Human tissue option is not a macabre option

Article by John Blundell in The Scotsman

EVERYONE in Edinburgh knows the story of Burke and Hare. We have all enjoyed being horrified by the macabre stories of people being murdered to have their bodies retailed to the surgeons’ theatres for anatomical lessons.

At the core of a horrible narrative is a simple lesson in micro economics. Burke and Hare would have had no business to transact if people, or their families, were free to donate (or sell) cadavers. The murderers were paid £7 10s for their first corpse. Robert Knox, the surgeon who bought them, was not prosecuted. Burke was hanged.

This is not a historical curiosity. We are still muddling the now huge market in human tissues from the dead and living. It is probable most readers of this article will have donated or received blood. Many will have a relative who has exchanged a cornea. Fewer will have had a liver transplant and fewer still a heart from a stranger.

The government sees there is a huge shortage of human organs for the medics to work their miracles. They are considering nationalising our bodies; the state will assume the right to take whatever organs may be deemed of second-hand value. I don’t doubt the coherence of this - supplying hospitals with useful human tissues rather than let them be buried or incinerated to no value. Yet coercion is rarely the right policy.

What is needed is a market. At the moment, the only donor motive is a mild benevolence. Many of us carry donor cards so that if we do fall under that bus our body parts may still be of use. This is far too hazy. It ought to be a standard part of every Scots lawyers’ will-drafting that you bequeath your body as you wish. The immediate family - spouse or children - would be notified. It would not be for them to object.

When I have suggested payment must be part of the equation, many are horrified at bringing in money at a time of great distress. Yet sizeable amounts of money do change hands: the medical and paramedical staff are paid their professional fees. Why must the donors be excluded ?

We all get a small glow of virtue if we donate blood, yet blood is not uniform. Those with rare types ought to be priced more highly, so there are none of the ritual "shortages" hospitals report. The donation of tissues while you live is a different matter but, again, price would permit co-ordination between supply and demand. I would willingly give a kidney to one of my sons, but I’d be more ambiguous about a stranger.

The extraordinary advances in medicine are creating an expanding demand for organs. The suppression of a proper regulated or authorised market is creating, as it always does, an illicit market. Most weeks we can read of impoverished people in Third World countries being given footling sums for an organ - with the real profits going to the doctors and middle men. What is needed is an open and transparent exchange - or we will revive Burke and Hare’s trade across frontiers.

Science may cure this ethical dilemma, with stem-cell research and other genetic techniques. But the biggest single prize in medical research is the conquest of diabetes. It is the most rapidly-advancing health disorder in Scotland. One possibility that would have seemed pure science fiction only a decade ago is the use of the equivalent organs in pigs. How astonishing removing organs from porkers may prove to be.

Also, if we have something useful to others, we can trade. Why is medicine different ? I fear it is because of the medics’ protection of their own crafts. Doctors are often as restrictive as the worst trade unionists. They can make hefty fees from transplants. Good luck to them. Yet it is entirely foolish that the donor is exempted from this market - or the donor’s family.

No doubt there are subtle ethical and clinical matters to be resolved, but the essence of any "shortage" is the suppression of free exchange.

William Burke found that as the price of bodies rose, £14 per corpse was his best price - for anything less it would not have been worth his risk, he argued at his trial. We are still letting a fog about delicacy and propriety neuter an important new expertise. Let us have a free market in human tissues.

John Blundell is general director of the Institute of Economic Affairs.