Problem: Not enough kidneys for people who desperately need organ transplants. Solution: Set up a market to encourage donors to come forward. Simple.
Well, at least it sounds simple when you read two economists who argue that paying donors would be more effective than relying on people to give up organs voluntarily. Gary Becker and Julio Elias say 95,000 patients sat on waiting lists in 2012, and yet only 16,500 actually got operations. The rest remained on dialysis, which is far from ideal:
“The toll on those waiting for kidneys and on their families is enormous, from both greatly reduced life expectancy and the many hardships of being on dialysis,” they write in the Wall Street Journal.
“Most of those on dialysis cannot work, and the annual cost of dialysis averages about $80,000. The total cost over the average 4.5-year waiting period before receiving a kidney transplant is $350,000, which is much larger than the $150,000 cost of the transplant itself.”
The current policy of informed consent limits the number of organs available, Becker and Elias say. And even “implied consent”–where people have to opt out of donating–wouldn’t be much better. Countries like Argentina, Austria and Denmark, which have that system, also have shortfalls, they note.
The answer therefore is to pay donors to come forward, and they reckon a sum of about $15,000 a kidney should be enough to spur supply (taking account of surgery risks, loss of work time, and the lifestyle inconvenience). “The number of people on dialysis would decline dramatically, and deaths due to long waits for a transplant would essentially disappear,” they write.
Becker and Elias are well aware people might find their proposal immoral. Transplant doctors are generally against the idea and people recoil at the notion of a market in body parts. But they say you have to stack that against thousands of people dying unnecessarily, as happens today:
Any claim about the supposed immorality of organ sales should be weighed against the morality of preventing thousands of deaths each year and improving the quality of life of those waiting for organs. How can paying for organs to increase their supply be more immoral than the injustice of the present system?
Also, the idea of money-for-body-parts isn’t unprecedented. We allow mothers to auction their wombs for surrogate births, for example. There isn’t much difference in allowing someone to sell a kidney. And the risks–including that people might give up a kidney without thinking it through, or be taken advantage of–could be minimized. Donors could be made to sit out a cooling-off period before going ahead.
Perhaps the economists’ idea is a good example of the market intruding into an area of life where it doesn’t belong. Perhaps we should keep naked trading for stuff like TVs and stocks. Becker and Elias don’t think so. They reckon we’d get used to the idea, especially when we see the benefits:
Eventually, the advantages of allowing payment for organs would become obvious. At that point, people will wonder why it took so long to adopt such an obvious and sensible solution to the shortage of organs for transplant.