According to a new book, The U.S. Organ Procurement System, written by economists David Kaserman and A. H. Barnett, there are 80,000 Americans on the organ-transplant waiting list. Twenty of them die each day as a direct result of organ shortages; that’s over 7,000 each year. These lost lives are not so much an act of God as they are an act of Congress because of its 1984 National Organ Transplant Act, which prohibits payment to organ donors. Reliance on voluntary donations has been an abject policy failure. It’s noteworthy that everyone else involved in the organ-transplant business is rewarded handsomely–that includes surgeons, nurses, and organ-procurement workers.
How might an organ-transplant market work? Lloyd Cohen, a law professor at George Mason University, envisions letting people contract in advance to permit the harvesting of any usable organs when they die. The money earned would become a part of their estate. Many people are offended by the notion of human body parts becoming commodities for sale. That’s at least a tiny bit inconsistent because there is a market for human blood, semen, and hair.
How many vital things in our lives do we depend on altruism or voluntary donations to provide? Food is vital, water is vital; so are clothing and housing. We don’t depend on altruism and voluntary donations to provide these goods. And for good reason–there’d be massive shortages. Why should we depend on altruism or voluntary donations to provide what we may one day need more urgently than food, water, clothing, or housing? All objections to organ sales are either nonsense, ignorance, or arrogance. Let’s look at some of them.
One concern is that if organs are sold rather than donated, poor people couldn’t afford them. There’s a difference between methods of attaining organs and methods of distributing them. For example, poor people need food but Congress hasn’t mandated that food prices be zero so that poor people can eat. If Congress did that, there’d be massive shortages and poor people would probably starve. Instead of such a policy, we simply allow the market mechanism to supply food and then subsidize purchases, through programs like food stamps. That same principle can be applied to organ transplants: allow the market to supply organs, and if needed, subsidize or rely on charity for their distribution.
Won’t organs be very costly? Kaserman and Barnett and others estimate that the organ shortage would be resolved at prices of $1,000 to $3,000 per donor. To the extent that markets would eliminate organ shortages, they would significantly reduce health-care costs. For example, the cost of kidney dialysis is about $44,000 per year. The cost of kidney transplant and medical care for the first year is about $90,000. After the first year, medical treatments, mostly for immunosuppressant drugs to prevent rejection, are $16,000. That means after about two and a half years, transplants save the medical system $27,000 per year compared to long-term dialysis.
Another concern is that if there’s a market for organs, poor people will sell theirs and become ill. The proposals made so far provide monetary payments only for cadaver organs. But from a strictly ethical point of view, people should be able to dispose of their organs for whatever reason they please. Why? If we agree that people have property rights in themselves, that is, own themselves, they have a right to dispose of themselves any way they please so long as they do not violate the property rights of others. If I needed a kidney, I would prefer that someone who is unwilling to give me one would be free to sell me one, rather than for me to do without.
Some people have argued that an organ transplant market will lead to murder and the sale of the victim’s organs to unscrupulous organ brokers. Murder will remain illegal and punishable. However, when the sale of a commodity is illegal there’s a heightened potential for illegal activity and concomitant social disorder. During Prohibition there was far more criminal activity associated with alcohol manufacture, distribution, and consumption than there is now. To the extent that prohibition of organ sales reduces supply, everything else equal, there’s greater incentive for illegal activities involving organ transplants, including murder.
The medical profession has traditionally been opposed to organ sales. Its opposition would seem to violate Hippocrates’ admonition, primum non nocere (first do no harm). But the profession has recently taken steps, however timid, toward ending the day-to-day deaths due to organ shortages. At its July meeting, the American Medical Association endorsed trials in which payments will be made to organ donors or their families as a means to encourage cadaveric organ collections.