Free the Market for Body Organs

by Don Boudreaux on July 5, 2009

in Health, Seen and Unseen, The Profit Motive

The Boston Globe's Jeff Jacoby eloquently challenges the refusal to allow transplantable body organs to be freely bought and sold.  Here are his closing paragraphs:

No one would dream of suggesting
that medical care is too vital or sacred to be treated as a commodity,
or to be bought and sold like any other service. If the law prohibited
any “valuable consideration’’ for healing the sick, the result would be
far fewer doctors and far more sickness and death.

The result of our misguided altruism-only organ donation system is much the same: too few organs and too much death. More than 100,000 Americans
are currently on the national organ waiting list. Last year, 28,000
transplants were performed, but 49,000 new patients were added to the
queue. As the list grows longer, the wait grows deadlier, and the
shortage of available organs grows more acute. Last year, 6,600 people
died while awaiting the kidney
or liver or heart that could have kept them alive. Another 18 people
will die today. And another 18 tomorrow. And another 18 every day,
until Congress fixes the law that causes so many valuable organs to be
wasted, and so many lives to be needlessly lost.

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{ 38 comments }

Martin Brock July 5, 2009 at 10:34 am

I agree with Jacoby's sentiments, but Congress could also raise availability of organs for transplant by eliminating other statutory impediments, notably the ban on using the organs of dead or dying people where the deceased has not left a declaration to this effect. This ban is not more "natural" than the allegedly "altruistic" ban on selling organs for transplant.

Expanded transplantation, and life extending technology more generally, raises many questions. What price is too high for another year of life? If I'm entitled to a billion dollars of personal consumption, why would I not spend all on another year of life? After all, I'm dead otherwise.

And if I can somehow entitle myself to this level of consumption, by writ of my influence within the state, why wouldn't I? "The rich" are rich because states enact forcible proprieties channeling control over vast resources toward a few individuals. That's just a fact. It'll always be a fact.

Federal employees, for example, are very "rich" in terms of their entitlement to health care, even if we don't describe them this way. I haven't seen precise statistics, but retired Federal employees undoubtedly consume much costly, life extending health care, because they're simply entitled to it, and hardly anyone says "no" when asked to accept a bit more life.

Chris O'Leary July 5, 2009 at 10:53 am

The simplest way to solve the problem is to use a lesson from behavioral economics and simply change the default option.

Their research suggests that if we moved from an opt-in to an opt-out system, availability of organs would go way up.

anon July 5, 2009 at 11:25 am

I don't mind donating my organs, as long as they don't go to a tax-eater, how can I ensure that?

Martin Brock July 5, 2009 at 12:59 pm

Their research suggests that if we moved from an opt-in to an opt-out system, availability of organs would go way up.

I don't have a serious problem with it, but I see no reason for the opt-out. Enacting rights for the dead is archaic and counterproductive.

Sam Grove July 5, 2009 at 1:23 pm

Instead of an opt-out, the living would have to provide for explicit alternatives, such as donating their bodies to medical schools, etc.

I suspect that a lot of those that die aren't suitable as donors anyhow, due to age.

Daniel July 5, 2009 at 1:59 pm

Reminds me of Mill who wrote: "Over himself, over his own body and mind, the individual is sovereign." Politicians have no reason to dictate what a person can or cannot do with his or her own organs.

Sam Grove July 5, 2009 at 2:25 pm

Instead of an opt-out, the living would have to provide for explicit alternatives,

In effect, transferring ownership of their bodies to other agencies upon death.

Enacting rights for the dead is archaic and counterproductive.

It's not the non-existing rights of the dead, but the rights of survivors, that matter here. I don't know how the law works here, but it appears to me that ownership of, or at least, responsibility for, the body of the deceased transfers to legal survivors, usually relatives.

K Ackermann July 5, 2009 at 2:48 pm

So is money the reason people would donate organs?

It's not like the donor gets to spend it.

Gosh; I'd like to give your child life, when I die, but I'll just take it with me unless I see some coin.

Social stigma can go along way. Morticians can paint clown faces on those who didn't donate.

vikingvista July 5, 2009 at 4:32 pm

"It's not like the donor gets to spend it."

Actually, the donor WOULD get to spend it. Not only as a living kidney donor, but potentially also as prepayment for donation upon death. Payment to heirs would also help relieve a person's burden during life of providing for his heirs, as is often wished by the elderly.

Government payment to donors for kidneys in Iran has apparently solved the renal transplant shortage in that country.

It is the bloody paternalistic and irrational age-old antimaterialist money-hating bigotry that is behind the current organ shortage, and responsible for the unnecessary deaths of thousands of Americans every year.

