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(Past) Time for a Free Market in Organ Transplants
Recently, a distinguished list of academics signed an open letter to President Barack Obama, Health and Human Services Secretary Sylvia Matthews Burwell, Attorney General Eric Holder, and the leaders of Congress. The letter implored the administration to take prompt and effective steps to end the shortage of organs now available for transplants, especially kidneys. Its signatories announced: “We call for the swift initiation of evidence-based research on ways to offer benefits to organ donors in order to expand the availability of transplants.“ As I explain in my new column for Defining Ideas at the Hoover Institution:
I chose not to sign that letter. It was not because I disagreed with its unhappy diagnosis that the chronic shortage of organs available for transplants, especially kidneys, is inexcusable; on that point, the letter was spot on. Rather, I refused to sign because I believe that the letter’s call to action was hopelessly slow in the face of an unending cascade of unnecessary deaths. If heeded, its call will be the latest in a long series of well-intentioned failed attempts to end the government scourge created by the current ban on kidney sales. This ban was implemented by the National Organ Transplantation Act (“NOTA”) of 1984, sponsored by Senator Orrin Hatch and then-Representative Al Gore. NOTA’s central provision makes it illegal to “acquire, receive, or otherwise transfer” an organ to another person for “valuable consideration,” which with minor exceptions blocks both cash and in-kind payments.
How do we remedy this situation?
To solve the problem of organ shortages, we must begin by repealing NOTA and implementing a free market for organs. The area in which that voluntary market would work best is for kidneys, both live and cadaveric. Kidneys are the most desperately sought organ. Of the close to 125,000 people now waiting on the Organ Procurement and Transplantation Network, (OPTN) transplant list, more than 100,000 are waiting for kidneys, and the number is rising daily. Relative to transplants of pancreas, livers, hearts, lungs, and intestines, kidney transfers are the easiest to execute, with the greatest benefits to the recipients and the transferors alike.
Many people, of course, are uncomfortable with the idea of creating markets in human organs, which is why I take up some of the most common objections in the piece:
So why not take the plunge? One standard objection is that individuals could be “coerced” into selling their organs. But this argument is exactly backwards. To find coercion, look no further than the family situation where one member is an organ match for a sibling or a child, but has serious qualms about taking the risk in question. Now money or in-kind benefits cannot be offered to offset that risk. So the full array of nonstop family pressures can be imposed in order to get the reluctant relative to change his or her mind. But in an open market, the potential of thousands of unrelated donors makes it both impossible and unnecessary to bring subtle pressures to bear on these strangers. Coercion is not an inherent consequence of voluntary exchanges. Rather, it is a far greater risk when only uncompensated transfers can be allowed.
A second objection is that the voluntary market will discriminate against the poor who do not have the means to pay. To this point, two responses are in order. First, right now rich people can influence the UNOS allocation process to work their way up the queue. Richer people have more contacts and more resources to spend on getting themselves on, if necessary, multiple queues. Worse still, there are all sorts of opportunities to divert cadaveric organs to favored recipients, as major transplant centers can keep harvested organs for their own patients by claiming that their condition renders them unfit to be transferred elsewhere. No system that allocates huge benefits for zero or below market price will be immune from influence, whether we are talking about rent-controlled units in Manhattan or unassigned kidney organs, whose donors, often young and poor, receives not one cent from the successful transfer.
Second, money does not have to be an obstacle to getting a kidney transplant. If we redirect some subsidy funds away from dialysis treatments, people who cannot afford to pay for an organ could still have the opportunity to receive a transplant. As the open letter notes, right now 7 percent of the Medicare budget goes to dialysis and organ transplantations. Figures for 2010 reported $32.9 billion going to End State Renal Disease, and the number is surely higher today. That money is misspent. As the letter notes “each transplant saves the health care system more than $100,000 compared to dialysis.” That money should be given to the recipients, and they should be able to keep the change when they buy an organ. The numbers cancel out even on the wholly unrealistic assumption that a kidney transplant, like dialysis, lasts only for one year. But write the total cost of the kidney off over several years, and the government can easily double the $100,000 figure, save money, and induce a ready supply of donors, who will accept lower prices as transplant techniques develop and the matching system improves.
You can read the entire column for the full treatment (including why any experiments with organ markets limited to the short-term will inevitably fail).
What do you think? Would you support the creation of a free market for organ transplants?
Published in General
I think my children will live to see this issue become a thing of the past when we are able to grow organs. Kidneys should be easy compared to say a Liver. The technology is close.
http://www.newscientist.com/article/dn23382-kidney-breakthrough-complete-labgrown-organ-works-in-rats.html
So while I might agree markets solve issues, I would much rather put energy into other areas.
Of course, I don’t need a Kidney.
Absolutely. And while we’re at it, let’s demote the FDA to, at most, an advisory board that publicizes risks, but has zero authority to decide what treatments are appropriate.
Yes I agree. I own my organs and I should be able to sell them. This may also incentivize good health, so that my organs will be graded better than others and therefore worth more.
I wonder what percentage of people who die suddenly and could be kidney donors are actually organ donors?
Supposing that the percentage is not that high, certainly it is not high enough, maybe it would make sense to pay people ex ante to be donors by, say, giving them free auto registration. Then, if and when they are killed, their organs become available.
I don’t see any ethical problems with this approach.
Knowing their usual approach, Progressives will simply mandate postmortem harvesting. First our dead bodies will become property of the state, then our living ones.
This is one of my hot-buttons. Thousands of people dying for lack of free (donated) organs.
There isn’t a shortage of organs, there is only a shortage of free organs. Price controls lead to shortages. It is bad enough when price controls create housing shortages, or raise unemployment. When it results in people dying, it is beyond understanding.
I work in the medical device industry. When a device is used on a patient, we make money, as does the surgeon, the hospital, the drug company, and everyone else involved. Why can’t the family of someone who dies make money too? Is it really better to let people die waiting for a free handout?
I am uncomfortable with paid organ donation. If you can sell a piece of your body, can you sell the whole thing? If you cannot sell the whole thing, why not? Or what defines the limit of what you can sell?
If you cannot sell something, it really is not property your property. No one today defends the practice of buying and selling living human bodies (slavery). So in that sense you do not “own” your body. Even the most extreme libertarian does not argue you have a right to sell yourself into slavery, peonage, or serfdom, even if your choice to do so is entirely voluntary and uncoerced. (At least I hope none do.) If you cannot sell yourself as a whole unit, how does one consistently defend breaking yourself into pieces and parceling yourself out? Especially for non-replaceable portions of your body.
Some may say my fears selling organs can lead to slippery slope resurrecting the institution of slavery are foolish. Maybe they are. On the other hand, look what the redefinition of marriage has wrought. Why should the redefinition of the body as alienable property be different?
Seawriter
So it is OK to give parts my body away, but I can’t sell them?
You can give away your services and property, too, without remuneration. I view donating organs in that same light. It is called charity. Once money gets into the mix, , things change.
Seawriter