Human Organs for Sale, Legally, in … Which Country?

Here is an oversimplification of a complex problem:

1. Thanks to the miracles of modern medicine, a sick or dying human being can receive a transplanted organ from another human being.

2. Some of those organs must inevitably come from cadavers: i.e., you can’t give your heart to someone else and still live.

But some transplanted organs can come from living people. Chief among them is the kidney: we are born with two but can live with one.

3. As the science has improved, there has been a huge increase in demand for transplantable organs. But the supply has not kept up with demand. The kidney waiting list gets longer every year, and every year more people die while still on the waiting list. The supply of kidneys from both cadavers and living donors is insufficient.

4. There are fewer cadaver organs than one might wish for because:

a) Traffic fatalities continue to fall.

b) Improved emergency-room care keeps alive people who in the past may have died.

c) Not that many people in the U.S. choose to be organ donors upon their death. (This could be significantly improved if the U.S. adopted a “presumed consent” rule, as some countries have.)

5. There are fewer organs from living donors than one might wish for because too few people are altruistic enough to undergo surgery and give an organ to someone they may or may not know and receive no compensation for said act.

6. Therefore, a movement is afoot to create a market for human organs in the U.S. whereby “donors” would be compensated for their time, trouble, and organ. There are many objections to this market:

a) Some say, for instance, that it would exploit poor people (although poor people are often the ones who need organs, which are currently not available).

b) Others say that such a market would be impossible to properly design and regulate (although this “kidney exchange” program, created by market-design expert Al Roth of Harvard, shows that one problem can have many clever answers). Also, compensation could come in various forms, ranging from cash to tuition to lifetime healthcare.

c) There seems to be a natural repugnance toward buying and selling human organs — illustrated nicely in this presentation by the economist Julio Elias, who has written with Gary Becker on a potential market for organs.

Considering all of these factors, it is hard to imagine that the U.S. will have an organ market any time soon. There is a fervent ongoing debate over our organ shortage, including an actual debate scheduled here.

While there has been some movement toward compensating donors in Israel and in Holland, there is just one country in the world that has apparently gotten rid of its organ shortage by creating a market. Before you read the name of that country in the following paragraph, take a guess. Now guess again, and again — maybe 20 more times.

Benjamin E. Hippen, a transplant nephrologist (and scholar) in North Carolina, recently published a paper called “Organ Sales and Moral Travails: Lessons From the Living Kidney Vendor Program in Iran.”

Yes, Iran.

“Although Iran clearly does not serve as a model for solving most of the world’s problems,” Hippen writes, “its method for solving its organ shortage is well worth examining.”

Here are a few facts from Hippen’s paper:

Insofar as the kidney procurement system in Iran can be characterized as a “market,” it is a highly standardized and regulated market with only modest room for negotiation. …

Vendors are paid in two ways. First, the Iranian government provides a fixed compensation to the vendor of approximately $1,200 plus limited health insurance coverage, which currently extends to one year after the exchange and covers only conditions deemed related to the surgery. Second, the vendor receives separate remuneration either from the recipient or, if the recipient is impoverished, from one of a series of designated charitable organizations; this amount is usually between $2,300 and $4,500. …

The most contentious disagreements in the literature regarding kidney vending in Iran have to do with the personal, physical, and financial consequences for vendors themselves. This issue is complicated by an absence of routine follow-up. …

Despite a flourishing kidney vendor program, biologically related donation has consistently constituted 12 to 13 percent of all donated kidneys, and that fraction has persisted in tandem with the rapid rate of growth in kidneys procured (without compensation to the donor’s estate or family) from deceased donors. …

I wrote to Hippen to ask what sort of reaction his paper has received. He said it has been received “cautiously.” One prominent transplant surgeon, he said,

… is reluctant to go out of his way to include Iran in the public discussion. While he has no quarrel with the paper that I’m aware of, he (legitimately) worries that it isn’t the whole story. I share the concern, which under the circumstances is not definitively answerable. The other concern, phrased in various ways, is that it is just unfortunate that all of this information is coming from Iran, for obvious reasons. Can’t do much about that.

