Love, altruism won't fix organ shortage

By Bill Steigerwald

Tribune-Review

October 9, 2005

It's a simple, deadly problem of supply and demand.

As of Wednesday, 89,576 Americans need organ transplants or they will die. Most need new kidneys and livers. Some need hearts, lungs and intestines. But there aren't enough new organs from either living loved ones and friends or from dead donors. Therefore, every year more than 7,000 Americans die waiting for transplant organs that never become available.

You'd think having 19 people a day die while waiting in line for kidneys and livers would be big news. Yet you really only hear about it when it's dropped into stories like The Washington Post's recent report on desperate organ-seekers who are using the Internet like a dating service to improve their chances of finding a matching donor.

No ethicist quoted in The Post story was upset about those 7,000 perennial deaths. They were more worried that people using the Internet were gaining an unfair advantage or undermining the official system that allocates all organs from cadavers anonymously to patients on hospital waiting lists.

No ethicist called for a congressional investigation into the causes of our permanent organ shortage. But the solution is as simple as Econ 101, say free-marketeers like law professor Lloyd Cohen of George Mason University: repeal the 1984 National Organ Transplantation Act, which prohibits people from buying or selling human organs, and allow people to be paid for donating their organs.

Cohen has spent 16 years urging market-oriented legal reforms that would increase the supply of organs from cadavers for transplant patients. His best idea, which he describes in Regulation magazine, is to create a futures market whereby "healthy people would be offered the opportunity to give an 'option' on their transplantable organs."

The organs, recovered after their donors die, would sell for a predetermined price of, say, $5,000 for a kidney. The money would be paid to the donor's heirs or estate.

Most medical ethicists reject the thought of letting the grubby hands of commerce infect the organ allocation process. They'd rather see organs buried and people die. But dignified, medically and morally sound ideas exist for using economic incentives to increase the supply of organs.

Selling body parts on eBay in not one of them. Neither is buying kidneys from poor people in the Third World. In fact, as Cohen told me Wednesday, this "organ tourism" would disappear if we allowed a market in the organs of dead people. So would the need for most living donors.

Cohen's idea, tragically, has been ignored for years. So have others, including the "rewarded gifting" idea of University of Pittsburgh neurobiologist Harold Kyriazi, which would allow money to be paid to families for the right to harvest organs from their recently deceased kin.

Just as we have ample amounts of blood, plasma and sperm, because we allow people to buy and sell them, we could also have all the life-giving major organs we need -- if we stopped relying only on love or altruism to supply them.

We should wise up and recognize the power of self-interest to do social good, Cohen says. "The only thing that keeps the current practice in existence is that those who suffer from it are still few in number and far from here," he said, adding that "the idea of condemning people to death on the altar of not recognizing self-interest as an important motivating factor is just evil, and absurd."

Bill Steigerwald is the Trib's associate editor. Call him at (412) 320-7983. E-mail him at: bsteigerwald@tribweb.com.

Copyright © 2005 Tribue-Review Publishing Company.

This article posted October 27, 2005.