The (Legal) Organ Market
On average in 2014, 13 people died per day waiting for a kidney transplant. While the nation has made impressive strides to increase the amount of donors over the past five years, it’s simply not enough. Recent estimates put the number of men, women, and children on the national waitlist at around 114,000. It doesn’t take a health professional to realize that those numbers are simply unacceptable. We need to do more to help ensure that there is a kidney, liver, pancreas, or what have you for any person in the country who needs one.
There are many scientists and foundations hard at work to alleviate and ultimately end this problem, with promising research in the pipeline, such as the development of kidneys from stem cells. But while we wait, confident in our growing medical abilities and hopeful that more donors will present themselves, the reality of the situation is that the waitlist is still there, and more people die waiting each day. So what can be done while we wait for the research to get where it needs to be?
The answer is simple: let the invisible hand manage it. Engage in the free market for organs. Of course, some people object to this. After all, isn’t it illegal? Those naysayers would be correct, and if one wanted to bypass a lengthy waiting list and just buy a kidney, they would have to turn to the other side of the market: the black market. This isn’t just some small set of back-alley deals; based on a 2017 estimate, somewhere between $840 million to $1.7 billion was generated in the sale of all organs that year.
Unfortunately, black market transactions bring with them a host of issues. For one, the absence of regulation means that poorly trained surgeons might be doing the surgery, which could lead to complications for both donor and recipient. In addition, the poor are disproportionately the ones who donate their organs, so if something goes wrong they can ill afford further treatment or time off. Finally, donors may never get a sizeable cut of the profits from selling their organs (a kidney goes for over $100,000), and instead may see only a small fraction of the money while brokers pocket the rest. Based on the illegal nature of the transaction, authorities can’t really be brought in to ensure fair treatment of donors.
But none of this has to be the case. Laws can be changed, and the organ market can be made legal. For some organs, a legal market may not be possible, but for organs like kidneys, where the donor can comfortably sell one and live off of the other, an opportunity exists. It might offend some of our sensibilities to commoditize the sale of parts of the human body, but if it can help meet the tremendous demand for organs, it’s worth considering. Given that the alternative is more and more deaths related to lack of organ availability, it seems callous not to explore all options at hand.
For an example of a modern-day, legal organ market, we can turn to Iran- one of the only countries in the world to legalize the sale of kidneys. In Iran, the government has a program set up where donors are paid a flat fee of several thousand dollars, as well as guaranteed medical care- with the option for recipients to pay for the kidney. While the system isn’t perfect (disadvantaged Iranians may be disproportionately targeted and underpaid or taken advantage of), most institutions seem to agree that there is essentially no wait for Iranian citizen to obtain a kidney.
So if people need to make some money quickly and, by doing so, help save someone’s life, then why not? As for the issues associated with the sale of the organs, the US regulatory system should hopefully be up for the task. It seems that we should be willing to take the leap to legalizing the market, at the very least for kidneys. Many questions about the entire system are unanswered, and there are probably unforeseen issues the market could cause. But a market for organs already exists, and a legal version could reduce many of its shortcomings and dangers. The question at this point shouldn’t be: is it right to put a price tag on organs? Like it or not, that’s already happening. Instead, we should be asking ourselves: how can we engineer a system to meet demand today and thus save lives?