Thursday, April 9, 2015

Free Organ Market Needed to End ‘Needless Deaths Waiting for Organs’

It’s well known that thousands of people are languishing and dying on organ transplant lists. As the New Jersey Star-Ledger editorialized in Needless deaths waiting for organs:

Just months after a Hillsborough teenager was killed by a deadly punch to the head, his mother got a letter from a 37-year-old father of six, whose life was saved from one of the boy’s donated kidneys.

"It takes a remarkable group of individuals that can make an unselfish decision during their grief and think of restoring life into someone else," he wrote.

Indeed. Yet all around us, people are dropping dead from a lack of donated organs, as life-saving parts are thrown into the ground or incinerated. Ask yourself: Does this make any sense?

No, it doesn’t make sense. Nor does nibbling around the edges of the problem make sense. The Star-Ledger offers, as a partial solution, fixing the NJ Motor Vehicle Commission’s “bureaucratic glitches.” In NJ, people can list themselves as organ donors on their drivers licenses, but the MVC apparently “isn’t recording the wishes of would-be donors” in many cases where the driver checked the organ donor box on his renewal form.

The Star-Ledger also supports a bill pending in the NJ legislature that would

institute the Golden Rule for organ donations: If you are willing to accept a donated organ, you should be ready to donate your own when you die.

This bill would let health insurers refuse transplant coverage to anyone who doesn't sign an organ donor card -- leaving non-donors on the hook for hundreds of thousands of dollars in surgery costs.

So the Star-Ledger’s solution is to fix a state bureaucracy and let (coerce?) insurers do what they should have been free to do all along. These fixes address a problem that government itself largely created.

It certainly would help if people’s health insurance policies had this provision. It’s interesting that insurers apparently are legally forbidden to institute prioritization rules under current law. Why should that be?

But there’s a bigger roadblock to clearing the transplant waiting lists; the “elephant in the room.” I left these comments:

I certainly agree that it is hypocritical to accept an organ transplant after one has refused to commit to being an organ donor. It is perfectly appropriate for doctors, hospitals, or insurers to set organ donor conditions or prioritize organ donors over non-donors in setting their policies concerning performing or paying for organ transplants, if they choose. Healthcare providers should be legally allowed to discriminate in this fashion.

But it is utterly wrong for government to impose these conditions by law—i.e., at the point of a gun, especially since government is a primary cause of all the “needless deaths” due to the organ shortage. If the goal is to expand the number of people willing to give organs to strangers and thus save lives—an eminently worthy one—we should demand the repeal of the vicious 1984 "National Organ Transplantation Act" (NOTA) and all other laws that ban or restrict material compensation for organ donors.

To be sure, compensation can and does take the spiritual form. Organ donation to a valued friend or relative is a gain or “profit” for the donor because the donor is helping to keep a personally valued relationship alive, well, and part of his life. There can also be a personal satisfaction in donating one’s organs to a stranger. I am an organ donor, precisely because I’d rather my organs help someone rather than be wastefully “thrown into the ground or incinerated.” But why is monetary or material compensation not equally morally valid? In fact donor compensation in both spiritual or material form is morally valid, because the best kind of human relationship is a win-win relationship—the exchange of value for value—where no self-sacrifice—no loser—is involved on either side.

We should liberate the organ donor market. Organ recipients materially profit in the form of a “second lease on life.” Why shouldn’t organ donors materially profit from the transaction? There is nothing wrong with a world where free and voluntary trade in organs is free to flourish. The right to freely contract to mutual advantage is a cornerstone of a moral society, and the practical benefits inevitably follow. All will benefit from the inevitable increase in the supply of organs, including the poor, who can benefit not only financially as donors but also as recipients as charitable organizations arise to buy organs and then offer them for free or at a discount to poor individuals who meet their criteria for deserving recipients. (For example, I might attach compensatory terms to my organ donor card, and donate the proceeds to charity rather than my estate. This would, in effect, redistribute money from those who could afford to pay for organs—including those with insurance—to those who can’t, in a moral, voluntary, rights-respecting way rather than the opposite—government coercion.)

Trade—the win-win relationship, as opposed to the lose-win scenario NOTA imposes on donors—is the ultimate form of good will and incentive. So long as the trade of organs for compensation is between consenting adults of sound mind, the government has no valid business infringing the inalienable rights of donors and recipients to voluntarily contract to mutual benefit. But a free market does not mean “anything goes,” with no safeguards. Government’s job would be to enforce contracts, prosecute abuses like fraud and other objectively identified forms of coercion, and otherwise protect individual rights. Insurers, doctors, and hospitals would have incentive to police their end, by confirming that contracts are on the up-and-up, both for ethical reasons and to avoid potential lawsuits and prosecution.

Progress in modern organ transplant medicine has raced ahead. Yet, tens of thousands of people needlessly suffer and die on donor waiting lists, precisely because we demand that organ donations be an “unselfish decision.” This is cruel and immoral. Even the Star-Ledger acknowledged that “A commercial trade in organs would undoubtedly save lives.” It’s time for the ethics and law of organ donation to catch up with the heroics of modern medicine.


Notice that the Star-Ledger acknowledges the life-saving potential of a free market in organs. Yet, it opposes a free market. Why? As the Star-Ledger explained in a 2012 piece, Don’t sell kidneys for transplant:

In Iran, where kidneys are bought and sold legally, this problem is a thing of the past. There is no waiting list.

But there are good reasons to keep the ban on organ sales in place. One is that even willing transactions can be abusive.

If kidney sales were legalized, we would likely see an import boom of kidneys from the developing world, where middlemen could buy them cheap. If you are a hungry farmer in Somalia, or Haiti, a few thousand bucks might seal the deal.

Remember, too, that in much of Africa and Asia, women are treated with about as much respect as farm animals. How many of these women would be pressured or forced into coughing up a kidney?

What I find amazing is that opponents of organ donor compensation base their arguments largely on fears that the “weak and vulnerable” will be victimized. But who is more vulnerable than people languishing on organ transplant waiting lists? Besides, if the government did its proper job of protecting individual rights, it would vigorously prosecute abuses while leaving legitimate trade free.

But the Star-Ledger’s opposition runs deeper. It considers legalizing profiting from organ donations—even profit benefiting poor people—a “vulgar step.” Consider the opening paragraphs of its 2012 editorial:

Levy Itzhak Rosenbaum was sentenced last week to 30 months in prison for his role in arranging the sale of a human kidney.

But some say these sales should not be a crime at all. The man who supplied a kidney to Rosenbaum was paid $25,000 and emerged unharmed, if somewhat diminished. The kidney itself saved a man’s life, and his daughter says she regards Rosenbaum as a “hero” for making that happen.

Notice that everyone in this transaction—the donor, recipient, and recipient’s daughter—are happy. Nobody was harmed. So what’s the problem. According to the ethics of altruism—which holds self-sacrifice for the good of others as the standard of the good—that’s exactly the problem. No sacrifice was involved. Yet the Star-Ledger opposes organ donor compensation, even as it laments the “Needless deaths waiting for organs.” This, dear reader, is the monstrous and corrupting nature of the ethics of altruism laid bare.

Related Reading:

The Monstrous Nature of Altruism Laid Bare

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