People who are ideologically opposed to a market in organs, Hippen told me,

… don’t dispute the data, but deplore the example. I freely concede (and take pains to highlight) that a crucial moral failing of the Iranian system is that there is insufficient data on the long-term outcomes of organ vendors, and the data that exist suggest that vendors are disproportionately impoverished, which in turn may put them at long-term risk for kidney disease. The Iranian transplant professionals I corresponded with in the course of writing the paper share the concern.

When I asked Al Roth about Hippen’s paper — which he said he admired — he raised a separate point of concern.

Not only is the health and welfare of the vendors hard to quantify, Roth said, but it is also hard to get reliable data on “what percentage of patients with E.S.R.D. (end-stage renal disease) fail to get treatment, and how much this contributes to the absence of a transplant waiting list.”

These considerable caveats aside, here is what Hippen thinks the U.S. should make of the Iranian organ market:

The portion of the National Organ Transplant Act of 1984 which prohibits the sale of organs should be repealed. … Because so much is still unknown regarding how organ sales would work in the United States, individual transplant centers and organ procurement organizations should be permitted to experiment with how to implement a system of organ vending.

This proposal strikes me as rational and wise, though it may never be tried out here. The repugnance factor in this country, as Roth and Elias have pointed out, may simply be too large to overcome.

But if data, like justice, is truly blind, then it is probably worthwhile to look toward a country that many Americans hate in order to save the lives of the people they love.

(If you’ve made it to the end of this long post, you may be interested to know that I’ll be discussing this topic sometime shortly after 6 a.m. E.D.T. on Wednesday, April 30, on the new public-radio show The Takeaway.)

[Addendum: Here’s the Takeaway radio segment.]


Kei Boon

Well is that not the exact problem from my understanding opt-in means you must sign up to be a donor and opt-out means if you dont sign up NOT to be a donor your organs will be donated. Do you not feel you have ownership upon birth of your organs? The opt-out method sounds like you have to clame your right to your organs before they are yours. The opt-out method would just catch the hard working middle class and those less informed off gaurd because they rarely have the time to spare. Some might say opt-out takes away the pressure of signing up but i rather have the right to keep my organs until I say they can be removed. If this means never then so be it.

Dave Undis

Mike:

In order to be eligible for preferred access to the organs of other LifeSharers members, you need to be a member for at least 180 days. This creates an incentive for people to sign up before they need a transplant. LifeSharers has over 11,000 members, and of these only 69 need transplants.

Dave Undis

Sara:

People who need transplants often make good donors. You can have a bad heart but still have good lungs, good kidneys, and a good liver.

People join LifeSharers for three reasons: (1) to increase their chances of getting a transplant should they ever need one, (2) because they want to donate their organs to other organ donors, (3) because they want to help create an incentive for non-donors to become donors.

John Heaney

Dave Undis:

It's true that we currently bury or cremate thousands of organs that could have saved lives. The latest data I received from UNOS indicates that we're getting a donation rate of about 60% of the approximately 15,000 people who die under circumstances where their organs can be harvested.

Now we know that we'll never get 100% contribution, and since the voluntary contribution rate last year grew by only .8%, it's safe to assume that we are reaching a plateau. Even with herculean efforts, it's unlikely that we'll reach a 70% contribution rate, which would add only 1500 or so more donors.

I applaud the efforts made to date to generate this level of awareness and public participation. However, the waiting list will exceed 120,000 in two to three years, average waits will exceed six years, and the average dialysis patient will only live five years on dialysis. When I do this math, I see clearly that efforts focused solely on increasing deceased donations are woefully inadequate.

Although a number of people have suggested that we adopt presumed consent (and it was a concept that I also embraced when I first heard it), I think that it's wrong to expand the power of the state to confiscate valuable personal property (your organs). The only reason the state wants possession of the organs is because they have value. Life saving value. And they are the ultimate personal property. If they possess such value, the owner should be compensated.

A raw power grab by the state will foster distrust, an assumption that the state if profiting at the expense of the individual and presents the possibility of public corruption. Compensate the donor and these concerns disappear.

