This is the second in a series of posts which will explain my positions on various social and political issues. These posts will appear infrequently.
Almost everyone knows the statistics concerning organ donations for transplants, and if you don’t know the numbers, you more than likely at least know that the demand for transplant organs vastly outnumbers the supply. Health professionals have been trying for years to get more people to donate organs to those in need with dismal results. As this is going on, nearly 6,000 people a year (17 each day) die in the US while waiting for an organ transplant. 6,000. Understandably, that number scares the hell out of me.
Currently, the United network for Organ Sharing (UNOS) is in charge of dispersing available transplant organs to waiting patients. If a person decides to become a living donor, there are many conditions they must agree to, including the following:
Disclosure that donors may not receive valuable consideration (including without limitation monetary or material gain) for agreeing to be a donor. In certain cases, donors may be reimbursed for limited travel expenses and may receive subsistence assistance.
This means, of course, that a donor may not donate his organ if he is being paid to do so, regardless of the circumstances. This strikes me as unfair, because every other person concerned with an organ transplant gets paid or receives valuable consideration. The doctors, nurses, clinic workers, dietitians, and counselors all receive payment, and the recipient receives the organ. However, apparently the donor is only allowed to donate if he is doing it out of the kindness of his heart. This doesn’t make any sense; why shouldn’t the donor get something for his efforts?
Lloyd Cohen is a law professor who agrees. He is featured in this week’s Newsweek in an article called Are Kidneys a Commodity?
Give Cohen credit; he’s thought through the unsettling implications of this idea in 21st-century America: the Internet auctions, the reality-TV shows (”American Kidney”? “Survivor: Dialysis”?), legal battles over custody of a kid on life support. That’s the price society would have to pay for the goal of getting more kidneys into people. As for the ethical objection that poor people shouldn’t be tempted into selling spare body parts for cash, running a small but measurable risk to their health, he suggests a comparison with other valued commodities that are dangerous to obtain, like tuna fish. People risk their lives on fishing boats because they’re paid for it. By the same token, says Sally Satel, a resident scholar at the American Enterprise Institute who debated on Cohen’s team at the IQ2 U.S. event, “we don’t think firemen are any less heroic because they are paid to save us.”
Simply put, there is no relevant reason to prevent donors for receiving payment for their organ donation, and every reason to allow it. Obviously, if donors were paid there would be more organs available for transplant, which would save more lives. However, I don’t agree with Cohen completely. His vision is that a person willing to donate should be able to sell his organ to the highest bidder for whatever price the market will bear. I wouldn’t want to allow this; it is what would draw out all of the worst-case scenarios that the people against paid donation fear. Rather, I would have a board of transplant experts come up with a fee schedule which would authorize a specific amount for a particular organ. Also, to ensure that not only wealthy people could have access to these organs, the fee would be paid by insurance (including Medicare/Medicade). Setting a specific payment amount for each organ does a few things: it prevents bidding wars between those who need the organs, it prevents price gouging by those offering the organs, and having the insurance company handle the payment ensures that the donors will get paid after the transplant has been performed.
I am sure there are people out there who probably think I have fallen off the rocking chair on this one. How can you put a price on human organs? How can you tempt poor people like that? All I can say is that just because a person is poor doesn’t make them stupid. Also, the current regulations regarding donor health would continue to be enforced, which means if you aren’t healthy enough to donate, it doesn’t matter who you are, you can’t donate. Frankly, all I see with this proposal is the upside, which is more organs available for transplants and more recipients being given a new lease on life.
Some of you will say that I am unavoidably biased in this matter. YES I AM. I’ll be completing my fourth year on the transplant list, and according to the transplant hospital my name isn’t even popping up in the top 100 list when a suitable organ becomes available. I might start showing up in year or two, or maybe longer. It just depends on who else is in the computer whenever a particular organ becomes available. Something to remember about the transplant list is that it doesn’t really exist as a list. It is more like a database of people, blood types, organs, and amounts of time on the list. Whenever an organ becomes available, they put in the pertinent information and run it against the database to see who the best match is. Joe Blow might show up as number two for organ A, and then show up as number eight for organ B. Just because you show up as number 2 for a particular organ doesn’t mean that you’re next. This is why a lot of us try and forget about “the list” and just live our life. If you spend too much time trying to figure out where you are on the list you’re likely to go into a depression that you’ll never recover from.
Ladies and gentlemen, paid organ donation is an idea whose time has come.
May 22nd, 2008 at 5:54 pm
I admit that I have not studied this issue in depth, but on first glance I would say that your idea is very reasonable and one that I would support.
