The Volokh Conspiracy

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Organ transplants

A Vivid Description of the Needless Suffering Caused by Laws Banning Organ Markets

A recent Canadian Broadcasting Corporation article describes the travails of a man and his family who have waited eight years for a kidney transplant. Such needless pain could be eliminated by legalizing organ markets.


Every year, thousands of people in need of kidney transplants endure great suffering because there are not enough organs available to satisfy the demand.  They can survive—for a time—only by going through the difficult and time-consuming process of kidney dialysis A recent Canadian Broadcasting Corporation article effectively conveys the pain involved:

Blair Waldvogel wishes he didn't have to spend so much time in his basement. But if he doesn't, he'll die.

The 52-year-old Winnipeg father has been on Manitoba's kidney transplant list for the past eight years. His Type O blood means Blair can only receive a kidney from a Type O donor and he hasn't been able to find a match.

So, four days a week, Blair Waldvogel goes downstairs to the guest bedroom, hooks himself up to his home dialysis machine, and sits there for four hours while the machine cleans his blood.

"I never imagined I'd get to eight years," said Blair…..

If you include the time it takes to set up the machine and to clean up afterwards, Blair has spent the equivalent of 348 days in his basement on dialysis.

"There have been some scary, scary times along the way," said [Blair's wife] Irene. She has had to call paramedics more than once after Blair passed out in his dialysis room because his blood pressure dropped too low.

As the article describes, kidney dialysis makes it extremely difficult to continue to live a normal life. Blair Waldvogel, for example, has had to quit his job as the president of the North American recycling program for an international steel company. The article also correctly notes that many dialysis patients endure even greater suffering than the Waldvogel family. And, every year, thousands die because organs do not become available in time to save them. Indeed, Mr. Waldvogel is somewhat fortunate to have survived for eight years on kidney dialysis, because the average life expectancy of dialysis patients who cannot get a transplant is only 5-10 years. The case described in the CBC article is in Canada. But the situation in the United States is no better.

In addition to the pain endured by patients and their families, society loses as well, due to patients' reduced productivity and the enormous expense of dialysis treatment (much of it subsidized by federal and state governments).

Nearly all of this death, suffering, and waste could be eliminated if only the US and Canadian governments would legalize organ markets, thereby increasing the supply of kidneys. For reasons I summarized here, laws banning organ markets are the moral equivalent of actively killing innocent people:

The injustice of status quo policy is more than just a matter of failing to help people in need. It is the equivalent of actively killing them. Consider a situation where Bob needs to buy food in order to keep from starving. Producers are willing to sell him what he needs at market prices, but the federal government passes a law saying that it is illegal to sell food for a profit. Bob is only allowed to acquire such food as producers are willing to give him for free. If Bob starves as a result, the government is actively culpable for his death. It cannot claim that it was merely an innocent bystander who refused to help him in his time of need. The same point applies if the government (or anyone else) uses coercion to prevent people from selling organs that ESRD patients need to live.

Unlike in the case of food, it is unlikely that ESRD patients would buy what they need directly from sellers. Most likely, the actual purchases would be done by hospitals, health insurance companies, and other specialized enterprises, which could screen them for quality and then offer them to patients (as is the case with many other types of transplants and complex medical supplies). But that does not change the morality of the situation.

In the same post and elsewhere, I also addressed various standard objections to organ markets, such as claims that they will corrupt our morals by "commodifying" the body, and lead to unjust exploitation of the poor.

By legalizing organ markets, we can save thousands of lives and greatly curtail the kind of suffering now needlessly endured by the Waldvogel family and thousands of others. As an extra bonus, we can also increase economic productivity and reduce health care costs in the process. Few if any other policy reforms can achieve such enormous gains at so little cost.