Organ shortage – opposing views and potential solutions

There was an article in the NY Times a few days ago discussing the organ shortage and giving some proposals (article here). I meant to blog about it, but my life has been pretty busy at the moment so I haven’t gotten around to it. However, Sigrid Fry-Revere of the Cato Institute wrote about the particular article today. Says Fry-Revere:

The organ shortage can only be solved by increasing, not decreasing, the control people have over the disposition of their organs. Only an increase in liberty, not a restriction of liberty, has any chance of solving the organ shortage. New and innovative ways to motivate individuals to donate, including the option of compensation for donation both in the case of deceased and live organ donation, are what we need, not new ways to take organs without people’s consent.

One option Brody discusses is donation after cardiac arrest. There is nothing wrong, in principle, with retrieving organs after cardiac arrest, but what defines death and when to give up on a patient are not decisions that should be motivated by a need for organs. It is never appropriate for a doctor to alter how he treats one patient in order to provide an organ to save another patient. Just last month, a San Francisco transplant surgeon was charged with three felonies for allegedly hastening the death of a patient in an attempt to harvest his organs.

When she says “taking organs without people’s consent” she’s referring to an opt-out system. We sign our drivers licenses when we want to donate organs, but in some countries you must ‘sign your card’ when you don’t want to donate your organs. Basically it’s as if the state owns your body when you die, hence the restriction on your rights (or your family members who also may not want your organs donated). An opt-in situation like we have is preferable rights-wise, but obviously there is this massive organ shortage with people dying everyday or getting so sick that they can no longer undergo an operation even if an organ becomes available. That’s why Fry-Revere suggests compensating people or family members for their organs – you still own them, but now there is an incentive for more people to donate when they die (or in the case of kidneys, possibly when they are still alive).

The most common criticism I hear against this suggestion is that it “unfairly targets poor people”. That is, if you offer a financial incentive poor people will be more likely sell their organs because they’re strapped for cash. I’m not really sure why people think this, for several reasons. First, I would argue that the people who are most harmed by organ shortages are poor people, who tend to have poorer health in general (i.e. more likely to have diabetes and thus more likely to have kidney disease, or more likely to have high blood pressure and have kidney disease). If poor people are more likely to have conditions that place them on waitlists, then it seems that allowing people to pay for organs (or their insurance, medicaid, medicare) would be most beneficial to poor people. I think that insurance would cover the procedure, because if a good match can be made and the patient treated earlier, it likely saves money in the long run.

Second, there are lots of clinical trials right now where you are compensated for your time that you could argue target poor people, but they don’t. For instance, all around my campus there are fliers to participate in vaccine trials, asthma studies, etc and get paid decent amounts. Poor people don’t sign up for these, college students do. But any time someone mentions “organ sales” I don’t hear people complaining that it unfairly targets young male college students. I understand that a vaccine trial is probably not as risky as donating a kidney, but both still entail a risk, so why do we compensate one group for the risk and not the other?

I think if organ sales were ever legalized, that you wouldn’t see a huge increase in live persons donating kidneys, but would probably see an increase in cadaver donations – perhaps compensation would take away some of the taboo. Maybe someone would agree to donate because they know their family could use the money to cover the cost of their funeral, or pay off any remaining medical bills (or maybe they were kind of leaning towards donation, and the compensation convinced them to donate just so they can benefit someone else). I don’t see why this should be a problem, or why it is so controversial. It’s a solution that allows for more organs (and probably better immunologic matches), more people to be treated before their quality of life becomes poor, and does not infringe upon the ownership of your body. I think at the very least we should try it out on a small scale, so that if any problems do occur we can learn from them before launching it nationwide. Do you disagree, and if so why?

To read Sigrid Fry-Revere’s article, click here.

9 Comments

  1. Todd said,

    September 1, 2007 at 9:33 am

    Well said.

  2. Dave said,

    September 1, 2007 at 8:51 pm

    Legalized organ sales would save thousands of lives every year. Until then, there is an already-legal non-financial incentive that can put a big dent in the organ shortage — allocate donated organs first to people who have agreed to donate their own organs when they die.

    Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren’t willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

    Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at http://www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

  3. melody duron said,

    November 8, 2007 at 12:34 pm

    i think people should donate they organs becaus4e there are many people waiting for a donation and they dont know when its going to be the last day waiting sometimes the last day waiting its not because they got the organ they need is because they died!!! PEOPLE DONATE YOU’RE ORGANS!!!!!!!!!!!!!!!!!!!!!!

  4. Amanda Clancy said,

    April 29, 2008 at 4:48 pm

    If medical professionals are getting paid to save lives every day, then why are the people who are also saving lives by donating their organs get compensated? It doesn’t make much sense-two people are essentially doing the same thing and only one gets paid for it.

  5. Eric said,

    August 16, 2008 at 9:01 am

    I donated to my father on Dec. 18, 2007. Money should never be an incentive to saving a life of another human being. If that crap starts up, we as a society have truly lost our humanity. Look how far we’ve fallen so far. Let’s not loose our last little bit of human spirit.

  6. kenneth said,

    January 29, 2009 at 2:56 am

    i am a conservative, but here is where i would differ from most of my conservative friends. i am all for the idea of lagalized, well regulated organ sales. i agree with the argument that if it is legal to seel blood , or plazma, both life saving things, then why should kidney sales be any different? i did a little research. the average cost of dialysis per person annualy is give or take a grand or so is $50,000. lets assume that a person can be on dialysis for 10 years. the cost of that alone over a 10 year period would be half a million bucks, with the patient getting steadily sicker without a transplant.now let’s condiser that a transplan surgery would be somewhere in the neighborhood of $70,000. also let me suggest what i think is a fair price of $50,000 to the donor as a one time payment. so far when added together we have $70,000 and $50,000 comes to $120,000. the recipient will most likely encure $10,000 annualy for the cost of follow up care. so 10 times $10,000 cmes to $100,000. add all 3 figures together and it equalls $220,000. that figure is less than half the cost of not allowing this to happen.and who would pay that $500,000? the tax payers of course. so even if you look at this from a purely monetary stand point, i dont see how anyone can argue against this.and $50,000 would get most people i know out of debt with some left over.and don’t even try that exploiting the poor argument. seeing as how this would be regulated, no one could get a kidney this way faster even if he was richer than someone else. the way i understand it is that the kidney would still go to who needs it worse.so lets see what we have here. we are asving the taxpayers over $280,000 a person over a 10 year period, we have people not dying because they can’t get a life saving transplant, and we also have many americans getting out of debt. this is not exploiting the poor. if anything it is helping the poor. and seeing as how donating a kidney or no more dangerous than an average tonselectomy, what we have here is a win win sutuation for all involved.

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  8. mark said,

    February 6, 2012 at 2:29 pm

    If I make a whole body donation for anatomical study and research I will receive a free cremation and burial . If I donate an organ my family receives a bill for disposal of remains. Both ways can save a life, but the compensation is not equal. One allows research and doctors to gain knowledge to save lives and the other although helping to save lives fills the pockets of hospital, doctors nurses, drug company’s and morticians .

  9. Maria May said,

    April 30, 2012 at 2:14 pm

    What the problem is, is the “dirty” doctors in America that kill the already dying for their organs just so they can be paid thousands of dollars. thats why im not donating my organs. Its cruel for professional doctors to do something so “low”. why should i be killed for someone who’s paying them to kill?


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