In my June 20th, 2006, column for the Pittsburgh Tribune-Review I argue for a liberalization of the market for transplantable human body organs. You can read the column beneath the fold.
Don’t fear the market
As Dr. Sally Satel reported recently in The New York Times, every 90 minutes an American waiting for a kidney transplant dies.
No one questions the humanity of eliminating the shortage of transplantable kidneys, but there’s a great deal of dispute over the best way to do so. I proposed in a previous column that donors be allowed to be paid market prices for their donated organs. The quantities of organs supplied for transplant will thus increase. And I’m hardly alone. Scholars more wise and knowledgeable than I am — such as the University of Chicago’s Richard Epstein, my George Mason University colleague Lloyd Cohen and Dr. Satel herself — have offered such a proposal.
Public hostility to this idea, however, is intense and goes beyond the aesthetic. Let’s look at some of the specific fears surrounding a freer market in body organs.
One fear is that the number of preventable deaths will rise once kidneys have market prices. A husband or a son might pull the plug on mom sooner than otherwise if he stands to gain monetarily from selling mom’s kidneys.
This fear is baseless. Forget that most kidney buyers will be hospitals or health insurers with strong incentives to avoid association with negligent or criminal medical practices.
Forget that the vast majority of hospital patients have loved ones who would not begin to be tempted by the prospect of monetary gain to weaken the medical care they demand for their fathers and wives and siblings and children.
Forget that whatever unnecessary deaths might be caused by a freer market in kidneys must be weighed against the lives saved by the greater number of transplants made possible by such a market.
Instead, ask if a free market in kidneys would add anything significant to the mix of incentives that already confront family members and physicians. Look first at families. Most family members who have a say in the medical treatment given to their loved ones also stand to inherit these loved-ones’ jewelry, automobiles, bank accounts and homes.
If we don’t worry that these financial prospects generally cause family members to deny sound medical care to their loved ones, why worry that a few more thousands of dollars that might be had by selling the kidney of a newly deceased loved one will turn kin into killers?
What about physiciansâ¢ Precisely because almost every patient will have relatives who not only have an interest in ensuring that their loved one receives proper medical care but who also will inherit rights to the patient’s kidney should the patient die, market prices for kidneys will give attending physicians and nurses little meaningful incentive to render substandard medical care to their patients.
A deceased person’s kidney, after all, would belong to the estate of the deceased — and any hospital employee who tries to steal the kidney would be found out and punished just as they would be found out and punished if they tried to steal a dead patient’s diamond ring or automobile.
A more extreme worry is that healthy people will simply be murdered and their kidneys extracted and sold on the open market. This concern flunks the smell test.
Hospitals and surgeons will not buy kidneys for transplant off the street. Nor will they agree to transplant into a patient just any old kidney that that patient carries into the hospital with him. Behaving so recklessly would not only expose hospitals and surgeons to criminal liability for being accessories to murder, it would hardly promote their reputations as trustworthy health-care providers. Kidneys harvested in such a manner are unlikely to be in good condition.
Of course, anything is possible. Our imaginations are sufficiently vigorous to imagine all sorts of loathsome treatment of sick family members and bizarre crimes that might, just might, be sparked by a free market in kidneys.
It’s important, in this light, to keep in mind today’s existing, actual situation. About 70,000 Americans are now on long waiting lists for kidneys. Many of these people are dying for want of kidneys, and even those patients lucky enough eventually to get one suffer for months or years through dialysis treatment.
By eliminating this shortage, a free market in kidneys not only will save and improve real lives, it will also reduce the cost of transplant surgery. Because the short supply of kidneys constrains the supply of kidney-transplant operations — you can’t perform such an operation without a kidney — the prices that hospitals and transplant surgeons charge to perform kidney transplants is kept unnecessarily high. Letting donors get paid for their kidneys will save lives and lower health-care costs by increasing the supply of transplant surgery.
In my next column, I’ll address yet other objections to this life-saving proposal.