Is America Ready for an Organ-Donor Market?

Probably not. But, in what is either a very odd coincidence or some kind of concerted effort to get out the organ-market message, there are OpEds in both the N.Y. Times and Wall Street Journal today arguing the case.

The first one, headlined “Death’s Waiting List,” is by Sally Satel, a psychiatrist and American Enterprise Institute scholar. Satel herself received a kidney transplant and is now arguing that the delivery system is terrible and that the Institute of Medicine’s new report, “Organ Donation: Opportunities for Action,” is even worse. “Unfortunately,” Satel writes, “the report more properly should be subtitled ‘Recommendations for Inaction.” Satel’s main point is that the conventional argument against an organ market — i.e., that no part of the human body should ever be “for sale” — has been made obsolete, and then some, by the “markets for human eggs, sperm, and surrogate mothers.”

The WSJ piece, headlined “Kidney Beancounters” (abstract only), is by Richard Epstein, the University of Chicago legal scholar and Hoover Institution fellow. Epstein is even more hostile to the IOM’s report (though maybe the Journal just let him get away with more than the Times let Satel get away with), saying the report is “so narrowminded and unimaginative that it should have been allowed to die inside the IOM.” Epstein writes further that “The major source of future improvement lies only in financial incentives; yet the IOM committee (which contains one lawyer but no economist) dismisses these incentives out of hand … The key lesson in all this is that we should look with deep suspicion on any blanket objection to market incentives — especially from the high-minded moralists who have convinced themselves that their aesthetic sensibilities and instinctive revulsion should trump any humane efforts to save lives.”

Though his OpEd doesn’t say so, I am pretty sure that Epstein is an advisor to LifeSharers, a self-described “non-profit voluntary network of organ donors” that seeks to use non-financial incentives to encourage organ donation. A while ago, we received an e-mail from David Undis, the executive director of LifeSharers. He wrote:

Incentives are missing in organ donation. That’s one of the reasons so many people are dying waiting for organ transplants.

A free market in human organs would save thousands of lives a year, but politically speaking it’s a pipe dream. There’s very little likelihood Congress will legalize buying and selling organs in the foreseeable future.

I formed LifeSharers to introduce a legal non-monetary incentive to donate organs — if you agree to donate your organs when you die then you’ll receive a better chance of getting an organ if you ever need one to live.

It is surprising to me, and to many people much closer to the subject than me, that so little headway has been made in reforming the organ-donation process. I have never heard a single person say they were happy with the way things are — and, while I am sure Undis is right when he writes that a free market in organs is, politically speaking, a pipe dream, it seems that things are starting to move at least a bit in that direction. As Satel writes in her Times piece today, “Ethics committees of the United Network for Organ Sharing, the American Society of Transplant Surgeons and the World Transplant Congress, along with the President’s Council on Bioethics and others, have begun discussing the virtues” of offering organ donors incentives such as “tax breaks, guaranteed health insurance, college scholarships for their children, deposits in their retirement accounts, and so on.”

It is interesting that, while all these incentives are financial, none of them are in the form of cold hard cash, which may make them more palatable.

I wouldn’t be surprised if, between these two OpEds, at least a few minds are changed today.

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  1. StCheryl says:

    The dysfunctional state of the human organ market also points out additional reasons to support stem cell research. Setting aside the problem of the organ shortage and its myriad causes, organ transplants carry with them the risk of rejection. Thus, anyone who has an organ transplant now (and for the foreseeable future) must take powerful immunosuppressant drugs for the rest of their life, thus compromising their immune system. Transplantable organs created from people’s own stem cells might not create a rejection risk; but even if that problem is not overcome, creating organs for transplant from stem cells could eliminate the availability problem.

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  2. StCheryl says:

    The dysfunctional state of the human organ market also points out additional reasons to support stem cell research. Setting aside the problem of the organ shortage and its myriad causes, organ transplants carry with them the risk of rejection. Thus, anyone who has an organ transplant now (and for the foreseeable future) must take powerful immunosuppressant drugs for the rest of their life, thus compromising their immune system. Transplantable organs created from people’s own stem cells might not create a rejection risk; but even if that problem is not overcome, creating organs for transplant from stem cells could eliminate the availability problem.

