Free Market Organs

Last week, Doug linked a post about British Prime Minister Gordon Brown’s support for a policy that would allow hospitals to harvest organs without prior consent of the decedent or his/ her family. In essence, the organs of all deceased British citizens would belong to the government’s healthcare system except for those individuals who “opted out” prior to death.

The policy in the U.S. is an “opt in” approach rather than “opt out.” Why is this distinction important? Answer: the presumption of ownership. If citizens have an option of opting in, this shows that individuals own their bodies; to suggest that an individual has to opt out shows that citizens’ bodies are property of the government (unless s/he makes an affirmative claim on his/her body).
The reason for Brown’s support for this policy is quite obvious: like just about everywhere else in the world, Britain is having an organ shortage.

So if presumed consent is not the answer to solving the organ shortage, what is? Randolph Beard, John D. Jackson, and David L. Kaserman of Auburn University published a study in the Winter 2008 issue of Cato’s Regulation Magazine. The team studied the effectiveness of current policies aimed at maximizing donor participation and organ matching. Among the policies they analyzed were: increased government funding for organ donor education, organ donor cards (such as having the words “organ donor” on driver’s licenses), required request, kidney exchange programs, and donor reimbursement. None of the policies have come close to solving the shortage. The researchers estimate that roughly half of the potentially viable cadaver organs are ever harvested. With the exception of the inefficient kidney exchange program, one feature that all of these programs have in common is that they each rely on altruism on the part of individuals to donate organs without any sort of compensation.

The one solution which the researchers believe would be effective, monetary compensation to organ donors or their families, is illegal almost everywhere. In 1984, the National Organ Transplant Act was passed making it a crime in the U.S. for a surviving family to receive payment for their loved one’s organs. The law was passed mostly on ethical grounds without any consideration for what would happen to the supply of available organs. The researchers estimate that some 80,000 lives from 1984 to present have been lost because of the bill’s passage and other subsequent policies in the current “altruistic” system. The researchers further project that another 196,310 lives will be lost between 2005- 2015 (and this is what they consider a “conservative” estimate!).

As controversial as compensating families organs of deceased family members is, the thought of an individual driving to a hospital, removing an organ (such as a kidney), and selling that organ to someone in need of the organ for a profit is a complete non-starter. This shouldn’t come as a shock given that in today’s lexicon; the word “profit” is a dirty word. The people who scream bloody murder whenever people decide to “scalp” tickets to sporting events or tickets for Hanna Montana concerts (what’s the big deal with Hanna Montana anyway?) will not likely be in favor of selling vital organs. Anti-capitalist objections aside, free market buying and selling of organs appears to be the most practical solution.

Cato Institute’s Director of Bioethics Studies Sigrid Fry-Revere found that Iran is the only country that does not have an organ shortage and has not had a shortage in ten years. Why? Because Iran (of all places!) is one of the only countries where it is legal for individuals to buy and sell organs from live, voluntary, donations. Revere’s findings also revealed that even if all the viable organs were taken by force by the government from cadavers, there would still not be enough organs to provide an organ to everyone who needs one (Cato Daily Podcast dated January 15, 2008). Maybe the Iranians are on to something here?

David Holcberg, writing for Capitalism Magazine agrees arguing in favor of a free market system for organs on both practical and moral grounds:

If you were sick and needed a kidney transplant, you would soon find out that there is a waiting line--and that there are 70,000 people ahead of you, 4,000 of whom will die within a year. If you couldn't find a willing and compatible donor among your friends and family, you could try to find a stranger willing to give you his kidney--but you would not be allowed to pay him. In fact, the law would not permit you to give him any value in exchange for his kidney. As far as the law is concerned, no one can profit from donating an organ--even if that policy costs you your life.

Patients' attempt to circumvent this deplorable state of affairs has led to the emergence of "paired" kidney donations, an arrangement whereby two individuals--who can't donate their organs to their loves ones because of medical incompatibility--agree that each will donate a kidney to a friend or family member of the other. But this exchange of value for value is precisely what today's law forbids. Thus, under pressure to allow this type of exchange, in December the U.S. House and Senate passed The Living Kidney Organ Donation Clarification Act, which amends the National Organ Transplant Act to exempt "paired" donations of kidneys from prosecution.

The congress says that kidneys can be exchanged without sending anyone to jail; how thoughtful. While this is an encouraging step in the right direction, why won’t our elected officials go the rest of the way? Is it the potential risks for the donors? Holcberg points out that the risk for a healthy person dying from donating a kidney is about .03% and usually live normal lives without reducing his or her life expectancy.

No, I suspect the objection to selling organs is more rooted in the overall distain far too many people have towards capitalism. It’s simply unethical to make a profit off of something that someone else “needs” whether its gasoline, Hanna Montana tickets, or a kidney. Only the “privileged” will be able to buy organs if such a system were adopted, they would argue.

Even if this were true, denying a person the right to purchase an organ to save his or her own life should not be subject to a vote or someone else’s ethical hang-ups. If I want to remove a kidney and sell it to a willing buyer for $30,000 (or whatever the going market rate is) I ought to have that right. Why must we assume the government has the right to tell us what we can do with our bodies whether it’s selling our organs by our own choices or government taking them from us after we die without prior consent? Our individual rights of life, liberty, and property demand that we have the ability to make these choices for ourselves.