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A Legal Market for Fetal Organs?

Question: Should buying and selling human organs be legal?

Jacob Appel:  Sure.  I've actually written about a legal market in fetal organs, which I think is somewhat different from a legal market in organs of post-born adults.  And I would strongly favor legalizing the market in fetal organs because I don't feel that fetuses are people and therefore the risk of exploiting them is minimal and I feel that women are capable of making reproductive choices in relation to their fetuses particularly people who abort may want to save the lives of other individuals by making their organs available.  And I think they should be able to profit from this. 

In contrast, for adult organs, I think there should be a financial mechanism for allowing people to sell their organs.  But I don't necessarily think there should be a market.  I think a market opens itself up to abuse and will likely have the organs go to the highest bidder and make it most available to the wealthy. 

In contrast, you want to create financial incentives so there are enough organs available for all 70,000 people who need kidneys, for example, in the United States.  But then you don't want to distribute them based on economic opportunity, or economic -- based on assets, you want to distribute them based on need.  So, I would have a system where the government bought up organs for people, let's say $10,000 for a kidney and then distributed them using the same system we have now, on a first-come, first-served, or need based approach.  I think to tell people they can make other economic decisions in their lives, they can choose to be a laborer at $7.00 an hour for 40 hours a week, but they can't choose to avoid three months of work by selling a kidney is an unnecessary involvement, or an unnecessary intervention in the individual decision-making of people. 

I will add, and I think this is often lost in the debate over organs.  We focus excessively on the risk of exploitation of people who would sell their organs.  We don't focus on the passion of people who die every year because they don't get organs.  And if you are one of those individuals, or one of their relatives, you may see the question from a very different light.

Question: How difficult is it to obtain a life-saving organ in America today?

Jacob Appel: Oh, it's extraordinary difficult.  I don't have the numbers in front of me, but there are approximately 115,000, 120,000 people on the waiting list for different life-saving organs in the country and with kidneys, we do have dialysis, so we can prolong the lives of these people a number of years.  But the people who need heart transplants, or liver transplants, the majority of them, I believe die while waiting.  Certainly a good plurality of them dies while waiting.  Unlike kidneys where you can have a live donor make a donation, these people have to wait for cadavers.  So the question arises, why not pay people who know they're going to die, or people to make their organs available in a pool if they are going to die to harvest their organs as soon as they do die, which would also reduce the risk of exploitation.  These people are at death's door and are dying anyway. 

As for kidneys, while dialysis is life prolonging, dialysis is not always life saving.  It also substantially reduces the quality of life of individuals involved.  In contrast, not having a kidney has no impact if you have one kidney of your own on the life quality or life expectancy of the individuals that give a kidney, on a virtually zero risk. Extremely low risk procedure.  The real question that arises is, do we have an ethical obligation as healthy individual with two kidneys to give one to a stranger?  And it's a challenging question.  Maybe we do.  We don't have the mechanism in place to make that happen.  In fact, in the rare cases where people have tried to do that in this country, hospital ethics committees have often stepped in and questioned the capacity, or sanity of the individual who is seeking to.  Which to my way of thinking is somewhat perverse. If someone is willing to, not sacrifice their life, or quality of life, but make a great altruistic **** for a stranger and we say this person must be crazy.

Recorded on March 1, 2010
Interviewed by Austin Allen

The bioethicist believes it's an idea whose time has come. But how could such a market be regulated to prevent abuses?

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  • The massive star in the Kinsman Dwarf Galaxy seems to have disappeared between 2011 and 2019.
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  • Maybe it's still there, but much less luminous and/or covered by dust.

A "very massive star" in the Kinman Dwarf galaxy caught the attention of astronomers in the early years of the 2000s: It seemed to be reaching a late-ish chapter in its life story and offered a rare chance to observe the death of a large star in a region low in metallicity. However, by the time scientists had the chance to turn the European Southern Observatory's (ESO) Very Large Telescope (VLT) in Paranal, Chile back around to it in 2019 — it's not a slow-turner, just an in-demand device — it was utterly gone without a trace. But how?

