Dying People Shouldn't Have to be Beggars

It's time to consider the economics of organ transplants

It is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner, but from their regard to their own interest. … Nobody but a beggar chooses to depend chiefly upon the benevolence of his fellow-citizens.—Adam Smith, The Wealth of Nations

Consider the economics of an organ transplant. Everyone involved gets something of value. The doctors and nurses are paid. The hospital receives money. The organ recipient gets something that will save her life. And the person donating the organ gets a nice, warm feeling inside.

We can all admire the selflessness of the donor. But if pure altruism is such a wonderful motivator, why don't we rely on it to get medical professionals to provide their services?

Simple: Because we would find that there are far more people demanding free care than people supplying it. To make sure that we can obtain the treatments we need, we elect to pay, not hope. It's too important to rely on altruism.

Our approach changes, though, when it comes to procuring kidneys and livers. In fact, since 1984, it has been illegal to pay someone to surrender a body part, even posthumously. Campaigns to browbeat Americans into signing organ donor cards, however, haven't sufficed. The transplant organ shortage has grown.

Since 1989, kidney donations have doubled. But the number of patients in need of them is five times higher than it was then. Last year, 4,456 people died while waiting for a kidney transplant. The story with livers follows the same line.

Among the losers from this guaranteed-shortage policy are victims of cancer and other lethal diseases who need bone marrow transplants. Some of them have filed a lawsuit, which goes to court in Los Angeles this week, asking to be allowed to offer compensation to donors—which is now a felony punishable by five years in prison.

One of the people involved in the lawsuit is Doreen Flynn of Lewiston, Maine, a single mother with five kids—including three afflicted with a rare, fatal blood disease that can be cured only with a bone marrow transplant.

The ban is particularly indefensible in this realm. Someone giving up a kidney loses an important organ for good. But bone marrow donors produce new marrow to replace what is lost. Given that it's legal under federal law to buy and sell blood and sperm, why is bone marrow treated differently?

Monetary incentives would offset the downside of letting strangers perforate your flesh with sharp instruments. Someone who provides marrow has to go through a longer and less enjoyable process than supplying blood or sperm.

Typically, marrow donors have to get injections for five straight days. They then undergo a blood-collection process that takes three hours and sometimes has to be repeated.

Often, donors are anesthetized so a needle can be inserted into a hip bone. In that case, says the American Society of Clinical Oncology, they may need a week to fully recover.

Donating is not an excruciating experience, but it's unpleasant and time-consuming enough that about the only people who do it are those with a strong motive (say, a friend or relative in need).

One result is that one of every three volunteers matched to a recipient backs out, leaving the patient high and dry. According to the Institute for Justice, which is handling the case, 1,000 people die each year for lack of a suitable marrow donor.

If Americans could be paid for bone marrow, more would step forward. Nobel Prize-winning economist Gary Becker of the University of Chicago, in a 2007 paper written with Julio Jorge Elias of the State University of New York at Buffalo, figured the kidney shortage could be eliminated for $15,000 per organ.

That's not much, considering that it means the difference between living and dying. It would add only 10 percent to the total cost of a transplant.

The fee would be much lower for bone marrow, simply because the donor can quickly regenerate what is lost. In the California lawsuit, the plaintiffs only want to be able to try offering compensation in the form of a scholarship, a housing allowance or a gift to a designated charity.

There is certainly no better option on the horizon. The benevolence of our fellow citizens can be striking. But it's not something to bet your life on.

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