don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

Yesterday I reviewed some issues that arise during contentious debates about organ donations. There is, at present, more demand than there is supply. How best to increase the supply of human organs available for transplantations to improve or save lives? At present, the sale of organs, from living donors or even from cadavers, is illegal in America and most western nations. Why? Reasons vary, but all come down to ethical qualms or fears of exploitation and inequities. Some argue that a market in organs would create situations where donors ignore the risks in order to gain needed funds.

As for inequities, everything is said to have a price, but some things are considered off limits. (While prostitution may be illegal nearly everywhere, it is practiced everywhere, just the same.) The prospect of an organ market where the rich would likely go to the head of life and death queues seems unacceptable to opponents of an open organ market. The complexities of ownership and effects of market pressures on donors, recipients, society, the doctor/patient relationship, not to dwell on related matters like cloning, fetal tissue research, abortion, death and dying, health care law, patients' rights and medical ethics all make such organ markets anathema to many, including those who hold power in society.

None of these barriers, however, should keep us from pondering (or pontificating in my case) about what might be a best solution to the organ shortage. If a solution can be connected to such wellness perspectives as personal responsibility, maximum freedom and the like, then it would deserve our support. Do you agree?

There are existing pressures to create a market for donors of human organs, of one kind or another. Half the American people are in favor of payments for donated cadaver organs. Public officials in Pennsylvania have offered a $300 funeral benefit to families of those who donate organs for transplant after death (see USA Today, June 2, 1999.) In other countries, a sizeable black market in organs already exists, particularly for organs from living donors. The need for organs is great, as I noted yesterday. Last year, there were nearly 80,000 people on organ donor lists. Unfortunately, there were but 5,984 cadaveric organ donors. In all, 22,854 lifesaving organ transplants were recorded, along with 5,800 deaths of persons on waiting lists. Even those who oppose a market in this area acknowledge that the shortage would be eliminated if financial incentives were offered for organs.

Financial incentives could be offered on a partial basis. For example, even while making it illegal for donors to sell their own or their children's organs (!) while living, laws could be fashioned to allow the sale of medically-suitable body parts for harvesting after death. The number of such donations would surely increase dramatically beyond the approximately 6,000 if this change were instituted.

If you read the earlier essays about my organ donor plan, you know that an incentive system could be established wherein those who agree to donate their organs would have preferential access to organs for themselves and their children. That is, the first to get organs would be those who cared enough to offer their own after death. What could be fairer than that?

Another financial incentive, not quite the same as a market for organs but close, would be for the state to offer benefits to donors, such as estate tax deductions or funeral expense credits for organ donors. A variation on that would be to channel donations of organs to nonprofit organizations, in return for tax advantages. In India, living organ donors are paid for organs, such as for one of their kidneys, bone marrow and so on. Donors receive cash, free health care following the operation and other benefits. As you might imagine, the supply of organs increased a great deal when this system was put into place.

Perhaps the first step toward such a market would be to permit a market in cadaveric organs, wherein body parts could be sold like other commodities, with proceeds going to the family of the deceased. As with any system, safeguards could be instituted to prevent abuse, such as requiring provisions in the will of the deceased clearly signaling his/her approval of such transactions by beneficiaries. Even rationing, as is done with everything from hunting permits, oil drilling leases, cellular telephone licenses and radio frequencies, could be employed to mitigate undesirable features of a market in human organs.

Consider that everything else about transplant procedures is subject to free-market norms, why should donors be treated differently? The organ procurement organizations receive about $25,000 for every kidney they retrieve from a cadaver. The surgeons who do the transplants, the hospitals where the work is done and all the other medical personnel profit from transplants. Why not the owner of the organ, or his/her descendants? A liver transplant operation averages about $300,000, not counting the money earned by varied parties for follow-up care. Kidney transplant operations bring in about $100,000, plus $12,000 in follow-up care annually. There already IS a free market in organ donors. The only person not making any money is the donor! Does this make sense?

Worries about domination of the organ market by the rich might be unfounded. For one thing, the cost of organs is already included in the current price structure, except that it is the organ procurement agencies and the doctors, not the donors, who get the money. With the advent of organ sales by donors, either these current beneficiaries will have to share profits or the costs of transplants will have to rise with organ markets. The former seems more desirable and fair, do you agree? A recent Cato Journal article suggested that cost savings are possible with a free market (see "The Rationing of Transplantable Organs: A Troubled Lineup" by Charles T. Carlstrom and Christy D. Rollow, The Cato Journal, Vol. 17, No. 2.)

James Blumstein, an advocate for organ sales, reasons that organ selling should be allowed because it would be no different from the selling of other goods and services in the health care market. For example, those with more money can buy life-saving drugs like AZT for AIDS -- why should they not have more access to organs? Furthermore, since most organ donations are based on altruism, the poor are likely to have access to at least as many donations in a free market system with vastly more organs available than today with a constricted supply. Blumstein and others believe organ sales are a human rights issue. We have a right to own our bodies. We are free to damage our bodies with smoking, substance abuse and so on or to cultivate physical excellence with exercise and sound diet -- the right to do as we choose with our bodies should not be abridged. For more information from advocates of donor sales, visit a website maintained by advocates of such reforms at OrganSales.com -- this site has many useful links as well as worthy information of its own.

I favor the capitalist business model, with minimum restrictions, because free people should be able to do what they like with their lives, including decisions that affect their health, life and death. We have too many nanny laws wherein governments seek to protect us from ourselves. Patients and families should not be forced to endure scarcities artificially created by the absence of a market for organs. Doctors, medical personnel and others are not expected to be altruistic, so why force this position on potential donors? Organ selling, along with preferences for those who sign living wills, would increase the supply of organs to the point that few will die on organ waiting lists.

That's my wellness take on the matter -- what do YOU think? Comments welcomed and appreciated. Other things being the same, I think the wellness view will always be to let people do as they like, especially if no one else is harmed but one or more are helped. All the best. Look on the bright side of life.

(Note: This essay will be filed in the archives in the PHYSICAL DOMAIN under the skill area of appearance and aging. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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