Compensate the donor and the kidney transplant waiting list disappears altogether. For God's sake, it's an idea worth trying before another 7000 patients die this year alone.

Read more...

Omer

Add to the oversimplification -

People nowadays live long.

"a) Some say, for instance, that it would exploit poor people (although poor people are often the ones who need organs, which are currently not available)."

I thought it was the poor in India, pimping out their organs.

"b) Others say that such a market would be impossible to properly design and regulate ..."

Regulation would help prevent exploitation?

Mike

Dave Undis,

Sounds like a worthy program, but am I the only one who sees a glaring loophole? Couldn't you just game the system by joining up the minute you are diagnosed with some form of organ failure? If that's true, shouldn't any doctor worth his/her salt recommend to a patient that they sign up ASAP? Shortly, anybody on the waiting list is on the donor list. Sure, there will be more organ donors, but are these the people we want as organ donors?

Have Lifesharers controlled for this?

htb

The "presumed consent" idea is a bit of a red herring; the law itself doesn't have that much of an effect. (In some places, actually, switching to presumed consent seems to have decreased donation rates.) The US kidney transplantation rate significantly exceeds that of many "presumed consent" countries.

The Spanish solution, BTW, is *not* presumed consent. They switched to presumed consent and saw little improvement. Their solution was the creation of the National Transplant Organization in 1989 -- a carefully trained group of physicians dedicated to identifying every possible cadaveric organ, and showing up on the spot to ask (yes, ASK) the family to agree to the donation.

(It also helps that they have more traffic fatalities than we do, and therefore a larger pool of healthy cadavers.)

Still, it's worth looking at the numbers: Spain's model system produces 35 donors for every 22 of ours -- a number, BTW, that is almost exactly the same as France, which has a presumed consent system, and which is actually better than many countries with a presumed consent system. What matters seems to be a determination to act immediately (and to have people die from car wrecks and strokes instead of cancer), not the legal default.

Read more...

John Heaney

Univ. of Chicago economist Richard Epstein captured perfectly the sentiment expressed by many opponents of free market incentives in organ procurement when he labeled the opposition the Tyranny of Repugnance.

I understand the personal sentiment that finds the attachment of commercial incentives to organ donation distasteful. Their discomfort is identical to the sentiments expressed when life insurance was first proposed, when the concept of surrogate motherhood was suggested and when payment for sperm donation was introduced. Society has adapted to these concepts as they will likely adapt to the concept of organ donation incentives.

It's important to note that if any individual continues to find the practice repugnant, they have the personal freedom to refuse to participate. They can still elect to donate their organs without restitution or simply refuse to participate in any organ donation program at all.

However, their personal repugnance should not be allowed to threaten the lives of over 100,000 people waiting for transplants by prohibiting even the testing of potentially life-saving programs that introduce assorted free market incentives.

The only solution to our critical organ shortage is to solicit organs from living donors. Nobody argues this fact. Those truly committed to finding ethical solutions to our critical shortage of organs must acknowledge the powerful role incentives can play in attracting donors and work to develop ethically sound programs that protect the health and welfare of the voluntary donors while saving the lives of thousands who are now lingering on an ever growing transplant waiting list.

Many potential solutions have been proposed and can be explored at www.organomics.org

Read more...

wes

John Heaney,

Here are some simple observations about 'markets': 1) People with the highest willingness-to-pay for a good are the ones who get them 2) People with the lowest willingness-to-accept for a good are the ones who sell them. There is nothing particularly mythical or fantastic about that.

Here is a less simple observation about human behavior: People are fairly bad at predicting how current decisions will make them feel in the future. And a big cash payday today is all the more potent in obscuring those affective forecasts.

In a market for widgets, who cares what happens? In a market for human organs or other goods that carry severe and/or extremely complex consequences, pragmatic censorship seems prudent. That is why crack cocaine is not sold at the supermarket, why a person cannot sell themselves into slavery, and so forth. Certainly there are willing buyers and sellers in those markets, but as a society, we aren't willing to accept it. And for good reason.

