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Pittsburgh Tribune-Review: “Selling organs; two alternate plans”

In my Pittsburgh Tribune-Review column of July 10th, 2006, I continued to press the argument for liberalizing the market for transplantable human body organs – this time by recommending a proposal by GMU law professor Lloyd Cohen.

You can read the column beneath the fold.

Selling organs; two alternate plans

In previous columns I argued that adults should be allowed to buy and sell kidneys. The upside of permitting a free market in kidneys is vast: thousands of lives saved each year and thousands more delivered from the misery and indignity of dialysis. The downside is almost nonexistent.

Many of the arguments against a free market in kidneys spring from merely the egocentric objections of those who thoughtlessly — or selfishly — elevate their own aesthetic objections to such commerce over the lives of real people. And the many other arguments in opposition are, at best, highly speculative.

While I would immediately lift the prohibition on kidney sales, there are several intermediate measures that would yield much benefit. One of the most promising is proposed by Lloyd Cohen, a professor of law at George Mason University.

Cohen recommends that all of our body organs be considered to be parts of our estates in the same way that our homes and jewelry are parts of our estates. When someone dies, his heirs own his body organs just as they own his other properties. These heirs can sell, give away or ignore these organs.

The advantages of Cohen’s proposal over the current blanket prohibition on sales are clear. Each year, thousands of healthy transplantable body organs are buried or cremated, needlessly destroyed despite their ability to extend and improve the lives of thousands of people. By treating all transplantable organs as property of the deceased person’s estate, this wholesale destruction of lifesaving body parts will be significantly reduced.

It’s easy to bury a loved one with his or her healthy kidneys or heart if agreeing to have those organs harvested for transplant brings only a sense of satisfaction from helping a stranger live longer. But if sale of the loved one’s organs will bring thousands of additional dollars to the estate, I’ll bet my pension that the number of body organs harvested for transplant from newly deceased persons will skyrocket. As a result, thousands of living people will enjoy longer, healthier, and more productive lives.

Of course, as with all properties destined to become part of a person’s estate, that person would have great leeway to determine the disposition of his organs. If he objects religiously to his organs being harvested, he merely must specify in his will that no such harvesting is to take place. His family and the courts will be bound to honor this demand.

Or if someone specifies in her will that she wants only her nephew Bob or her daughter Ann to receive her kidney (or heart, or lungs, or…) for transplant, that provision, too, would be honored.

Cohen’s proposal avoids a major objection to a free market in kidney sales — namely, that too many living persons will impair their health by selling their kidneys to make a quick buck. Cohen’s proposal can be adopted without permitting living persons to sell their organs.

Still, objections are raised — most notably, that potential heirs will skimp on the quality of a sick loved one’s medical care.

No one knows what the prices of transplantable cadaveric organs would be if these were salable on the market. But is it plausible that adding the value of these organs to our estates will endanger our lives given that already our real estate, automobiles and many other assets are part of our estates? It makes no sense to dismiss Cohen’s proposal on such flimsy speculations.

Another intermediate measure, even more modest than Cohen’s idea, is to allow living people to sell rights to harvest their organs upon their deaths. That is, while I’m still prohibited from selling my kidney when I’m alive, I would be permitted to sell to you — or to a hospital, a medical insurer, anyone — the right to harvest my kidney (and other organs) upon my death.

Today we are all encouraged to become organ donors. But moral encouragement is all we get. How many more of us would sign up to become donors if we received some payment for our agreement while still alive?

Because no one knows what condition my body organs will be in when I die — and because I likely will not die until around 2040 — the prices that I would be able to fetch today for the rights to harvest my organs upon my death would be modest. My guess is that the future right to harvest my kidneys would fetch a price of no more than $200. Still, for $200 I am more likely to take the necessary steps to agree to become an organ donor than I am when the price I earn from taking such steps is $0.

Is there any reason to prohibit the sale of rights to harvest organs in the future?