It is morally repugnant that people are not allowed to sell their organs. It is also a prohibition sadly endorsed by nearly all physicians including leading transplant surgeons. This is just another example of why physicians are far too paternalistic to be allowed to influence government policy.

"No one would dream of suggesting that medical care is too vital or sacred to be treated as a commodity, or to be bought and sold like any other service."

What planet is he living on? Advocates of a government health care monopoly routinely make this argument.

Sam Grove July 5, 2009 at 4:35 pm

Gosh; I'd like to give your child life, when I die, but I'll just take it with me unless I see some coin.

Perhaps my family needs to be taken care of after my death. Is your child more important than mine? Perhaps…only to you.

Or maybe I want my organs sold with the funds going to medical research or some charitable cause.

Martin Brock July 5, 2009 at 4:37 pm

I see no reason for a man's relatives to own his corpse; however, I don't have a fundamental problem with relatives exercising some authority over its disposal. It's a practical question. If people commonly want their relatives to rot in the street where they fall, then I'm not happy leaving the disposition to relatives. If people commonly want their relatives' bodies to serve some useful purpose, to benefit the living, I'm happier leaving the disposition to them.

If relatives, or a deceased's appointed heirs, want to sell the body for this useful purpose, I don't have a fundamental problem with that either; however, I don't favor some unlimited right of relatives or heirs to do whatever they like with the body, because it has value to the living and no more value to the deceased.

Sam Grove July 5, 2009 at 6:22 pm

If people commonly want their relatives to rot in the street where they fall,

I hate when people do that.

Martin Brock July 5, 2009 at 7:24 pm

The point is that relatives are not simply entitled to do what they want with a deceased person's body, regardless of the deceased's will before death. Many regulations already govern disposal of the body. Entitling emergency room attendants to salvage some organs from it seems no greater intrusion. Whether heirs should receive any compensation is a separate question. I don't have strong feelings about it one way or the other. I certainly don't think it's any sort of "natural right".

Dr. T July 5, 2009 at 7:49 pm

K Ackerman said: "So is money the reason people would donate organs?

It's not like the donor gets to spend it."

No, but the donor's family gets money to pay the funeral expenses and to cover other costs. Consider it to be the equivalent of a variable benefit term life insurance policy. The amount payable to the beneficiaries would vary based on which organs were suitable for transplant.

vidyohs July 5, 2009 at 7:57 pm

Let's see, just how important is it that we all have access to other's organs, either in a free market, or in a forced harvesting system?

Wow, mother nature built in a system of death upon organ failure, and we have learned to circumvent that for a brief period, perhaps even a few years!

So, if I get a liver transplant that will mean I get to see the whole season of American Idol, Dancing with the Stars, teaching the grandkids what they think is ridiculously archaic in the first place, make that first playoff game for the Texans, maybe create the new theory of interspatial white holes that eat up interstellar conversations?

I personally have no dog in the hunt, but in my own opinion when one's organ(s) fail, it is nature's way saying Adios.

Buy them, sell them, leave me out.

Babinich July 5, 2009 at 8:19 pm

Posted by vidyohs on 07/05/09 @ 7:57:10 PM

"So, if I get a liver transplant that will mean I get to see the whole season of American Idol, Dancing with the Stars, teaching the grandkids what they think is ridiculously archaic in the first place, make that first playoff game for the Texans, maybe create the new theory of interspatial white holes that eat up interstellar conversations?"

vidyohs,

No worries…

You will not receive the liver because some bureaucrats in Washington DC cooked up a statistical model that deems your demographic as being ineligible for the transplant.

:')

vidyohs July 5, 2009 at 8:49 pm

Babinich,

Yes brother, my attitude at soon to be 68, is that if'n I ain't done it by now then I ain't missing anything if I go.

And, my living will says let me go if I can't feed myself or take care of my bodily functions, including clean-up. Just let me go. Don't waste any money.

K Ackermann July 5, 2009 at 8:51 pm

What if somebody sells a defective organ?

indiana jim July 5, 2009 at 9:01 pm

Speaking of organ donations reminds me of John Pryne's lyrics to "Please don't bury me":

Woke up this morning
Put on my slippers
Walked in the kitchen and died
And oh what a feeling!
When my soul
Went thru the ceiling
And on up into heaven I did ride
When I got there they did say
John, it happened this way
You slipped upon the floor
And hit your head
And all the angels say
Just before you passed away
These were the very last words
That you said:

Chorus:
Please don't bury me
Down in that cold cold ground
No, I'd druther have "em" cut me up
And pass me all around
Throw my brain in a hurricane
And the blind can have my eyes
And the deaf can take both of my ears
If they don't mind the size
Give my stomach to Milwaukee
If they run out of beer
Put my socks in a cedar box
Just get "em" out of here
Venus de Milo can have my arms
Look out! I've got your nose
Sell my heart to the junkman
And give my love to Rose

Repeat Chorus

Give my feet to the footloose
Careless, fancy free
Give my knees to the needy
Don't pull that stuff on me
Hand me down my walking cane
It's a sin to tell a lie
Send my mouth way down south
And kiss my ass goodbye

Repeat Chorus.

