Reprinted by permission of The Washington Times
2 October 1997
There are currently about 45,000 people waiting for a human organ transplant. About 3,000 of them will die on that waiting list because a suitable transplant organ will not become available in time.
The short supply of organs has recently led to some overt attempts to ration them in a way that would be more beneficial to society. For example, the United Network for Organ Sharing has altered its guidelines for those needing a liver transplant so that those with acute liver problems get priority. Those with a chronic liver condition like hepatitis or cirrhosis (which could be the result of alcohol abuse) cannot rise above the second level in priority status.
The legislature in the state of Washington recently passed a measure - which the governor vetoed for being too vague - that would prohibit those on Death Row from receiving "lifesaving health care procedures" such as an organ transplant.
Now the Cleveland Clinic is being accused of removing organs before some patients are legally dead.
Instead of looking for new ways to ration organs or take them prematurely, we should ask how we can increase the supply of organs so that doctors are not forced to decide who lives and who dies.
The answer is to compensate donors for their organs. Unfortunately, doing so is currently against the law. That's because the National Organ Transplant Act (1984) prohibits "any person to knowingly acquire, receive or otherwise transfer any human organ for valuable consideration for use in human transplantation." As a result, altruism is the only legal motive for individuals or their surrogates to donate their organs.
But while altruism is a noble motive, it is seldom a compelling one. Economic theory clearly recognizes that when demand for a good or service is high, its price will increase until the supply and demand reach an equilibrium. If the price is prohibited from rising, a shortage will occur because people will not provide a product when the price is too low. Thus, permitting donors to receive some type of compensation for their organs would help alleviate our organ-shortage problem.
Opponents of a market for organs immediately conjure up images of strange people selling off body parts. But a market for organs could develop in a number of ways: Some would be more open and direct, while others might be indirect and incorporate the concerns of some of those who oppose compensation.
We could, for example, permit a donor pool. Dr. Robert M. Sade, a surgeon and professor of medicine at the Medical University of South Carolina, and his colleagues have proposed creating an in-kind market for organs. Every adult would be given the option of joining the Transplant Recipient and Donor Organization. Membership would require permission to have your organs removed at death, and only those joining would be permitted to receive a transplanted organ. Those who chose not to join would be electing for standard medical care, short of transplantation. Thus, the only way to receive an organ while living would be to have given permission to have your organs taken at death.
Permit people to receive after-death compensation. A person wanting to become an organ donor would simply contract with an organ-donor organization, which would compensate the deceased's estate for each organ successfully harvested. The compensation could be in a variety of forms. A hospital or organ-donor network might pay part or all of a donor's burial expenses, for example. Such a provision might encourage lower-income people who could not afford life insurance to sign up for the program as a way to provide for their funeral costs. (A similar provision has been supported by an article in the Journal of the American Medical Association.)
Or contribute funds to the donor's designated charity - a hospital, university or social services agency. Let people sell whatever they want, when they want. The most open and market-oriented approach would be to let anyone who wanted to sell one or more organs do so. Thus, if someone needed a kidney and was willing to pay for one, a compatible donor could provide the recipient with a kidney for the market-set price.
A variation on this proposal would let people sell their organs now at a discounted price for harvesting after death.
There are obvious dangers in this approach that would need more thought before it is adopted. The pressures on people unable to make knowledgeable decisions might be prohibitive.
The point is, there are ways to encourage people to donate their organs to help others live. These mechanisms would increase the supply of organs, the waiting lines and needless deaths would decrease if not disappear, and donors and recipients would have more choices.
While opponents to these proposals want more organs, they don't want a market for organs. Paternalistically, they impose their values on everyone else. And with regard to organ availability, while paternalism lives, people die.
Pete du Pont, former governor of Delaware, is policy chairman for the National Center for Policy Analysis.