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  3. Why does money have to be involved? Why not make it that you automatically opt in to the donor pool and have to opt out to not donate your organs. If you did that, you’d have too many organs…

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  4. Why does money have to be involved? Why not make it that you automatically opt in to the donor pool and have to opt out to not donate your organs. If you did that, you’d have too many organs…

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  5. russgold says:

    The ‘offer to donate to get priority in receiving’ plan makes a lot of sense. A danger with a’money for organs’ scheme of any kind is suggested by a number of science-fiction stories by Larry Niven, in which he postulates a black market for organs, fueled by kidnapping and murder. If a donated heart is worth $20,000 and each kidney brings $5,000, then any random stranger is worth $30,000 to the unscrupulous, even ignoring the value of everything else.

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  6. russgold says:

    The ‘offer to donate to get priority in receiving’ plan makes a lot of sense. A danger with a’money for organs’ scheme of any kind is suggested by a number of science-fiction stories by Larry Niven, in which he postulates a black market for organs, fueled by kidnapping and murder. If a donated heart is worth $20,000 and each kidney brings $5,000, then any random stranger is worth $30,000 to the unscrupulous, even ignoring the value of everything else.

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  7. jheaney says:

    As the recipient of a kidney transplant, and the founder of a non-profit organization to increase organ donation, (blog.organomics.org) I’d like to add a few comments and clarifications.

    First, the prospect for cloned organs, though exciting, is not likely for at least a decade. Immediate solutions need to be explored and tested in order to save over 7000 lives per year.

    Second, cadaver organs can only be harvested from people who die while in the hospital and do not have any condition that would render their organs unusable. There simply aren’t enough people who die under these conditions to satisy those waiting for an organ.

    Third, the fear of a black market in organs relies upon urban legend and medical ignorance. No one is going to be kidnapped, have their kidneys removed, and wake up in a bathtub full of ice. Organs have to be carefully removed, tested and prepared for an identified recipient. Moreover, if there were a government regulated marketplace, the need of a black market to satisfy unmet demand would be elminated.

    And why don’t you ask any of the 1500+ athletes at next month’s Transplant Games in Louisville, KY if their transplant is a false security.

    Transplants represent the only life-saving option for over 90,000 people. We have the ability to eliminate the transplant waiting lists entirely yet the entrenched medical and political potentates reflexively refuse even to consider the introduction of incentives that could save thousands of lives. From a dialysis patient’s perspective, their ethical niceties and aesthetic reservations are, quite simply, monstrous.

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  8. jheaney says:

    As the recipient of a kidney transplant, and the founder of a non-profit organization to increase organ donation, (blog.organomics.org) I’d like to add a few comments and clarifications.

    First, the prospect for cloned organs, though exciting, is not likely for at least a decade. Immediate solutions need to be explored and tested in order to save over 7000 lives per year.

    Second, cadaver organs can only be harvested from people who die while in the hospital and do not have any condition that would render their organs unusable. There simply aren’t enough people who die under these conditions to satisy those waiting for an organ.

    Third, the fear of a black market in organs relies upon urban legend and medical ignorance. No one is going to be kidnapped, have their kidneys removed, and wake up in a bathtub full of ice. Organs have to be carefully removed, tested and prepared for an identified recipient. Moreover, if there were a government regulated marketplace, the need of a black market to satisfy unmet demand would be elminated.

    And why don’t you ask any of the 1500+ athletes at next month’s Transplant Games in Louisville, KY if their transplant is a false security.

    Transplants represent the only life-saving option for over 90,000 people. We have the ability to eliminate the transplant waiting lists entirely yet the entrenched medical and political potentates reflexively refuse even to consider the introduction of incentives that could save thousands of lives. From a dialysis patient’s perspective, their ethical niceties and aesthetic reservations are, quite simply, monstrous.

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    • patatonna says:

      Yes look at the dialysis patient who costs his health insurance $44,000 usd py. Why would his insurance company like to outlay a $90,000 usd py for an expensive and iffy operation and the costs $16,000 usd py of anti rejection drugs for the rest of the patients life? Because there there has been an established financial break even point and that is 2.7 years after the patient receives their transplant. It’s all about the Benjamin(s). Once more insurances assume this stance there will be an increased amount of pressure on the government to give some sort of incentive for organ donation. Oh but that was before Obamacare. Now with the death panels will there also be organ harvesting like in China?

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