Whose Organs Are They, Anyway?

Morality and the transplant system

Julian Sanchez | June 26, 2003

(Page 2 of 2)

The strength and uniformity of opposition to LifeSharers becomes more mysterious in light of the transplant community's attitude toward other, apparently quite similar programs. UNOS already has a system of rewards in place for living donors. Their organ allocation formula gives four extra "points" to potential recipients who have donated organs themselves, a preference that amounts to a four year reduction in the average waiting time for an organ. UNOS has even created local variances in its allocation policy for programs like the New England Medical Center's Hope through Sharing, which allows living donors to designate friends or relatives to be moved up on the waiting list. Despite his objection to organ "commodification" and to judging the behavior or character of organ recipients, Joralemon acknowledges that such programs are, in essence, a reward for the risk undergone by living donors.

There is no comparable incentive in the official system for post-mortem donation, despite the fact that deceased or "cadaveric" donors are arguably an even more important source of organs. A single body can provide organs for transplant into many patients, and certain organs, such as lungs and hearts, obviously cannot be obtained from living donors. In 2002, 6,182 cadaveric donors, just under half of all donors, provided organs for 18,281 transplants, or almost three-quarters of the total performed. Yet less than half of the recently deceased whose organs could be transplanted actually become donors, despite the fact that post-mortem donation is essentially costless (except perhaps for those who harbor religious objections to transplantation).

Oddly, the same arguments UNOS now rejects as justifications for LifeSharers have in the past been employed by UNOS itself. In 1998, Dr. Lawrence G. Hunsicker, then president of UNOS, testified before Congress opposing a regulation that would end preferences for local recipients in organ allocation. Among his arguments, Hunsicker cited concerns that organ donations would decline if donors thought their organs would be more likely to get shipped across the country than transplanted to sick people in their own communities.

Hunsicker quoted several doctors to this effect, such as Steven Rudich of the University of California at Davis in Sacramento, who was "absolutely convinced that if organs are allocated away from Sacramento to larger metropolitan areas, organ donation would be severely compromised." In short, UNOS was willing to allow geography, a morally arbitrary factor if ever there was one, to play a role in allocation, at least in part because it was believed that this would boost donation rates.

Ultimately, it is hard to avoid a suspicion that part of the hostility toward LifeSharers stems from a sense that amateur interlopers are encroaching on the medical experts' territory. McGee, who was surprised by the number of people who "were made very, very uncomfortable by any criticism of the existing transplant system," says that "so many people have gotten so attached to the current system just because to create a new one would create massive cognitive dissonance." As UNOS spokesperson Annie Moore put it, "Lifesharers has created their own system, and they're doing it themselves. They're not acting within the system."

In a world increasingly characterized by the triumph of markets over central planning, the allocation of organs remains a command economy. Who can blame the planners for resenting the first entrepreneurs?