Some years ago, one of my mother’s best friends from high school—a woman named Brenda—had become gravely ill and desperately needed a liver transplant. After years on the waiting list to receive an organ, she finally was able to get a transplant and underwent a successful operation. Brenda died the day after receiving a new liver because, after all that time, her body had become too weak to carry on.
Brenda’s story is a tragically common one. There are over 122,000 people on the waiting list to receive an organ, with one being added to the list every 10 minutes and 22 Brendas dying on average every single day, according to the U.S. Department of Health and Human Services. This status quo is unconscionable.
The issue here is simple economics: there is a sharp incongruity between the supply of organs and the demand for them. Currently, there are two legal ways someone can receive a life-saving organ. One way is by having a loved one who is a blood and tissue match donate their organ—this is known as an altruistic donation. The other way is by getting on the waiting list to receive an organ from someone who has already died—this is known as a cadaveric donation.
According to Tina Rosenberg in her New York Times article on kidney donation, the average time one has to wait in order to receive a kidney ranges from three to 10 years, depending on multiple factors such as geography and blood type, among others. What’s more, patients cannot even get on that list until they are about to start dialysis, which depressingly gives them only about a five to 10 year lifespan after treatment begins.
Furthermore, the cost of dialysis for one patient in America is about $80,000 per year, and the more time a person spends on dialysis, the greater the probability of complications and death after the kidney transplant, according to that same New York Times article. Further still, Medicare.gov states that, under original Medicare, the program covers 80 percent of the financial expenses for dialysis, which imposes great costs on the government and the taxpayer.
How can we increase the supply of organs, potentially conserve taxpayer dollars, reduce the transplant waiting list and ultimately save lives? The answer may be to legalize a regulated market for organ sales: to provide monetary compensation for organ donors.
Iran provides us with Exhibit A. In the Iranian system, kidney donors are paid monetary compensation. Thus, the waiting list for a kidney had been essentially eliminated by 1999. While there are problems with the Iranian system, one could argue that the resources and infrastructure of a regulated American system would overcome these shortcomings. The chief takeaway from Iran’s program is that—thanks to paid compensation—those who need a kidney can quickly get one.
Many argue that this kind of system would exploit the poor. Some believe that offering money to those who donate organs will cloud the judgment of the impoverished and cause them to make a decision regarding donation that they will later regret. Others think that the idea of providing monetary compensation might crowd out altruistic donations. Basically, this means that when money gets thrown into the process, some believe that it will be counterproductive and make those who would have donated altruistically no longer want to donate.
Dr. Simon Rippon of Oxford University presented one of the most compelling objections to a regulated market for organ sales in his 2014 piece for the Journal of Medical Ethics, titled, “Imposing Options on People in Poverty: The Harm of a Live Donor Organ Market.” Dr. Rippon starts his argument by asserting that sometimes having extra options, even if not taken, can be harmful. He continues, stating that those who are in poverty are most likely to utilize this kind of system of compensation. The crux of Rippon’s objection is that exchanging money for organs commodifies them and subjects those who are in poverty to harmful social and legal pressures to sell their organs in order to uphold financial or legal obligations. Dr. Rippon raises important questions when he asks:
Would those in poverty be eligible for bankruptcy protection, or for public assistance, if they have an organ that they choose not to sell? Could they be legally forced to sell an organ to pay taxes, paternity bills or rent? How would society view someone who asks for charitable assistance to meet her basic needs, if she could easily sell a healthy ‘excess’ organ to meet them?
One answer to Dr. Rippon’s objection raised by Luke Semrau in his 2014 article, “The Best Argument Against Organ Sales Fails” from the Journal of Medical Ethics, would be to set a cap at how many people could receive monetary compensation for their donation, thus limiting the scope of the phenomenon and preventing it from influencing societal expectations. Another answer to Rippon is to diminish social and legal pressures by providing non-cash incentives to donate, such as health insurance or tax breaks rather than direct payment.
It seems like some of the most prevalent objections to a legalized market in organ sales were empirically refuted in a 2010 study. As described in a Penn Medicine press release:
In the first empirical study of how Americans might make decisions if offered financial incentives for kidney donation while alive, Penn researchers found that the offer of payment did not cloud a person’s judgment of the risks associated with live kidney donation, motivate poorer persons to sell a kidney, or “crowd out” a persons altruistic incentives to donate.
However, one caveat regarding this research is the acknowledgment that participants’ choices in a hypothetical setup, such as the one presented in the study, may not reflect what someone would do in a real-world situation.
Large-scale implementation of a regulated organ market might not be the right move at this moment, but perhaps smaller scale experimentation with this policy would prove valuable. The prospect of conserving government expenditures while simultaneously saving American lives seems worthy of a local or state experiment with this regulated market.
Iran shows us that organ waiting lists can be greatly reduced and even eliminated when people get paid for donating organs. This option is ethically sound and appears economically viable. While there are legitimate concerns about the implementation of this new market, should such concerns outweigh the opportunity to help those 22 people who die each day we don't try?