And not to make light of the issue, but I can’t resist pointing out that you are conceding here that an unfettered free market would not be a good thing in this situation and you are essentially supporting big government regulation.
May 22nd, 2008 at 6:28 pm
Mostly, I agree.
But about that price set by some authority or other, I would put it as an optional path providing some other benefit: many years ago I gave blood, which I would have done anyway, but the hospital in return (and not because I asked, it was a standard part of the paperwork) contracted not to charge for up to six pints of blood I might need in the next eighteen months. Something on this order - donate a kidney, and if one of your organs fails in the next three years get 50% off hospital and doctor costs.
Why? Because set prices are at wide variance with market, even when supposedly tied to the market: think of property taxes on your home (if you “own” it along with the bank) which are often set as a percentage of some mythical “market” value or government “assessed value” which bears no relation to what any Realtor would say is what it could sell for. There are communities which realise their values are so badly out of date that, rather than pay for re-evaluating, they simply set the taxable percentage to an also-arbitrary 125% or more.
And who sells their house for what they were taxed?
May 23rd, 2008 at 4:18 pm
Mike, for almost everything the free market is the best way to regulate anything. However, in this case, the need for an organ is not voluntary in nature so the demand for organs is not due to market forces. Basically, the need for an organ is forced upon people due to an illness. Given this, I do not think it appropriate to allow the normal market forces to drive the prices for organs. In a normal market, if the price gets too high or unreasonable, people can curb the demand to bring prices down. Not so with organs; once you need one, you have to get it. Therefore, some sort of price control is necessary in order to ensure availability for the widest spectrum of people.
Also, I never suggested that the government run this operation; I think UNOS could continue to run things in conjunction with the insurance industry.
May 23rd, 2008 at 4:24 pm
teqjack:
I wouldn’t tie the amount of the fee for donation to any type of market force. Also, the fee is not based on the perceived “value” of the organ in question. After all, the gift of life is beyond value or price.
Rather, the fee would more than likely be an arbitrary determination of what the proper compensation for someone donating an organ should be. They may take such things as lost wages, inconvenience, and whether or not the donor has a rare blood type into consideration.
Imperfect, but a whole lot better than what we have now.
May 24th, 2008 at 2:13 pm
So the free market is OK for everything except this one case that happens to directly impact you?? Come on, Nick. Plus, there are lots of other examples of things that we need and can’t do without. Healthcare in general tends to be like that. If I break my arm, I NEED to get it fixed. I can’t voluntarily choose not to. If I get sick I NEED certain medicines. And so on. And so on.
If unfettered market forces aren’t good for organ donation, why would they be so for these other examples?
And as for UNOS running things seperate from the government, aren’t you aware that they are simply a contractor for OPTN which was established by the Congress in 1984? Don’t fool yourself into thinking this is all free market stuff with no government oversight and regulation. It’s not.
May 30th, 2008 at 9:45 pm
I don’t have anything against this idea, although I can see why it makes people uncomfortable.
Doctors are so overly concerned about the ethics here that they are willing to let the maximum number of people die. As long as their system makes them feel good about “fairness.”
Here’s another idea. Only people who registered as organ donors be eligible for transplants. The shortage will soon be gone.
May 31st, 2008 at 4:26 pm
Mike:
I must have missed the part of UNOS being a contractor, however UNOS is still supposed to be run as a private, non-profit organization. The fact that it isn’t working as well as it could is probably due to whatever government oversight there is.
As for your broken arm, yes, you do need it fixed. However, here in San Antonio, you have a myriad of choices of where to go; there are at least 4 or 5 hospitals in the Medical Center alone. Same with the medicine you need for your mystery illness; you can go to the ER if it is bad enough, you can go to your regular doctor, or you can go to a specialist. Afterwards, you can get your prescription filled at the HEB Pharmacy, CVS, Walgreen’s, or any other number of privately owned pharmacies, based on whatever criteria you want. The free market works for healcare just as well as anything else.
Steve O:
I’m not sure I can agree with your idea. People like me, who are diagnosed with a chronic illness early in life can never donate organs, for the most part. For me, it is because diabetes effects almost all of the other donation-type organs in my body. Am I to be disqualified?
As for fairness, there isn’t a whole lot about organ failure which is fair. I can see why you would want to make the dispersement of a limited number of transplant organs as fair as possible, but in truth that isn’t how it is done right now. The doctors are more concerned about how long the organ will function in a particular patient, not whether it is fair. Older transplant hopefuls get turned down all the time if the doctors have someone available that they think the organ will last longer in.