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We’re really not impressed with this argument about organ donation. Not at all impressed in fact. For the actual argument is that we should abandon any thoughts of whether a system actually works or not – you know, saves lives – and instead we should concentrate upon how we all feel about it. What does our system say about the sort of society we want to be?

This does rather mean that we’ll end up with the system which kills people but makes certain dilettantes feel good. Not a useful trade off. This all starts at the ASI:

Sure, it sounds sensible. People die waiting for organ transplants, other people die with organs that could potentially be transplanted. Confiscate that second stock to feed the need, why not?

Well, the why not is, quite apart from anything else like “Our Bodies Alone” and such slogans is that it doesn’t damn well work. For near all of us die, even if with organs intact, with the organs in no fit state for transplant. There just aren’t enough of us who die healthy enough that is.

Opt out organ donations systems do not in fact solve our basic problem, a supply of organs for transplant. We know this because Wales has tried it and they got….well, how many new transplants do you think they got from this? The actual number is none. Nationalise the corpses of an entire nation and gain exactly nothing from it.

The correct answer is a paid market in live donations of course. There is only one country in the world without people dying on dialysis while they wait for a kidney. There is also only one country where live donors are paid – and paid well, something around a year’s median household income – for their kidney. It is not a coincidence that the two places are the same, Iran. Transplants are also cheaper than dialysis over time, that’s exactly why the Mullahs instituted the system. Islam can be very practical in such things, during the post-revolution sanctions they noted that they couldn’t afford to keep people on dialysis for a decade. So, they didn’t, and brought in the paid market for live donors instead. Deaths and costs fell, life expectancies rose. Good policy really.

But back to England’s recent nationalisation of the corpses:

According to the BMJ, ‘Welsh opt-out law fails to increase organ donations.’ There has been no significant increase in donation as a result of the change from opt-in to opt-out.

When you think about it (and I suspect few have), this is not totally surprising – because it’s relatively rare that a death will result in organs being available and suitable for transplant. It pretty much requires the donor to be relatively young and healthy, which typically implies being in accident, as a result of which they die in hospital, so the organs can be harvested quickly.

However, I think in terms of social benefit, the opt-out system may well be worthwhile even if it doesn’t do a lot to increase the number of donated organs. It says that we, as a society, care for each other.

That is, damn the effectiveness and let’s do it for the feelz. This is not how public policy should be made.

Leading to the important point about why not. Let’s say that we do run policy for the feelz. Many are uncomfortable with the idea of paying for kidneys. No, not for any rational reason and that’s fine, there’s no natural law which says we all must be calculating machines. It’s just icky, bringing money into this. So, now we bring that vague distaste into law making and we end up ruling out the system which works, paid live donation.

The reason we shouldn’t be doing it for Teh Feelz is because people die. And how do you feel about that then?