I'll Give You My Heart...

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There
are not enough kidneys. We are short on lungs. We are lacking in
livers. So you want a heart valve, a cornea, a pancreas? Get in
line.

Each
day, this is what dozens of ailing people hear. The United
Network for Organ Sharing
(UNOS) is a government agency which
handles allocation of organs from donors to patients. According
to UNOS, there are more than 87,000 Americans waiting to receive
viable organs right now.

To
reiterate, a government agency is allocating resources, and the
result is — drum roll, please — a shortage.

According
to its website, UNOS matches
organ donors with waitlisted recipients by taking into consideration
several factors both biological and logistical. They include the
following: blood types and immunological characteristics of the
donor and recipient, size of the organs to be transplanted, time
spent on the UNOS waiting list, physical distance between the donor
and the recipient, age of the recipient, and the ever controversial
"medical need."

The
allocation process may seem quite complicated, but never fear. UNOS
has policies
and bylaws
to help them decide who should get organs and who should not.

Government
regulations explicitly prohibit the sale of human organs. In other
words, the price of organs is fixed at zero. The demand for viable
organs is enormous compared with the supply. It doesn't take an
economist to know that this is a recipe for a shortage.

As
with all forms of government meddling, the market in organs is distorted
— that's the simple reason why thousands of people will die waiting
for an organ transplant this year.

And
also, as with all forms of government meddling, the system of organ
allocation in the US creates some interesting unintended consequences.
Perhaps the most obvious is a lack of incentive to donate organs.
Doctors and UNOS experts must determine that altruism is the only
motivating factor in any organ transaction between a living donor
and a recipient.

Any
shortage or long waiting list encourages people to try and get around
it. Patients often plead with their physicians to report their medical
need for organs as greater than the physician may feel comfortable
doing. Sometimes, under threat of lawsuits, or simply to save their
patients, doctors comply.

There
is also the question of whether the UNOS system leads to special
treatment for prominent VIP's in need of organs. Many people cried
foul when Mickey Mantle received a liver transplant after practically
no wait time; he died shortly after receiving the new liver.

And
as with any commodity which is illegal to sell but carries a high
demand, there is a black market in organs. Wikipedia
puts the price of a fresh kidney at about $125,000 US dollars. A
small portion covers transportation costs; the rest is split between
the donor, a private hospital, and the broker. The broker reaps
about $55,000 in profit on each of such transactions. It is difficult
to find reliable data on how often black market organ transactions
occur in America, but the organ trade is certainly alive not only
in the US but all over the world.

Those
who end up on the UNOS waiting list face a good possibility that
they will die waiting for an organ. There is, however, a silver
lining. Even in the face of a seemingly insurmountable system of
government intervention and central planning, the market is finding
solutions to the problem of organ scarcity.

A
young man named Todd Krampitz was recently diagnosed with severe
liver cancer. He underwent 6 weeks of chemotherapy. Then, doctors
removed three-fourths of his liver. What was left of it was later
found to contain more cancer, so Todd was informed that he would
need a liver transplant in order to survive — he was put on the
UNOS wait list. Todd didn't take the news lying down. He and his
loved ones set up a website,
which received a flood of media coverage, and used it to network
with potential donors. Todd received a liver within weeks, and lived
to tell his tale.

LifeSharers
is another fascinating alternative to the virtual death sentence
of the UNOS waiting list — a community which seeks to ameliorate
the shortage of organs. Members of the voluntary association receive
preferential access to the organs of other LifeSharers members,
should they become available. LifeSharers participants are promised
first access to the organs of others in the group regardless of
their status on the UNOS list. If a suitable match for LifeSharers
donor's organs cannot be found in a LifeSharers recipient, the organs
can go to someone on the UNOS list. There is no fee to join. The
only requirement for membership is that all members must agree to
themselves be organ donors.

You
can imagine the complaints from critics of this system: it gives
members an unfair advantage; it allocates organs to those who might
not have the greatest "need." I can't understand how LifeSharers
is any different than an organ donor who specifies that his organs
should go to his family members or friends before others. After
all, they're your organs. You grew them yourself.

You
own your body — and you should decide if, when, and how you want
to give of it.

You
own your body. What a powerful concept. Yet nowadays more and more
we are being bombarded with legislation and propaganda that implies
just the opposite.

Still,
vestiges of autonomy remain which continue to be thought of as socially
acceptable. Professional athletes, models, actors, movers, security
guards, and surrogate mothers all make a living from the use of
their bodies. It is common for Americans to sell their eggs and
sperm, which have the potential to create new human life. But to
sell our organs and to prolong or improve an existing life — from
this we are prohibited.

Why
shouldn't we sell our organs? This idea is nothing new; still I
feel compelled to bring it up. Despite the dismissal of organ sales
as exploitative, coercive, damaging to the quality of organs, and
dangerous, the proof is in the pudding. Areas of the world such
as Iran (where it is legal to sell kidneys) and India (where kidney
sales are technically illegal but a de facto market exists) are
the only places which do not face shortages. I learned of this from
James Stacy Taylor, who has written a book
on the subject, which will be available this spring. I saw him speak
at a conference last spring, where he addressed the four most common
objections to a market in human organs. I found his arguments delightfully
difficult to refute.

A
final caveat: If you sport an orange sticker on your government
issued driver's license (which, incidentally, is slated to become
a de facto
national ID
), you may think yourself an organ donor. Actually,
most people are unaware that the orange sticker is only half the
battle. The most important step in becoming an organ donor is a
conversation with your family about your final wishes. If you happen
to expire and your organs are usable, you certainly won't be around
to give your consent to harvest them, no matter how much you wished
to donate during your life. If you're the orange sticker type who
hasn't yet expressed your desire to be a donor to your loved ones,
I implore you to do so.

And
please, for life and for liberty, start a discussion with your friends
about market-oriented approaches to the allocation of scarce health
resources. You could open minds. You could also save lives.

January
1, 2005

Stephanie
R. Murphy [send her
mail
] studies Biochemistry at the University of Massachusetts
at Amherst. She is a member of LifeSharers
Organ Donation Network
.

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