Peter Jaworski has done an absolutely wonderful job in drafting an open letter showing just why it is NOT unethical to pay bone marrow donors. I’ve signed this, and so has Matt Zwolinski, Jason Brennan, Alexei Marcoux,Chris MacDonald, Kevin Vallier,Chris Freiman, and others.

The letter is beautifully written, and, I think, utterly compelling.

Unfortunately, I’m starting to realize that the answer to the question of whether the providers of body parts for medical purposes–such as bone marrow donors, organ donors, and plasma donors–should be compensated for their donations has in some quarters become something of an ethical purity test. Those who have adopted this approach believe that if you are a “good” person, concerned for the poor and the vulnerable and opposed to their unjust exploitation, then you must OPPOSE compensation–and must do so no matter what the facts of the matter might be.

Now, opposing compensation on the grounds that it will exploit vulnerable people is not in itself a dogmatic position. I think it’s wrong, but reasonable people (such as, for example, Julian Koplin and Paul Hughes) have provided arguments in support of it. But for some people and organizations opposition to compensation runs so deep that it’s beyond the reach of rational argument. Compensation is just WRONG, no matter what.

I realize that I’m making a strong claim here–that some parties to the debate are acting in bad faith. But I’m willing to go further. Some parties to this debate are (at least partially) morally responsible for thousands of preventable deaths. They use their political power to block compensation to satisfy their urge to signal that they are “good”, condemning people to death as they do so–and doing so *knowing* that this is what they’re doing.

There are two reasons why I believe that some parties to the debate are acting in bad faith.

First, it’s been over a decade since the publication of my book Stakes and Kidneys: Why markets in human body parts are morally imperative, and Mark J. Cherry’s Kidney for Sale by Owner. The arguments in these volumes complement each other, and, I think, provide a compelling case for the legalization of donor compensation for all non-vital body parts. Both books were widely reviewed in the scholarly press and the mainstream media; both have had multiple editions. (Cherry’s has just been reissued.) Both have been the subject of multiple Author Meets Critics events, and both have been the focus of Special Issues of journals. But neither the most prominent popular critics of donor compensation nor any of the organizations that oppose compensation have bothered to engage with the arguments to show where we go wrong. They’ve just ignored us… and continued to spout the same arguments that we undermined a decade ago. That’s NOT acting in good faith.

In fairness, it might be the case that they just thought our arguments weren’t worth addressing. And someone might say that I’m just annoyed at being sidelined by people who make the real decisions. (Although both Mark and I have served as consultants to medical professionals and organizations who have listened to us, and taken our views seriously.) Maybe. But the second reason can’t be dismissed as easily…

Second, some of the arguments that have been offered against donor compensation (in particular, for blood and blood products) have been incompetent at best, and deliberately misleading at worst. The WHO, for example, issued a Global Status Report In 2013 in which it argued that countries should become self-sufficient in safe blood and blood products, and that these should be secured through voluntary non-remunerated donation (VNRD). These two claims were putatively supported by a wealth of citations to peer-reviewed academic papers, the results of Royal Commissions and Public Inquiries in both Canada and the United Kingdom, and data collected from Non-Government Organizations. Taken together, the works cited by the authors of the WHO Report appear clearly to justify its recommendations.

Yet not only did NONE of the sources cited by the authors of this WHO Report support their conclusions many actually supported the view that donors should be compensated. In fact, reading through the sources it was difficult to see how the WHO’s authors could possibly have thought that they supported the points that they claimed they supported. My strong suspicion is that the authors of this Report thought that no-one would check their sources and so they provided them to give the appearance that their views had factual support. (I published a paper detailing the WHO’s mis-use of their sources; soon after it was published the Report disappeared from public sight.) Of course, I might be wrong here, so I wrote to all of the authors asking if they’d like to co-author a piece correcting the errors of the Report. I only received two responses: One (pleasant) from a chap at the NIH who said that he’d like to, but NIH rules forbade him from co-authoring, and one (weird) from a chap in Australia who said he didn’t see any point in correcting it! Publishing putatively factual reports opposing compensation that you must know are utterly misleading isn’t acting in good faith.

I very much hope that this letter makes its way into the right hands, and that it leads to action. But, unfortunately, many of the hands that belong to people who have an interest in this issue are very dirty indeed.