And I think, listening to it is even more fun than the lyrics

:>)

Martin Brock July 5, 2009 at 11:09 pm

My living will also says that my living body may be used for scientific or medical purposes if I'm brain dead.

Martin Brock July 5, 2009 at 11:13 pm

What if somebody sells a defective organ?

Good question. Selling organs raises many. With homeless old men selling kidneys for wine to transplant mills in the Bahamas, you'd want a tight screening process.

Sam Grove July 5, 2009 at 11:13 pm

The point is that relatives are not simply entitled to do what they want with a deceased person's body, regardless of the deceased's will before death.

Nobody is simply entitled to do what they want with a lot of things, such as waste, attractive nuisances, booby traps, dirty oil, discharging firearms, etc.

Lotro powerleveling July 6, 2009 at 3:46 am

I am glad to talk with you and you give me great help! Thanks for that,I am wonderring if I can contact you via email when I meet problems.

Freelance Unbound July 6, 2009 at 6:02 am

"No one would dream of suggesting that medical care is too vital or sacred to be treated as a commodity, or to be bought and sold like any other service."

Uh – they do in the UK… you may find if you start to go the National Health route in the US (as I believe there is a lobby to do) that this notion will becomes more prevalent.

Dave Undis July 6, 2009 at 7:25 am

As the death toll from the organ shortage mounts, public opinion will eventually support an organ market. Changes in public policy will then follow.

In the mean time, there is an already-legal way to put a big dent in the organ shortage — allocate donated organs first to people who have agreed to donate their own organs when they die. UNOS, which manages the national organ allocation system, has the power to make this simple policy change. No legislative action is required.

Americans who want to donate their organs to other registered organ donors don't have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at http://www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. Non-donors should go to the back of the waiting list as long as there is a shortage of organs.

David J. Undis
Executive Director
LifeSharers
http://www.lifesharers.org

Gil July 6, 2009 at 8:35 am

"As the death toll from the organ shortage mounts . . ."

Golly, it's almost sounds as though some see it as almost a natural right to access others' organs. It wasn't overly too long ago that organs couldn't be transplant at all. After all, there's nothing stopping people from donating their organs right now. Presumably, it a high price was put on organs then those who wouldn't normally donate them would seem it to be worthwhile. Then again how much is organ retention due to religious belief? Some seem to believe they need all their body parts for a future physical resurrection.

vidyohs July 6, 2009 at 8:58 am

Gil,

Proofread for clarity man, sheese!

It is a stretch of drug addled fever, maybe, that causes you to think anyone is promoting a right of someone to access another's organs.

What is being promoted here is the understanding that each of us has the right to dispense of our organs in anyway we choose, as they are ours not the governments. Therefore for there to be a government prohibition on the sale of spare parts is an intrusion into individual freedom.

Yes donation is available now and that should be promoted as well, but do you think for one moment, good sir, that donation is free? Ha, perish the thought!

The donor may not benefit financially from the donation, but the medical personel certainly do and make a tidy profit at it as well.

What Don suggests and others support is the idea that, why should not the donor benefit if he is going to give up a spare part while still living.

But, you know this, you sly little puppy.

RG July 6, 2009 at 10:19 am

Vidyohs,
You act like Gil is crazy for suggesting that someone here is claiming that others should have a right to another's organs. Martin said all of the following:

"Enacting rights for the dead is archaic and counterproductive."

"I don't favor some unlimited right of relatives or heirs to do whatever they like with the body, because it has value to the living and no more value to the deceased."

"The point is that relatives are not simply entitled to do what they want with a deceased person's body, regardless of the deceased's will before death. Many regulations already govern disposal of the body. Entitling emergency room attendants to salvage some organs from it seems no greater intrusion."

It seems to me like that is exactly what he is advocating, eh?

Gil July 6, 2009 at 10:48 am

Golly vidyohs living people can donate organs too (e.g. a kidney).

This discussion reminds of an anecdotal story whereby there were claims of bodies of the recently deceased being stolen for food so families would watch over a recently deceased till the body began to puetrify before burying. Gee, what selfish gits for letting good food going to waste, eh?

vidyohs July 6, 2009 at 3:15 pm

RG,

Puhleeze! If you read this blog more than once a year you have to know that you are putting me in an awkward position here.

"Enacting rights for the dead is archaic and counterproductive."//This in no way asserts that others (specifically live people) have a right to harvest organs from the dead. It is simple straightforward common sense though poorly worded. We do not enact rights, we enact privileges. However that little anomoly is just Martin's hangup in understanding or acknowledging natural rights.

