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January 24, 2008

Free Market Organs

by Stephen Littau

Last week, Doug linked a post about British Prime Minister Gordon Brown’s support for a policy that would allow hospitals to harvest organs without prior consent of the decedent or his/ her family. In essence, the organs of all deceased British citizens would belong to the government’s healthcare system except for those individuals who “opted out” prior to death.

The policy in the U.S. is an “opt in” approach rather than “opt out.” Why is this distinction important? Answer: the presumption of ownership. If citizens have an option of opting in, this shows that individuals own their bodies; to suggest that an individual has to opt out shows that citizens’ bodies are property of the government (unless s/he makes an affirmative claim on his/her body).
The reason for Brown’s support for this policy is quite obvious: like just about everywhere else in the world, Britain is having an organ shortage.

So if presumed consent is not the answer to solving the organ shortage, what is? Randolph Beard, John D. Jackson, and David L. Kaserman of Auburn University published a study in the Winter 2008 issue of Cato’s Regulation Magazine. The team studied the effectiveness of current policies aimed at maximizing donor participation and organ matching. Among the policies they analyzed were: increased government funding for organ donor education, organ donor cards (such as having the words “organ donor” on driver’s licenses), required request, kidney exchange programs, and donor reimbursement. None of the policies have come close to solving the shortage. The researchers estimate that roughly half of the potentially viable cadaver organs are ever harvested. With the exception of the inefficient kidney exchange program, one feature that all of these programs have in common is that they each rely on altruism on the part of individuals to donate organs without any sort of compensation.

The one solution which the researchers believe would be effective, monetary compensation to organ donors or their families, is illegal almost everywhere. In 1984, the National Organ Transplant Act was passed making it a crime in the U.S. for a surviving family to receive payment for their loved one’s organs. The law was passed mostly on ethical grounds without any consideration for what would happen to the supply of available organs. The researchers estimate that some 80,000 lives from 1984 to present have been lost because of the bill’s passage and other subsequent policies in the current “altruistic” system. The researchers further project that another 196,310 lives will be lost between 2005- 2015 (and this is what they consider a “conservative” estimate!).

As controversial as compensating families organs of deceased family members is, the thought of an individual driving to a hospital, removing an organ (such as a kidney), and selling that organ to someone in need of the organ for a profit is a complete non-starter. This shouldn’t come as a shock given that in today’s lexicon; the word “profit” is a dirty word. The people who scream bloody murder whenever people decide to “scalp” tickets to sporting events or tickets for Hanna Montana concerts (what’s the big deal with Hanna Montana anyway?) will not likely be in favor of selling vital organs. Anti-capitalist objections aside, free market buying and selling of organs appears to be the most practical solution.

Cato Institute’s Director of Bioethics Studies Sigrid Fry-Revere found that Iran is the only country that does not have an organ shortage and has not had a shortage in ten years. Why? Because Iran (of all places!) is one of the only countries where it is legal for individuals to buy and sell organs from live, voluntary, donations. Revere’s findings also revealed that even if all the viable organs were taken by force by the government from cadavers, there would still not be enough organs to provide an organ to everyone who needs one (Cato Daily Podcast dated January 15, 2008). Maybe the Iranians are on to something here?

David Holcberg, writing for Capitalism Magazine agrees arguing in favor of a free market system for organs on both practical and moral grounds:

If you were sick and needed a kidney transplant, you would soon find out that there is a waiting line–and that there are 70,000 people ahead of you, 4,000 of whom will die within a year. If you couldn’t find a willing and compatible donor among your friends and family, you could try to find a stranger willing to give you his kidney–but you would not be allowed to pay him. In fact, the law would not permit you to give him any value in exchange for his kidney. As far as the law is concerned, no one can profit from donating an organ–even if that policy costs you your life.

Patients’ attempt to circumvent this deplorable state of affairs has led to the emergence of “paired” kidney donations, an arrangement whereby two individuals–who can’t donate their organs to their loves ones because of medical incompatibility–agree that each will donate a kidney to a friend or family member of the other. But this exchange of value for value is precisely what today’s law forbids. Thus, under pressure to allow this type of exchange, in December the U.S. House and Senate passed The Living Kidney Organ Donation Clarification Act, which amends the National Organ Transplant Act to exempt “paired” donations of kidneys from prosecution.

The congress says that kidneys can be exchanged without sending anyone to jail; how thoughtful. While this is an encouraging step in the right direction, why won’t our elected officials go the rest of the way? Is it the potential risks for the donors? Holcberg points out that the risk for a healthy person dying from donating a kidney is about .03% and usually live normal lives without reducing his or her life expectancy.

No, I suspect the objection to selling organs is more rooted in the overall distain far too many people have towards capitalism. It’s simply unethical to make a profit off of something that someone else “needs” whether its gasoline, Hanna Montana tickets, or a kidney. Only the “privileged” will be able to buy organs if such a system were adopted, they would argue.

Even if this were true, denying a person the right to purchase an organ to save his or her own life should not be subject to a vote or someone else’s ethical hang-ups. If I want to remove a kidney and sell it to a willing buyer for $30,000 (or whatever the going market rate is) I ought to have that right. Why must we assume the government has the right to tell us what we can do with our bodies whether it’s selling our organs by our own choices or government taking them from us after we die without prior consent? Our individual rights of life, liberty, and property demand that we have the ability to make these choices for ourselves.

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7 Comments

  1. A free market in human organs would save thousands of lives every year. Unfortunately, there is no reason to think Congress will legalize this in the foreseeable future.

