Bring On the Organ Market

Why Obama should support the repeal of the National Organ Transplant Act

Bill Steigerwald | December 16, 2008

There's a beautiful thing President-elect Obama could do on his first day in office to prove he's serious about being an instrument of real change.

It'd be politically painless. He'd double-cross no special-interest group. He'd offend no important voting bloc. And he wouldn't have to create a new federal bureaucracy or spend $30 billion to make it happen.

With just the power of his oratory and his yet-untarnished moral authority, our new changer-in-chief could save 7,000 American lives a year, put an end to the physical and mental suffering of another 100,000 men, women and children, and save billions of dollars in unnecessary medical costs.

All he has to do on Jan. 20 is call for the repeal of the National Organ Transplant Act of 1984. That's the terrible federal law that criminalizes the buying and selling of human organs for transplant operations—and therefore makes it a virtual certainty that the supply of kidneys, livers, and hearts will never meet our demand for them.

Justifications for prohibiting the trade in major human body parts—including that the world's poor will be forced into selling their children's organs to Westerners or people will be kidnapped and have their organs harvested—are largely irrational, exaggerated, or bogus, as an Oct. 11 article in The Economist magazine pointed out.

Meanwhile, the "moral" arguments of the ivory-towered medical ethicists, who think treating human body parts like a commercial commodity is an indignity that trumps saving lives, are indefensible. So is the position of the National Kidney Foundation, which recently lobbied against a bill that would have permitted the mere testing of financial incentives.

The bad news is that more and more patients need organs and legal sources in the United States—altruistic donors, family members, and cadavers—can't possibly keep up. About 74,000 Americans were on waiting lists last year for kidneys alone; about 4,300 (12 a day) died waiting; in 2005, 341,000 Americans were on dialysis at a total cost to Medicare of $21 billion; living donors totaled 6,000 while 7,400 people allowed their organs to be used after they died.

The good news is that, as The Economist reported, doctors, patient groups, and politicians around the world are coming to realize that paying for organs is the only practical and ethical solution. Israel, for example, now allows donors to be paid about $1,500 for lost work time and recuperation.

No one expects Obama to start reading old Cato Institute position papers on how the free-market could provide all the human spare parts the world needs. But he might want to pick up When Altruism Isn't Enough, the new book edited by Sally Satel, a psychiatrist and a kidney transplant recipient.

With contributions from physicians, legal scholars, economists, and philosophers, Satel's book spells out how to design a safe, ethical, affordable, and practical government-regulated system for rewarding individuals for donating their organs to strangers. She also makes the ethical case that we have a moral imperative to do so.

Obama should have Satel's book on his presidential nightstand. And if he wants to know how a market for transplant organs might work in practice, he can call up the leaders of the only country on the planet where donating organs for money is officially sanctioned.

That progressive land—where today there is no waiting list for kidneys, where dying citizens do not have to go abroad to get a transplant, and where since 1988 kidneys have been traded freely—is Iran.

Bill Steigerwald is an associate editor at the Pittsburgh Tribune-Review. This article originally appeared in the Pittsburgh Tribune-Review.

Comments

|12.16.08 @ 4:32PM|#

Is there any sentence that begins "There's a beautiful thing President-elect Obama could do" that shouldn't be followed by:

Ain't. Gonna. Happen.

Just askin', is all.

JCoke|12.16.08 @ 4:36PM|#

I think it would be very politically painful, but thats just me

Warty|12.16.08 @ 4:44PM|#

Bill Steigerwald is the main reason why the Pittsburgh Tribune-Review is worth reading.

Warty|12.16.08 @ 4:47PM|#

Possibly the only reason.

Erm|12.16.08 @ 4:51PM|#

I mostly skimmed, but ...

Would it have put him over his word count to explain how the Economist debunked the arguments. I don't doubt that they did, but who will be swayed by, "this magazine says ...?" Did he even name the article(s)?

Maybe he could have pointed to the studies that econometrically disproved the objections.

I like the cut of his jib, but I don't think this is well argued.

Erm|12.16.08 @ 4:55PM|#

And I don't see where he's going with his last argument. If opponents view this is as heartless, hypercapitalist exploitation, why would you point to a country known for heartless exploitation as your example?

OTOH, if the objection is that the policy is overly radical, liberal, etc., then it works, I guess.

|12.16.08 @ 4:58PM|#

Dee: All right, where'd you get the human meat from, Frank?

Frank: I got a guy.

Dee: You got a guy?

Charlie: Uh, you got a human meat guy?

Frank: I got a guy for everything, Charlie.

Lefiti|12.16.08 @ 5:02PM|#

The Market, the Market, the Market

The Market can do no wrong

Ding dong dong
Ding dong dong

Head|12.16.08 @ 5:28PM|#

I'll make a market in the number of Lifiti's sexual encounters. Offered at 1.

|12.16.08 @ 5:34PM|#

Yes, the market can solve many problems and this might be one of them. However....(there's always a however) I would go along with this only if there were the equivalent of a "birth certificate" for human parts, with the notarized signatures of the donor and doctor who removed the organ. And no "Obama style" certificates, either.

To do less and you'd be down the slippery path the Chinese Communist Party has taken where they illegally harvest the organs of political prisoners like those of the Falun Gong. You can find the report here:

http://organharvestinvestigation.net/

|12.16.08 @ 5:34PM|#

Hey, let's combine legalization of organ donation with legalization of assisted suicide! Just imagine the business opportunities!

"Look, your Mom is going to die in a few months, anyway. She can either spend down your inheritance keeping him alive, or you can keep the inheritance PLUS an extra $50,000 from harvesting her good organs."

