Organs should be for sale

Allowing an open market for organs would improve access to transplantation, reduce human suffering and save lives

Mark J. Cherry, Citizen Special

April 13, 2006

Too many critically ill people are seeking too few transplantable organs under the current voluntary system of donations. Legalizing the sale of these organs would shorten waiting lists, save lives and allow donors to leave a financial legacy to their families Photograph by : Bill Keay, The Vancouver Sun

In the United States alone, more than 7,000 people die every year while waiting for organ transplants. According to the Canadian Institute for Health Information, about 4,000 Canadians are queuing for organs, but several hundred will likely die yearly while on the list; 242 patients died while waiting in 2004. Many others endure pain and suffering, at times even in hospitals on life support, while queuing for available organs. In Canada only 1,795 patients received organ transplants in 2003 -- a continuing tragedy.

As demand for transplantable organs has risen, however, rates of organ donation have been relatively stagnant. In short, the current altruism-based policies of organ donation have simply not been up to the task of meeting the medical demand for transplantation.

Such suffering is all the more tragic since much of it could be prevented by legalizing the buying and selling of human organs for transplantation on the open market. Public policy that expands the number of living donors would multiply the availability of transplantable organs, such as kidneys, bone marrow, and liver segments. If it encouraged families to make organs available from recently deceased relatives, this would also increase the availability of non-redundant organs, such as hearts from cadaver donors.

The market would create incentives to do both. In a single move we could significantly increase the number and quality of available organs, thereby improving access to transplantation, reducing human suffering, and saving lives. Surely, these are worthy policy goals.

Consider some possibilities. A market would allow families to sell the organs of a deceased loved one, rather than just to donate them.

Knowing that their families would benefit might persuade many more people to agree to donate. Some might be willing to consider a futures contract in which they agree to sell any usable organs upon their death to a particular buyer and have the money paid as a death benefit to their descendants. Others might wish to sell a redundant internal organ, such as a kidney, while still living. Indeed, some might see it as heroic -- saving the life of another, at some risk to themselves. We accept paid rescue workers, who risk their lives to save others, in many areas of life (ski rescue teams and so forth), why not in organ transplantation?

Barter markets open up related possibilities, such as organ trading, in which the families of those in need of transplant trade with each other for the necessary healthy organs. Recently in Toronto, two couples were involved in a life-saving swap of kidneys, the first such trade in Canada. Or, imagine a "triple swap" in which three patients, who are not tissue-compatible with their own willing donors, each exchange their donor's kidney for a kidney from another of the donors. Each donor would then provide a kidney to one of the three transplant patients.

Other market-based incentives include higher priority on the waiting list to those families whose members donated organs, the payment of funeral expenses, or various tax credits. Each of these cases is little different than the current system of organ donation, except that donors or their families receive financial or other valuable compensation.

What a repugnant solution!" rings the typical challenge to the market. But such emotions may be misplaced.

Let's consider some specific concerns. It is often claimed that the market would exploit the poor, that it would coerce poor people into selling their organs, something that they would not normally consider. But, markets respect people as morally in authority over themselves and able to make choices in their own best interests. Persons would be free to negotiate a bargain from which both parties expect to benefit: on the one side, a life is saved, on the other, a family is provided with significant resources to improve their lives. Unlike illicit trading on a black market, a legally regulated market could set minimum price standards and duties for follow-up care for living organ vendors.

Another reason that a commercial market would discourage unscrupulous practices is that in legitimate markets customer satisfaction and a good reputation are essential to long-term profits. Successful organ procurement and transplantation requires the skilled services of many professionals. Hospitals and highly skilled transplant surgeons have significant professional incentives to encourage virtuous tendencies in the medical marketplace. Neither would be likely to put their medical reputation and licence at risk by dealing with the black market. Moreover, each would be governed by the usual professional standards of practice.

Critics also claim that only the rich would be able to afford organs, while the poor would suffer in extra long queues for state-funded transplants. But this consequence is unlikely for many reasons. First, even with a market individuals could still donate organs for free out of charity to family members, friends, or strangers. Such donations are usually motivated by love, beneficence, altruism or fear of the stigma for failing to donate.

Second, since the market would increase the number of organs, making transplantation more readily available, it would reduce queuing time for the entire wait list.

Third, meeting the medical needs of those waiting for transplant is very costly. Reducing waiting times would also thereby save money for public health insurance programs.

It is time to stop the political and social hand-wringing and honestly consider the hard facts of the public policy challenges. Current altruism-based systems of organ donation are not working adequately, whereas a market in human organs for transplantation would save lives and reduce human suffering.

Proper regulation may be needed to ensure that the system benefited all those in need. But if we fail to act, those in need of transplants will continue to languish on ever-longer waiting lists until they run out of time.

Mark J. Cherry is a professor in the department of philosophy at St. Edward's University in Austin, Texas. He is the author of Kidney for Sale by Owner: Human Organs, Transplantation, and the Market (Georgetown University Press, 2005).

Copyright © 2006 The Ottawa Citizen.

This article posted May 16, 2006.