    Fortunately, there is an already-legal way to put a big dent in the organ shortage — allocate donated organs first to people who have agreed to donate their own organs when they die. The United Network for Organ Sharing, which manages the national organ allocation system, has the power to make this simple policy change. No legislative approval is required.

    Americans who want to donate their organs to other registered organ donors don’t have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at http://www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

    Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren’t willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

    Comment by Dave Undis — January 24, 2008 @ 4:40 pm
  2. “Presumed consent” is wide open to abuse. View my website http://www.illegalorgandonor.com to see how Australia overcomes the organ donation shortage problem. My 20 year old son, Andrew David Shea, was set up to have a cycling accident in Brisbane, Queensland, Australia. I live in Sydney, Australia. I was told that Andrew was killed instantly. Instead he was taken away from the accident site alive and used as an illegal organ donor. My son died a horrible death. A lot of people got money. From his sad Mum, Alexandra Samootin.

    Comment by Alexandra Samootin — January 26, 2008 @ 4:00 pm
  3. Having a transplanted kidney, I can say that thousands of lives may be saved in a free market system, but not mine. Could I get financing or be able to afford to finance I have no special leverage that would enable someone to give me a kidney. Would not like to have begged for one, either. Although, I would not be able to survive as long, as a kidney patient I do have dialysis. Some other people would not have any other option, so should they die because they could not buy the organ. This is another trip down the road to Social Darwinism, which at times, libertarianism seems to travel.

    Comment by VRB — January 27, 2008 @ 9:35 am
  4. VRB, have you considered that the people who would buy their own organs would be taken off the waiting list for everyone else? I’m not advocating getting rid of the waiting list by any means; what I am advocating is offering additional options (and thereby shortening the wait for everyone).

    Part of your objection seems to be (correct me if I’m wrong) that because not everyone would have the ability to buy organs that no one should. At some point we have to recognize that life isn’t fair and that there will always be people who can afford things (yes, even critical things such as organs) that others cannot.

    You say you don’t have any leverage but I doubt that. There is always charity and hopefully family that would help you out. I know that if we were living under a free market organ regime and my wife needed a kidney, I would not hesitate to go to the local hospital, have one of mine removed, and sell it for the amount required to buy her a kidney (all of this assuming that my kidney is not a match).

    In the current system, the system chooses who receives priority and who doesn’t. If you over a certain age, your chances for receiving an organ is nil. Those who make these decisions also have to consider lifestyle factors such as obesity, smoking, and drinking. Certainly it’s only fair in the current system to take these factors into account; a smoker should not be ahead of a non-smoker for a heart transplant. On the other hand, if a smoker has the means to pay for a heart, then s/he should be able to without worrying about breaking the law.

    Comment by Stephen Littau — January 28, 2008 @ 11:26 am
  5. BTW VRB, I’m glad that you were able to get your kidney. Hopefully, your life will be extended with great quality as a result.

    Comment by Stephen Littau — January 28, 2008 @ 11:32 am
  6. Stephen,
    Thank You.

    Since I have “O” blood type, it would depend who was taken off that list for it to have moved me up.

    Age doesn’t reduce your chances of getting a donor organ. My donor was older than I and had died from some other cause. I was 58 years old. The biggest problem is finding a donor that has the right blood type. That and the order in which you apply, pass the requisite test, sets your place, not necessarily lifestyle. I also smoked at the time and there were several other recipients there; we were again tested to see if we were healthy enough to have the surgery and if our antigens had remained the same. They now match two instead of six. I was the more healthy, enough to get the transplant, even though I was listed last from the ones that were called. I am going into details because transplantation criteria has changed in the last thirty years and the donors don’t have to be perfect; such as a young accident victim. I believe with a little more information that there would be more organs available. I think that many people feel that their life would end too soon in order to harvest their organs.

    Selling organs would put a lot of pressure on the poor and lead to more theft of organs. I think with money as a motive, that many a life would end too soon. There was a news item today, where a doctor in India was stealing poor people’s kidneys and transplanting them into the rich and foreigners. What is ironic, most people can survive, function and live a long time on kidney dialysis. I worked and went to school while I was on dialysis. One person I knew had been on dialysis for 12 years, had rejected two transplants and was still working. There is more technology and advances in medicine that make waiting not as urgent as it use to be.

    I think we should push more for research on cloning organs, prevent our DNA from becoming some persons or corporation intellectual property. Cloning organs and being able to fix whatever problem would be with the organ; would be the desirable way to proceed. My kidney disease is genetic and it doesn’t always lead to kidney failure. As some of you on this blog believe that government should not solve all problems, I believe that the free market cannot or should solve this problem. In saying this I am not saying this is a government problem, either. This has been the way the medical community had decided the process of determining who gets a transplant, that stays within their ethical code. Because of this I think the solution should lie within the bounds of medicine. If that is not acceptable, as you said, “life isn’t fair.”

    What happened to the preview.

    Comment by VRB — January 28, 2008 @ 4:48 pm
  7. The progress in organ cloning is encouraging. Like anything else, lots of testing will be required before we see engineered organs being used for transplants. From there, I imagine much of the shortage problems will be solved.

    In the meantime, I still think that organs can be sold on the open market in a transparent and safe system.

    Oh yeah the preview…
    We are having some problems with plugins on the site so Brad has been removing some to see if it fixes the problem (you might have noticed that our quotes on the top are gone too for the moment).

    Comment by Stephen Littau — January 28, 2008 @ 9:01 pm

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