"Mom.... let's talk."

|12.16.08 @ 5:51PM|#

Which statement is more wrong?

(1) The market can do no wrong, or
(2) The government can do no wrong.

Discuss amongst yourselves.

MAX HATS|12.16.08 @ 5:56PM|#

Obama not a libertarian, never claimed to be. Shock, awe, mock disappointment. Cue concern trolling.

|12.16.08 @ 6:08PM|#

However....(there's always a however) I would go along with this only if there were the equivalent of a "birth certificate" for human parts, with the notarized signatures of the donor and doctor who removed the organ. And no "Obama style" certificates, either.

No problem. A good chain of title is completely consistent with a market in anything, including organs.

Lefiti|12.16.08 @ 6:09PM|#

Hey, the number is a lot bigger than one! Sheep count, right?

|12.16.08 @ 6:09PM|#

Hey, let's combine legalization of organ donation with legalization of assisted suicide! Just imagine the business opportunities!

I got no problem with that, as long as we police, and maybe even beef up, the requirement for informed consent. Also completely consistent with libertarian principles.

|12.16.08 @ 6:11PM|#

Hey, let's combine legalization of organ donation with legalization of assisted suicide! Just imagine the business opportunities!

"Look, your Mom is going to die in a few months, anyway. She can either spend down your inheritance keeping him alive, or you can keep the inheritance PLUS an extra $50,000 from harvesting her good organs."

"Mom.... let's talk."

You make it sound like that would be a bad thing. I'm not convinced that is true.

It did remind me of this story though.

Published: March 29, 1984

Elderly people who are terminally ill have a ''duty to die and get out of the way'' instead of trying to prolong their lives by artificial means, Gov. Richard D. Lamm of Colorado said Tuesday.

Erm|12.16.08 @ 6:12PM|#

Is Lefiti debating the premise that supply rises when the price rises? Really?

Look -- stumbling into every thread and blurting our, "markets don't work," like some kind of economics-denial Tourette's patient doesn't make you look sophisticated. We can debate whether a particular solution is best solved by harnessing market forces (many are), but you're not debating. You're wallowing in your ignorance and unreasonableness as though you're truly proud of your shallow obtuseness.

|12.16.08 @ 6:13PM|#

The government will give us organlegging and the death penalty (with organ-harvesting) for minor offenses. Or so I've read.

tarran|12.16.08 @ 10:24PM|#

Pro Libertate

Don't forget corruption. Remember how they harvested Naomi Mitchison's legs while her appeal was pending because some politically connected woman had had an accident and the Lunar government wanted to come up with replacement limbs quickly?

|12.16.08 @ 11:03PM|#

Obama should have Satel's book on his presidential nightstand.

Isn't his nightstand already groaning under the weight of a thousand FDR books telling him how to use a cigarette holder properly and get away with court packing?

Seriously, I will never understand how the pro-choice party can be so anti-choice when it comes to this issue.

emerson|12.16.08 @ 11:36PM|#

Bravo, Bill Steigerwald. This is one of the great undiscussed tragedies of our lifetime.

For a great podcast on this topic, here's Richard Epstein and Russ Roberts on Econtalk:
www.econtalk.org/archives/_featuring/richard_epstein

MJ|12.17.08 @ 7:37AM|#

"There's a beautiful thing President-elect Obama could do on his first day in office to prove he's serious about being an instrument of real change."

Is there anything more pathetic than a political pundit trying push off his own personal policy preferences on a popular political figure? Has Obama given any indication that he favors a market in organs? That Obama's overall philosophy would suggest he would even be open to such a policy?

This is notjusding an open market in organs is unworthy in and of itself, but that writing this kind of piece is.

Pointing out that Iran is currently the only country that does this is not a positive. Steigerwald needs some pointers on how to make a sale.

Dave Undis|12.17.08 @ 8:59AM|#

As the death toll from the organ shortage mounts, public opinion will eventually support an organ market. Changes in public policy will then follow.

In the mean time, there is an already-legal way to put a big dent in the organ shortage -- allocate donated organs first to people who have agreed to donate their own organs when they die. UNOS, which manages the national organ allocation system, has the power to make this simple policy change. No legislative action is required.

Americans who want to donate their organs to other registered organ donors don't have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. Non-donors should go to the back of the waiting list as long as there is a shortage of organs.

SLO|12.18.08 @ 3:37PM|#

Epi-

Just saw that episode last week. Hilarious!

|12.19.08 @ 7:00PM|#

Saving 100,000 Lives, $100 Billion, and Righting an Injustice: NOTA should be repealed.

The National Organ Transplant Act (NOTA) prohibition of selling organs and tissue is against the public interest by: a)criminalizing otherwise law abiding citizens when seeking to save their own lives; b)preventing willing sellers from receiving life-changing financial benefits at negligible medical risk; and c) by denying the deceased the opportunity to bequeath a final gift to their families - lifesaving organs for life changing sums of money.

The public's economic interests strongly favor a market mechanism making more organs available to critically ill and dying people, particularly those in need of kidneys. Few taxpayers are aware they support each dialysis patient for an average of 7 years at an average of $512,000 per year per patient, costing $3.6 million per patient. The average cost for a kidney transplant is estimated at $100,000 including 2 years of immunosuppressant medications. With 217,000 people on kidney dialysis, the cost savings to society approach $100 billion per year; and the quality of life improvement for the recipient is priceless.

Even if the donor is paid $1 million for a kidney, the total cost for a new kidney is a fraction of the cost of dialysis.