Sunday, July 08, 2007

Helpful writing

As of June 11, 2007, at 8:04 pm Eastern Daylight Time, there were 96,724 Waiting List Candidates for organ transplant. Up to that day, doctors have performed 6788 successful transplants in 2007. Add the numbers together; in 2007 103,512 live people needed transplants and 6.5% got them.1  Since approximately 6000 patients die each year awaiting transplant, estimate another 3000 expectant transplant patients died and fell off the waiting list in the first half of the year.2   On the kidney transplant list alone, 18 people die each day, awaiting a donation that never came.3

For the transplant recipient who heads up the National Kidney Foundation, Mr Charles B. Fruit, the difference between the donors available for the patients in need is not worrisome because the Foundation is working to correct the gap. “The foundation is working to attack the organ shortage through improvement in organ-donation education for families and the establishment of standards to ensure the health and safety of living donors. A wholesale sellout to the law of supply and demand is not the answer.” Further, Mr Fruit asserted that a market based solution to procuring more kidneys for donors would be as bad for consumers as the gasoline market. “We moralists can only pray that his proposed market mechanism for the transaction of hearts, lungs, kidneys and other life-saving human organs would work a little better than it does for the nation's consumers of gasoline.”4  It is telling that Mr Fruit castigates the gasoline market as an example not to emulate, while the truth is that anyone in the US who needs gasoline can buy it, although at a price that some might call excessive.

Notwithstanding Mr Fruit’s revulsion at the idea of a market for organs, the current system is failing those who need the lifesaving assistance a donated organ can provide. The United States has more than 300 million people. The fact that the current system of donating organs can only muster enough for around 13,000 surgeries a year actually compares quite unfavorably to the gasoline market Mr Fruit disparages. As Jack Copeland pointed out, “during the last 20 years, a variety of approaches have been tried to improve the numbers of donated organs in this country. We’ve tried television and radio advertising, educational programs, and driver’s license declarations. But they’re not working.”5

Clearly, another approach to acquiring needed organs is required in order to give some hope to the thousands of terminally ill patients who languish on organ donation waiting lists. Richard Epstein, the James Parker Hall Distinguished Service Professor of Law at the University of Chicago, recently proposed that there be established a market for organs. His argument is basic supply and demand: since the current price for donated organs is set by law at zero, there is infinite demand for organs and almost no supply of the healthiest, most desirable organs. Consequently, a huge waiting list has grown up, and that backlog is managed quite inefficiently by favoritism, blind luck, and is some cases, corruption. Since he is legally prohibited from experimenting with supply and demand to prove his thesis, he has to rely solely on something else. “So, we must resort to theory, which predicts that an increase in price will lead to an increase in supply, for organs as for any other good or service. It is not the case that everyone will jump from the rafters to donate -- but in a nation of 300 million people, it should be possible to induce 70,000 healthy donors to part with a kidney.”6

This argument was not persuasive to David J. Rothman, PhD of the Center for the Study of Society and Medicine, College of Physicians and Surgeons of Columbia University. Dr Rothman argued that a market in organs would lead to wild disparities between the recipients and the organ brokers who would reap disproportionate benefits and the donors who would get a relatively modest financial gain at the cost of part or all of an actual organ with potential adverse effects on the donor’s health. “Sale of organs is a zero sum game in which any advantage one participant necessarily leads to disadvantage of one or more of the others.”7

Those against an organ market are concerned about the potential of exploiting vulnerable populations who might be pressured to sell an organ. Ironically, in an actual market situation, recipients could be more choosy about who they would buy kidneys from. These recipients would bid up the price on kidneys from healthy donors with good lifestyle habits, a condition that would give both the donor and the recipient a better chance at survival. Healthy donors would be well compensated monetarily and would likely retain their health, making it unlikely that anyone would be “exploited.” Additionally, since the paid donors would be healthier, it is likely that the overall mortality rate from multiple surgeries required would go down. “They're not going to go up, and, in many cases, my guess is is that the [mortality} numbers will actually be lower because if you get a purchase population, you're probably going to get a healthier stock giving than you will in the family situations, where a husband or a wife may give a kidney to a child, even though he or she may not be the perfect donor.”8

While we may recoil initially from the idea of selling organs for transplant, the long waits that are literally killing people who could otherwise be helped by a functioning organ market, mean that the idea must be considered. The objections that have been raised by some ethicists are based on the lurid practices in some countries with anemic medical regulatory regimes. In a Western Country with a history of functioning markets, the highest standards of medical practice and the protection of a legal system that enforces contracts, there seems little likelihood of exploitation. On the contrary, the profit motive in working markets that bring all manner of goods to the American consumer should be trusted to do the same for the lifesaving goods of transplanted organs.

1  United Network for Organ Sharing (UNOS)Main Page;; accessed 11 June 2007.
2  Brian Handwerk, “Organ Shortage Fuels Illicit Trade in Human Parts.” National Geographic. January 16, 2004., accessed 11 June 2007.
3  Richard Epstein, Kidney Beancounters. Wall Street Journal. May 15, 2006; Page A15
4  Charles B. Fruit. National Kidney Foundation Position on Payment for Organ Donation Makes News. National Kidney Foundation Website. June 2. 2006 accessed 11 June 2007.
5  Jack Copeland, “We Should Pay for Donor Hearts.” Arizona Alumnus Magazine. Spring 2003., accessed 11 June 2007.
6  Epstein.
7  David J. Rothman, PhD. “Ethical and Social Consequences of Selling a Kidney.” Journal of the American Medical Association, October 2, 2002, pg 1641.
8  Richard Epstein and Russ Roberts. “The Economics of Organ Donations.” Library of Economics and Liberty. Podcast Transcript June 5, 2006. accessed 11 June 2007