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.

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.