Organ Trading Is Not So Weird

Personal Health

Something unusual happened to me. I wrote an op-ed for the New York Post and nobody wrote to tell me they disagreed. Yet the policies I am arguing for are certainly not the norm. I argued in favor of incentives to promote organ donations.

I suggested that last week's news of the allegation that a surgeon in California brought about the premature death of a patient to harvest an organ shouldn't be such a surprise. With the outrageously long wait for donated organs, something had to give.

The statistics are overwhelming. Yet there seems to be a certain complacency about them. Some 96,825 patients are waiting for an organ donation in the United States, according to the United Network for Organ Sharing. In 2002, more than 6,000 people died during their wait. Consider the attention the media gives to trapped miners or a grisly murder case. And we are all gripped by the sad loss of perhaps fewer than a dozen lives in the bridge collapse. All tragic, but minor in scale compared to the 6,000 or so dying each year for lack of organs. Sure, these examples are all different in their own way. But if we share the goal to reduce the number of premature death, perhaps we can make the most gains (and, dare I say, for the least amount of money) by making a dent in the organ shortage crisis.

Unless you're lucky enough to have a relative or some other highly motivated and altruistic donor, there is no legal way to improve your chances in the painfully slow race against death.

The shortage of organs available for donation from unrelated donors has led to the macabre black market that exists today. National Geographic reports that a poor neighborhood in India is known as "Kidney Village," since residents illegally sell their kidneys for about $800, far less than the $100,000 that some recipients have been willing to pay. A whole new industry, transplant tourism, has emerged to meet the needs of the wealthy patients creating demand.

Current patients face a choice between two extremes: Wait for a fundamentally broken system and risk death, or venture into the unregulated Wild West of the black market for organs. But there is a better and more ethical alternative.

We don't need to delve too deeply into the black market to see that donated (or purchased) organs have a high value to potential recipients. Yet, because of the ban on incentives for donations, a familiar economic principle comes into play: Whenever a product's price is held below market demand, a shortage quickly ensues. Despite campaigns to increase altruistic donations, organ donations are basically stagnant.

As George Mason University economics professor Alex Tabarrok has argued, the status quo is no more ethical than exploring new approaches, even if we can't foresee all the downsides of those new approaches. There are many innovative plans that could help shorten the line for an organ -- and they do a better job than the current system of taking incentives into account.

As Tabarrok's colleague, Tyler Cowen, argues in his new book, Discover Your Inner Economist, incentives work -- and they can take forms other than cash. For instance, Tabarrok describes the "no give, no take" idea floated in Israel, which (with some exceptions) would allow only those who sign their donor card (or their relatives and friends) to receive a donated organ.

I argued in the Post that "a regulated system that creates incentives for donors, whatever those incentives may be, would save lives, reduce the shortages that promote the black market, and level the playing field, by helping all potential recipients, not just those who can afford a trip to Kidney Village."

Organ donations are not the only area where society seems to be squeamish about offering incentives. As I've written in this space previously, blood centers place limits on the offering of incentives for blood donations, even as they warn of perennial shortages.

There are signs of progress, which I will address in more detail in a future column. One bright example is an organization called LifeSharers. Executive Director David Undis explains that anyone who joins LifeSharers and agrees to offer his organs to other members after he dies "gets preferred access to the organs of other members." This is a small step in the right direction.

Should there be limits on what incentives should be permitted? If we allow the gift of an organ, why not allow a regulated system that would allow for flat-out payment for an organ?

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