In a recent piece for the Wall Street Journal, Gary S. Becker, a Nobel professor of economics at the University of Chicago and senior fellow at the Hoover Institution, and Julio Elias, economics professor at Argentina’s Universidad del CEMA, try yet again to make the case for a transplant organ market in the US. Their arguments — on the surface — appear compelling:
Between 2002-12, the waiting list for transplant kidneys grew from almost 54,000 to 95,000
In the decade between 2002-12 the waiting time for a transplant kidney grew from 2.9 years to 4.5 years
Kidney transplant patients between the ages of 45-49 live, on average, 23 additional years; dialysis patients in that same age group live, on average, only 8 additional years
The average cost to provide dialysis services is US$80,000 per patient, per year
The average cost of a kidney transplant is US$150,000 (conveniently excluding the extremely expensive drug regimen required to keep the patient from rejecting the organ)
Kidney donor exchanges — situations in which incompatible living donors join an exchange containing a compatible living donor — have grown rapidly since 2005 but account for only 9 percent of live donations and 3 percent of all kidney transplants (including cadaveric transplants)
“Highly preliminary study” of countries that use implied consent (cadaveric organs are assumed to be available unless donor implicitly opts-out) versus countries like the US that use informed consent (cadaveric organs are available only if the donor implicitly opts-in) indicate no “consistent changes in the number of transplant surgeries”
Increasing the supply of viable transplant organs is less expensive, would ease suffering, and reduce wait times and deaths
“Our conclusion is that a very large number of both live and cadaveric kidney donations would be available by paying about US$15,000 for each kidney”
While this laundry list appears compelling, Becker and Elias offer few solutions to the issues underlying an organ market. In fact, their arguments are the same ones that have been made for years. I deconstructed Nicholas Kristof’s nearly identical arguments in 2002.
I continue to beat the odds; on Groundhog Day this year I will have survived in-center hemodialysis for 14 years. I’m 59 years old. Do the math yourself. I’ve painted vague outlines of my position on a personal kidney transplant (here’s the current entire list). Here are a few specifics:
Twenty-year-old cadaver kidneys are offered to 95-year-old patients because they’re the next in line, not the highest and best use for that particular organ
Cadaver kidneys are provided to drug addicts who, within a year, go back to buying street drugs instead of their prescriptions and reject the kidney
Children and teenagers are being denied cadaver kidneys because of genetic defects that would cause them to likely reject the organ in five years or so; see number one, above, and remember what five years meant to you when you were a teenager
The United Network for Organ Sharing (UNOS) — the non-profit that manages the organ transplant system in the US under contract with the government — began considering a solution to the first-come-first-served problem, but there’s been little movement. Kidney transplant candidates on the cadaver organ waiting list can now elect to accept older organs, but that’s about the extent of it.
Kidney transplantation is not a cure for kidney failure; only another treatment modality complete with its own benefits and drawbacks. Becker and Elias conveniently fail to mention the outcomes of other countries that have tried organ markets. The evidence is far from encouraging. And markets always beget black markets.
Becker and Elias make the case that the market rate for a kidney in Iran is US$4,000 and extrapolate per-capita income to get the US$15,000 figure in the US. Really. Ask either if they’d sell a kidney for US$15,000 and demand an answer. Further, their US organ market would pay individuals for use of their organs after they die, allowing some sort of weird sell-forward market to develop in which reluctant relatives will suddenly and magically lower their resistance if a substantial amount of money is involved. Because, after all, everything has a price and markets can be made for anything.
Meanwhile, Becker and Elias make not even a hint of a mention of the promising phenomenon of altruistic kidney donation.
Pointing to the example of market-based surrogacy in the US to bolster their argument that organ payments would be effective in eliminating the organ shortage, Becker and Elias note that “the average payment to a surrogate mother is only about US$20,000.” Then the pair run completely off the rails, citing the all-volunteer US military. “But the all-volunteer force has worked well in the US, even during wars, and the cost of these recruits hasn’t been excessive,” they write. Surrogacy and the all-volunteer military are their evidence for an organ market actually eliminating the organ shortage; two straws grasped and we’re so far off in the deep weeds now that I can’t even see the rails any longer.
It would be much less expensive and much more simple, ethical, and moral to mandate implied consent for organ donation in the US. Under such a model, all cadaveric organs would be assumed to be available for transplant unless the individual implicitly, specifically, and willfully opts-out, Becker and Elias’s “highly preliminary study” of implied consent notwithstanding. In the meantime, let’s work on making the US organ transplant system more equitable and reasonable.
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Banging the drum, again, for organ markets was originally published by ARTS & FARCES internet on Thursday, 30 January 2014 at 6:41 AM CDT. Copyright © ARTS & FARCES LLC. All rights reserved. | ISSN: 1535-8119 | OCLC: 48219498 | Digital fingerprint: 974a89ee1284e6e92dd256bbfbef3751 (173.192.238.44)