Think about it, RG. If we recognize that a specific dead has rights, how far back do we go in that recognition? Archaic and counter productive wouldn't you say? At the same time the argument can be made that if we recognize that a specific dead has rights then the next logical step is to recognize that a specific future human has rights. Kinda messy isn't it?
Martin 1, RG 0

"I don't favor some unlimited right of relatives or heirs to do whatever they like with the body, because it has value to the living and no more value to the deceased."//Again RG, you seem to insert your own bias into your interpretation. Martin specifically said he does not favor the unlimited right of relative or heirs to do whatever the like with the body. In other words those relatives and heirs have no right to take the dead body and sell off or donate the organs, nor do they have the right to override a living will; and, the fact that the dead person no longer needs the organs is irrelevant.

"The point is that relatives are not simply entitled to do what they want with a deceased person's body, regardless of the deceased's will before death. Many regulations already govern disposal of the body. Entitling emergency room attendants to salvage some organs from it seems no greater intrusion."//This RG, simply reinforces my critique of your last quote. However, he goes on to add that because of the fact that there are already many regulations governing the disposal of the dead (the law – should I choose to obey it- prohibits me from simply taking my father's dead body and burying it in a home made pine box, down in the corner of my garden) that to him, it seems that allowing harvesting of organs by emergency room personnel seems to be no more of an intrusion into rights than what already exists in law.

That "however" does not declare support, one way or the other, at all of harvesting of organs.

You see Martin always leaves himself an escape hatch, and you can always assume many things from what Martin says; discovering what he actually means can take many trips around the mulberry bush.

BTW, as Gil is a left leaner, a solid case could be made that he is crazy. How can one be sane and believe that what has failed in every case can now be made to happen? But definitely Gil is frequently a crappy writer, perhaps because he frequently appears to be either a drunk or on something mind altering when he attempts to write.

RG July 6, 2009 at 9:14 pm

Vidyohs,
Thanks for the insight into the frequent commenters. It is important to know the enemy. I'm sorry if I led you to believe that I agreed with Martin that someone else has a right to a deceased person's organs. I don't think that at all. You don't have to argue that point with me. You just said Gil was crazy to suggest such a point, and I pointed out that Martin seems to think that the possible good that the organs of a deceased person could provide to society warrants the harvesting by some nurse because they have no value to the deceased. Gil may very well BE crazy, but he is right about SOMEONE here thinks there is some natural right to another's organs.

I'm with you. I think they idea is ridiculous. I also think there are some good ways to administer a market for organs. Acknowlegding that all of these ideas are illegal at this point, I think a company could offer cash to the living for an agreement to turn over all organs at the time of death. The payment would vary depending on age, health, and other variables. The company would lose money on some, and I haven't run the numbers, but it might could work.

Think about this. The company sets up booths on college campuses and offers students, who are generally younger and healthier than the average citizen, cash for their organs upon their death. The students who are in massive debt and in grave need of beer money would do it for almost nothing. Then, when they die, whenever that happens to be, the company gets their organs and sells them. On second thought, it might be better not to buy livers from students wearing fraternity swag. Of course, there would be a PR battle since we're banking on the sudden early death of our clients, but we'll cross that bridge when we get there.

vidyohs July 6, 2009 at 9:18 pm

Rg,

Obviously we never made contact at the level I thought we were trying to achieve.

That is my fault, I must have not been clear, but then your response leaves me to think you might be having a bit of fun right now.

Gil July 6, 2009 at 11:33 pm

"Gil may very well BE crazy . . ." – RG.

Charming. Then again I don't vidyohs as the bastion of commonsense either.

vidyohs July 7, 2009 at 6:13 am

Gilduck,

Shoot yourself in the foot again in protest, now that's charming.

Gil July 7, 2009 at 6:35 am

"Sori, should be 'First is government'"

Gee, you're not shy in misspelling and misusing words are you vidyohsgoose?

RG July 7, 2009 at 11:59 am

"Gil might very well BE crazy…" is me taking a lesson from Martin and leaving myself a way out.

Yevgeny July 7, 2009 at 8:19 pm

The obvious solution is that those you agree to donate their organs get priority over those that don't if and when they need a transplant. There would have to be a some sort of waiting period of a year or two before someone was eligible.

No buying and selling needed, no forced harvesting just a plain incentive to become a donor.

-Yev

John July 8, 2009 at 4:09 pm

It would seem that in the realm of health care, so many people think that the law of scarcity can be suspended. Giving everyone in America top quality health care is as feasible as putting a Ferrari in every driveway. Disparity of quality is inevitable, and will not go away no matter how hard we wish for it.

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