I'll Give You My Heart...

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