History is replete with examples of individuals who died for a particular notion of fairness, so let's not denigrate those people with a simplistic notion. Sometimes the way we live is more important than how long.

Read more...

Steve

If any one knows how i can sell one of mine please contact me 50,000

Steve

kiasta

Forget that $1200 and limited health care? They better give me 100's of thousands of dollars. How ridiculous, people actually do that for so little? I make more then that in a week WTF! The Iranians should strike for better wages for their um goods.

kiasta

Oh and also to those talking about moral issues, what planet do you live on? Like there are any morals in this day and age, everything is about money and power every decision made is revolved around money and power, why are organs any different? Because the people who need them are too poor to afford them? Well thats too bad huh? Guess you are SOL. Oh and you probably think I'm heartless blah blah blah but try growing up dirt poor, you would understand that nobody gives a F*** about you and your problems. Why should poor people who need money from organs give a F*** about other people?

Nuck

I strongly believe in creating a market for organs. I myself I a living donor, survived the process and recommend it to everyone that is capable. The need is so great that, we need to get over the idea that selling part of ourselves is somehow immoral. I agree it needs to be heavily regulated, however if it is not organized soon the overseas black market will continue. I believe if proper screening is done, market forces will dictate the price. To artificially set a price is ridiculous. Rich people get the best care anyway and most of the time they get the organs now. SO why not let the poor benefit from the need.
I wish more people would come forth and donor without compensation, but I don't see that happening anytime soon.

David Cory

presumed consent exists in a lot of democratic countries.. spain for example. however the shortfall of organs won't be overcome with just presumed consent.
the argument that this is "repugnant" is ridiculous. if free market capitalism is the true economic model of the united states; (we see it exercised in the lack of socialized medicine) no individual should prevent another from engaging in a transaction of their organs.

I was under the impression we lived in a free society. Not one where social sentiment can decide life or death; sadly the close mindedness from some people on this matter really makes me question if we really have made any progress as a society.

If someone wants to sell an organ what gives you the right to stop them.

friendsfrnd

Hi all, greetings to everyone.
I do like to sell my kidneys,eyes or any usable parts in body. as per recent medical reports, everything in good condition, if anyone intrested to buy can contact me, I need this money urgently,pls. contact me, I will not sell one kidney, any one interested to buy eyes, kidneys as whole can contact me at friendsfrnd@yahoo.com

Robert Cogan

Driving a car is a privilege, not a right and a costly one: think taxes for road maintenance, state police, pollution externalities. If it would save money on the whole, especially in life insurance and health care payouts, for many more organs to be available, then the better system would seem to be required response, presumed consent nonreversible by relatives. If you want to drive, especially a donor cycle without helmet, you're in the system!

Danny Jordan

Seems everyone wants to raise a stink when it comes to money except for the medical professionals. They certainly are not bashful when it comes to getting into the act. Unfortunately, many who have worked hard all their lives and save little for a retirement are raped by the medical profession when they get sick. I am not hearing anything about that problem. Justice!! What kinda of joke is being played out. Why aren't the medical school forced to accept more students and allow the supply and demand feature in our economy run it's course. Your waisting your time worrying about wheather or not someone sells their organs. The real problem is much bigger than that.

Fiona David

I agree with David Cory's post dd May 27th,
2008. I recently read about two Indonesian men who were convicted and fined of kidney trading in Singapore. They should not be punished for wanting to sell their organs. I'm very sure they're desperate enough to that extend. They needed the money to support their family and survive. I will also do the same in order to support my family. Which is more important? We need money for survival and the other person needed a kidney. So why not help each other.

Jeffrey Mason

I am in Great shape Former Ball Player want to Sale Organs. To Help someone who needs it. And help my Wife who also is sick. Call Me at home. 919-768-1572.or cell 919-721-9202.

SCOTT FRANK

I WILL SELL MY ORGANS, MY RIGHT TO HELP PEOPLE IS A CHOICE. I AM A 42 YEAR OLD HEALTHY MALE WITH B POSITIVE BLOOD TYPE.I AM WILLING TO SELL OFF ORGANS.MY CONTACT IS EMAIL ONLY.