Free the Kidneys!

Former reason editor Virgina Postrel talks about her star turn in Drew Carey's latest reason.tv production on creating a market for organ transplants:

The video is excellent, even though all of us look pretty awful. The only thing I'd fault it for is not making the point that--I cannot say this often enough--EVEN IF EVERY SINGLE ELIGIBLE CADAVER KIDNEY WERE DONATED, THERE WOULD NOT BE ENOUGH. This shortage cannot be fixed by changing the law to override families' wishes and turning everyone who hasn't explicitly said no into a deceased donor. All that would do is sow further mistrust of the organ transplant system, particularly among (calling Barack Obama) already-suspicious African Americans.

Whole thing, well worth reading, here.

Senior Editor Kerry Howley asked "Who Owns Your Organs?" in 2006. Contributing Editor Julian Sanchez explored the morality of organ transplants in 2003. Science Correspondent Ronald Bailey made the case for selling human organs in 2001. James DeLong decried the federal government's mishandling of transplants in 1998. (UPDATE: Cato has also published a recent study on the subject.) And by popular demand, once again, here's Drew Carey:

Comments

[Fluffy]

Can you guys educate me on the numbers involved? Because it seems counterintuitive to me that if you harvested the kidneys from every single person who died, you still wouldn't have enough. Aren't there more people dying than there are people who need kidneys?

[anon.]

Fluffy,

Remember, the question is not how many people are dying, but how many people are dying with kidneys healthy enough for transplant, and close enough to a hospital that the kidneys can be removed in time for transplant.

[jj]

Organs can only be harvested in very specific cases. They have to be disease free, and the time of death has to occur shortly before the time of transplant. Also, even if "number of organs"="number of transplantees", there would not be enough organs, since the organ must match the transplantee or it will be rejected by his/her body. Not an easy thing to accomplish, as I understand it.

[Fluffy]

Wouldn't those facts tend to undermine the case for an organ market, then?

After all, if there just aren't enough organs to go around period, then creating an organ market won't correct the supply problem. It will just change the way the [insufficient] available organs are allocated.

It also seems like it would lead to poor allocation of the available organs. The supply/demand mismatch would inevitably lead to very high prices for the organs, and would make it likely that wealthy people would buy up organs that are poor matches out of desperation [on the slight chance their body won't reject the organ]. This would keep the organ from a less wealthy person who is a good match. If the organ ends up being rejected by the wealthy person's body, that organ is a total loss.

Don't get me wrong, I think there are still autonomy issues here [you own your body, as far as I am concerned, and should be able to decide what to do with its "parts" after you die]. But the advocates of an organ market often advance utilitarian arguments, too, and I don't see how those arguments can be made to work if there is no way for the organ supply to ever be adequate, no matter what market measures are taken.

[Cracker\'s Boy]

All of that aside, I am STILL looking for a pair of testicles to replace the ones my wife took from me. Someone? Anyone? Please?

CB

[Jake Boone]

After all, if there just aren't enough organs to go around period, then creating an organ market won't correct the supply problem.

Except that a living person can donate a single kidney and still lead a normal life. With a market for kidneys, many people who otherwise wouldn't bother having a kidney removed would consider it (who wants to miss work and go through surgery for nothing?).

Seems to me that can't help but increase the number of kidneys available, since X% of these potential living donors would otherwise die in ways that don't allow their kidneys to be harvested (eaten by bears, lost at sea, navel-piercing gone horribly wrong, etc.).

[R C Dean]

Wouldn't those facts tend to undermine the case for an organ market, then?

No, they support it, because when you have an acute shortage you need to apply every incentive to increase the supply.

[charlie]

All that would do is sow further mistrust of the organ transplant system, particularly among (calling Barack Obama) already-suspicious African Americans.

Did anyone else read this and go, "wtf?" Because only blacks are supposed to be suspicious of having their organs ripped out by the government when they die?

How "cosmopolitan" (sorry, can't help myself).

[John]

There is an economist, I believe at Harvard, called Alvin Roth who does a lot of work on markets (kidney trades specifically). He has done a lot to convince doctors that organ trading is a good thing. The concept of organ trading, however, raises an interesting point: how does "repugnance" affect the market? Roth gives an interesting lecture on this:
http://video.google.ca/videoplay?docid=8717497583686568676&q=al+roth+economics&total=6&start=0&num=10&so=0&type=search&plindex=1

[Brian Sorgatz]

But the advocates of an organ market often advance utilitarian arguments, too, and I don't see how those arguments can be made to work if there is no way for the organ supply to ever be adequate, no matter what market measures are taken.

It's not necessarily to make the situation perfect, but to make it significantly better. That's a strong enough argument in itself, I think.

[squarooticus]

All of that aside, I am STILL looking for a pair of testicles to replace the ones my wife took from me. Someone? Anyone? Please?

And I'm still waiting for someone to find this funny.

[Danny]

All of that aside, I am STILL looking for a pair of testicles to replace the ones my wife took from me. Someone? Anyone? Please?

"And I'm still waiting for someone to find this funny."

Sorry squarooticus. I am still young enough to find this funny. Maybe you lost yours so long ago that you don't remember what it's like not to have them?

[Click \'n\' Learn]

I'm pretty sure I already mentioned this, but I'll soon be offering a satire called something like "Inside Bombay's Bustling BodyPartsMarket". Perhaps I'll make it a condemnation, except the condemnation will be because the government is involved.

This will have been the second of my satires that have subsequently appeared in Reason as articles, both times with them being serious.

[joshua corning]

Wait a second did a libertarian give up her kidney to help a fellow human being!?!?!

Joe you are an asshole.

[Virginia Postrel]

Charlie raises a perfectly reasonable question. Obviously, there are plenty of white people (among others), who are suspicious of having their organs harvested against their will and possibly even before their deaths. That already-existing suspicion of the transplant system is all the more reason not to go to a "presumed consent" system.

But there are, in fact, both historical and contemporary reasons why blacks are more suspicious of the system than other Americans. In the late 19th and early 20th-century, for instance, southern medical schools were known as better places to learn anatomy than northern schools, because they had ready access to cadavers. Why? Because bodies could be swiped from black graveyards without fear of punishment. That's the sort of history that makes people angry and suspicious.

To take a more contemporary instance, states like California have made presumed consent the rule for taking tissue for sale from bodies subject to autopsies. This policy has especially alienated black and Hispanic families when they discovered that a loved one's corneas and other tissues (not transplantable organs) had been taken--and sold for profit--without their consent. That reaction may not be rational, and minority families may be unduly likely to take offense or attribute racial motivations where they don't exist, but these feelings are part of the realities that any good public policy must take into account.

"Presumed consent" sounds good in theory to many people. But aside from the fact that it wouldn't solve the kidney shortage, that policy isn't as benign as it first appears. What are the odds that there would be ongoing, high-profile campaigns to make sure that everyone knew how to forbid their organs from being taken? All the incentives are to keep the public ignorant and essentially declares people's organs state property.