The two leading theories about what happened are that either it's still there, still erupting its way through its death throes, with less luminosity and perhaps obscured by dust, or it just up and collapsed into a black hole without going through a supernova stage. "If true, this would be the first direct detection of such a monster star ending its life in this manner," says Andrew Allan of Trinity College Dublin, Ireland, leader of the observation team whose study is published in Monthly Notices of the Royal Astronomical Society.

So, em...

Between astronomers' last look in 2011 and 2019 is a large enough interval of time for something to happen. Not that 2001 (when it was first observed) or 2019 have much meaning, since we're always watching the past out there and the Kinman Dwarf Galaxy is 75 million light years away. We often think of cosmic events as slow-moving phenomena because so often their follow-on effects are massive and unfold to us over time. But things happen just as fast big as small. The number of things that happened in the first 10 millionth of a trillionth of a trillionth of a trillionth of a second after the Big Bang, for example, is insane.

In any event, the Kinsman Dwarf Galaxy, or PHL 293B, is far way, too far for astronomers to directly observe its stars. Their presence can be inferred from spectroscopic signatures — specifically, PHL 293B between 2001 and 2011 consistently featured strong signatures of hydrogen that indicated the presence of a massive "luminous blue variable" (LBV) star about 2.5 times more brilliant than our Sun. Astronomers suspect that some very large stars may spend their final years as LBVs.

Though LBVs are known to experience radical shifts in spectra and brightness, they reliably leave specific traces that help confirm their ongoing presence. In 2019 the hydrogen signatures, and such traces, were gone. Allan says, "It would be highly unusual for such a massive star to disappear without producing a bright supernova explosion."

The Kinsman Dwarf Galaxy, or PHL 293B, is one of the most metal-poor galaxies known. Explosive, massive, Wolf-Rayet stars are seldom seen in such environments — NASA refers to such stars as those that "live fast, die hard." Red supergiants are also rare to low Z environments. The now-missing star was looked to as a rare opportunity to observe a massive star's late stages in such an environment.

Celestial sleuthing

In August 2019, the team pointed the four eight-meter telescopes of ESO's ESPRESSO array simultaneously toward the LBV's former location: nothing. They also gave the VLT's X-shooter instrument a shot a few months later: also nothing.

Still pursuing the missing star, the scientists acquired access to older data for comparison to what they already felt they knew. "The ESO Science Archive Facility enabled us to find and use data of the same object obtained in 2002 and 2009," says Andrea Mehner, an ESO staff member who worked on the study. "The comparison of the 2002 high-resolution UVES spectra with our observations obtained in 2019 with ESO's newest high-resolution spectrograph ESPRESSO was especially revealing, from both an astronomical and an instrumentation point of view."

Examination of this data suggested that the LBV may have indeed been winding up to a grand final sometime after 2011.

Team member Jose Groh, also of Trinity College, says "We may have detected one of the most massive stars of the local Universe going gently into the night. Our discovery would not have been made without using the powerful ESO 8-meter telescopes, their unique instrumentation, and the prompt access to those capabilities following the recent agreement of Ireland to join ESO."

Combining the 2019 data with contemporaneous Hubble Space Telescope (HST) imagery leaves the authors of the reports with the sense that "the LBV was in an eruptive state at least between 2001 and 2011, which then ended, and may have been followed by a collapse into a massive BH without the production of an SN. This scenario is consistent with the available HST and ground-based photometry."

Or...

A star collapsing into a black hole without a supernova would be a rare event, and that argues against the idea. The paper also notes that we may simply have missed the star's supernova during the eight-year observation gap.

LBVs are known to be highly unstable, so the star dropping to a state of less luminosity or producing a dust cover would be much more in the realm of expected behavior.

Says the paper: "A combination of a slightly reduced luminosity and a thick dusty shell could result in the star being obscured. While the lack of variability between the 2009 and 2019 near-infrared continuum from our X-shooter spectra eliminates the possibility of formation of hot dust (⪆1500 K), mid-infrared observations are necessary to rule out a slowly expanding cooler dust shell."

The authors of the report are pretty confident the star experienced a dramatic eruption after 2011. Beyond that, though:

"Based on our observations and models, we suggest that PHL 293B hosted an LBV with an eruption that ended sometime after 2011. This could have been followed by
(1) a surviving star or
(2) a collapse of the LBV to a BH [black hole] without the production of a bright SN, but possibly with a weak transient."

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