Opening up the organ market

Posted: May 02, 2002 12:00 AM
What would be so terrible about getting a kidney from a vending machine? OK, maybe there's a lot that would be wrong, especially if you pulled the lever for a Baby Ruth and instead you got a kidney - which you really didn't want. But if you need a kidney, being able to get one easily and cheaply is a lot better than not being able to get one at all. Scientifically and socially, we're not at the point where we can get the body parts we need on demand, but we took a small step closer to that this week. The ethics committee of the American Society of Transplant Surgeons endorsed a pilot program that will permit the families of deceased donors to receive some small compensation for an organ donation. The move was made reluctantly, in the face of a longstanding organ shortage in the United States. As of this February, 79,523 people were on the waiting list for major organs, which is worse than this time last year. Meanwhile, only 22,593 organs were transplanted in 2001. A decade ago, there were only roughly 20,000 people on the waiting list. Meanwhile, experts agree that in the future, the demand for transplantable organs will only increase. In other words, it's a bad problem that promises only to get worse unless things change dramatically. Unfortunately, the change proposed by the transplant surgeons is not dramatic. The panel "was unanimously opposed to the exchange of money for cadaver donor organs," Francis Delmonico, a transplant surgeon and committee member told The Washington Post. Rather, a majority of the panel endorsed reimbursement "for funeral expenses or a charitable contribution as an ethical approach." In other words, you still can't buy a kidney from a dead person, let alone a live one. This is too bad. To date, the free market is still the best way to solve a shortage - at least without violence. Don't have enough bananas in your town? Well, just raise the price of bananas until it becomes worthwhile for someone to grow or ship more bananas to where you live. Have too many bananas? Well, the price lowers and pretty soon the oligarchs at the Organization of Banana Exporting Countries will turn down the banana spigots - or something like that. Why not do the same thing with pieces of liver (if you donate a piece of your liver, it will grow back) or with kidneys? Most of the anti-organ-market arguments fall into one of two categories: "that would be icky" or "but rich people will get kidneys exploiting poor people." The "icky" argument is actually the more understandable one. Many religions have serious taboos against the desecration or commodification of human body parts. Fair enough, to a point. It's funny. In the United States today there's a sizable and thriving market for all of the baby-making stuff: semen, eggs, wombs-for-rent, etc. It doesn't take a close student of the debates over stem cells or abortion to recognize that human reproduction is the most controversial area of medical ethics, fraught with taboo and heartfelt conviction on all sides. And yet, these markets flourish with little or no controversy. But it is still considered beyond the pale to sell a slice of your liver or an "extra" kidney. Besides, if you already believe it's OK to donate organs, what is so terrible about your family getting a few thousand dollars from an insurance company for your kidneys? If the money bothers you, tell your family to give it to charity. Which brings us to the "rich people" argument, which is really just another "icky" argument of a different stripe. Critics of organs for sale fear that creating an actual market for them will result in increasingly healthy rich people ghoulishly "exploiting" poor people. While I think it'd probably be OK for rich people to buy organs "direct from the dealer" as it were, I can see how political, ethical or legal considerations might make such an arrangement impractical. But paying donors needn't mean disproportionately rewarding rich people. We can keep the waiting lists as they are, if that's considered best. But, by paying donors - or the families of donors - we would be increasing the number of organs going to people in need, rich and poor alike. Besides, everyone else in the medical process gets paid, as the science reporter for Reason magazine, my friend Ronald Bailey, has pointed out. The doctors, nurses, lawyers and pharmaceutical companies all make money - very good money - off the dire needs of sick people. What is so horrible about the bereaved family of a brain-dead person getting paid, too? Once you accept that transplanting body parts is ethical, the emphasis should be on maximizing the number of organs available so long as everyone's wishes are respected. Don't think of a market as a way to make some people rich. Think of it as a way to make the system more efficient and therefore cheaper and more accessible to everyone. Organ vending machines are preferable to organ waiting lists. Hands down.