In defense of free market organ donation

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A recent survey by Donate Life America states that the percentage of Americans willing to donate organs has risen over the past year (only 43 percent are undecided or opposed to it, compared to 50 percent last year), but this increased willingness still hasn’t kept pace with the need for donors. The morality of altruism – which expects that potential organ donors will voluntarily “do the right thing” for free, often for strangers – has its limits. That’s why more than 100,000 people in the U.S. are on waiting lists to receive organs, and 6,500 people die each year during their wait. Demand far outstrips supply, as only 20,000 organ transplants are done each year. This wouldn’t be the case if there was a shift away from altruistic organ donation and rationing, by getting rid of the National Organ Transplant Act of 1984 banning such financial incentives.

If we want to save lives, it is high time that we address the supply side via a free-market organ system. While African-Americans comprise 13 percent of the U.S. population, we make up 35 percent of the individuals on the national waiting list for kidney transplants. However, we are only 11 percent of organ donors. Since the success of transplant operations rise dramatically when organs are matched between people of the same ethnicity and race, the gap between blacks who need organs and blacks who contribute organs leads to black people waiting twice as long as white patients for organ transplants. The good news is that the Donate Life America survey also found that the percentage of African-Americans who wish to donate their organs and tissue has increased to 41 percent, compared to 31 percent in 2009. Public education campaigns are not significantly changing this organ landscape involving black organ contributors, and will not until there are financial incentives.

Several opposing arguments to a free-market organ system arise. Some individuals – usually liberals who claim to be “pro-choice” on body-related matters – are squeamish about other individuals choosing to provide an organ in return for compensation. They contend that organ sales shouldn’t be allowed for ethical reasons. However, if such individuals argue that the government shouldn’t be involved when a female chooses to terminate a pregnancy (and I concur) because of individual liberty and she owns her body, then consistency dictates that the same principles apply to individuals who wish to contribute their organs as they see fit.

Besides, there are already other health arenas where individuals receive financial incentives and where body parts are treated as commodities, with little opposition: egg/sperm donors, surrogate mothers, and blood donors. Under the so-called altruistic organ donation system, everyone except the organ contributor receives tangible compensation in some way: the recipient gets a transplant, the doctors get paid for doing the transplant, the middlemen who help procure the organ get paid, and the administrators who do the proper paperwork to get consent also get paid. Why should the organ contributor be left out?

Most importantly, it certainly isn’t more ethical to continue allowing thousands of people to die prematurely each year because of prohibitions against organ sales. People like entertainer Barry White (who died while on the kidney waiting list) or sports star Walter Payton (who died while on the liver waiting list). Saving lives is by far the more ethical goal.

Other critics of a free-market organ system are concerned about coercive, organ trafficking activities or organ theft by unscrupulous individuals. One resolution is heavy regulation against fraud and abuse, and ensure that only sound adults contribute their organs. However, the morality of altruism dictating non-sale – which creates a shortage of organs in the first place – is the very root of the trafficking problem. The scarcity of organ contributors also inflates the cost of organ transplants than it would otherwise be.

A third concern is that a free-market organ system would favor the rich and possibly the young. Perhaps the 15 percent of individuals in Donate Life America’s survey who stated that they are undecided about contributing their organs would be induced to do so if they also maintained the right to decide who gets their organ, which would increase overall organ availability. Critics also ignore that such a system would help many people, who could use the funds received from donating an organ to improve their lives.In all, mutually beneficial transactions between individuals – not government and other bureaucrats – should determine organ contributions, and would significantly increase the likelihood that supply comes closer to organ demand.