'll tolerate this delay. We'll probably shorten it a minute at a time.

We'll also dispense with the distinction between ambulances and meat wagons. For now, officials are determined to keep these functions in separate vehicles, so families and neighbors don't freak out when the ambulance shows up. But in the long run, it makes no sense to have a vehicle on the scene that can do only half the job. I can't imagine cities assembling, staffing, and dispatching fleets of meat wagons when they already have fleets of ambulances ready to be dually equipped.

Until then, fear not the meat-wagon siren. As long as you can hear it, it wails not for thee. At least, not yet.

Hospitals vs. Factories

Last week I promised to start using this blog to highlight and explain the day's top stories. Unfortunately, scanning wires, papers, magazines, journals, and Web sites for the best stories (make sure to bookmark the Human Nature home page so you'll get the list every day) has taken so much time that I haven't been able to make good on my promise. Sorting out how long these tasks take, and which of them I should spend my time on, will take at least a few weeks. Anyway, I've cleared some time this afternoon to talk about today's stories, so let's get to it.

One item worth noting is today's Wall Street Journal article [subscription required] on hospitals replacing factories. Reporter Conor Dougherty lays out the data:

Demand for health care tends to stay strong during recessions. Cash-strapped consumers are more likely to cut back on new appliances or cars than emergency-room visits. Indeed, while the number of manufacturing jobs nationwide fell by 48,000 in March and by 310,000 over the past 12 months, health-care employment rose by 23,000 last month and is up 363,000 jobs on the year ... Growth in health care is fueling local economies across the country, as medical facilities replace factories. In Duluth, Minn., 20% of the jobs are in health care, compared with 14% a decade ago. In the Canton, Ohio, area, which lost the maker of Hoover vacuum cleaners and dozens of other manufacturers, the health-care industry is expanding rapidly. A similar story is unfolding in Anderson, Ind., once a major producer of cars and car parts.

I haven't researched this topic enough to analyze all the factors. But one theme is already intriguing: An economy based on constructing and repairing objects is giving way to an economy based on repairing and maintaining the human body. Faced with recession, consumers are deciding that widgets are expendable, but people aren't.

Actually, that's not quite right. We haven't decided that the health of ­all people is so important. The manufacturing that used to happen here is migrating to the developing world. Likewise, its replacement by hospitals is happening here, not there. Yes, American and European medicine are often being outsourced to poorer countries. But the patients benefiting from this overseas treatment are still American and European. Just ask all those transplant tourists.

My bet is that the trends reflected in this article will dominate the economy of the next century. The biotechnology of human health will increasingly become the technology most highly valued by the measure that counts most: economic demand. To put it in moral terms: The most valued objects of maintenance and repair will be subjects.

That's the good news. The bad news is that because the mechanism behind this process is economic, and because wealth is unevenly distributed, billions of people will benefit little or not at all. Dougherty shows us, through interviews and stories, how easily supply and demand can shuffle workers not only from manufacturing to health care, but vice versa when nursing wages don't add up. That's why, in much of the world, the economy will continue to value objects more than subjects, no matter what morality says.