there's also a shortage of cadavers for medical research in England and Florida:

u.k.
http://www.guardian.co.uk/medicine/story/0,11381,1635620,00.html

florida:
http://www.gainesville.com/apps/pbcs.dll/article?AID=/20051213/LOCAL/51212039/1078/news

body donation programs in the u.s.:
http://www.med.ufl.edu/anatbd/usprograms.html

the chinese "recycle" organs from condemmed inmates:
http://ethics.tamucc.edu/article.pl?sid=05/11/19/0044254

I also read somewhere China is providing bodies to U.S. medical schools, but I can't seem to find the link. Anyway, enjoyed the post.

peace,
A

Mr. Becker's argument seems cogent.
The worry about "commoditzation" and "exploiting the poor" betoken, I think, a total misunderstanding of the issue AND the CURRENT reality, in which a) there is a growing demand of organs, b) there is thus (and for other reasons) a diminishing supply, and c) exploitation is part and parcel to a "free" market system: it is part of, that is, making commodities out of "ordinary" things (as if there were such entities)=commodisation.
If the poor are exploited with this opening of the market, then they are REALLY being exploited now, with everything else. And I reject such patently illogical (marxist) claptrap. you can analyse "abuse" into any situation. the truth is, the immodest proposal is not unconstitutional.

Once the system is legalized, it'll be argued, crime wll not abate, (as with loosening gun control): on the contrary, just as blood HIV transfusion people have incentives to get money despite the horrible crime they commit (or neglect the money, and are evil, sick villains--probably few, relatively), poor people who shouldn't will succumb for want of lucre to put themselves and other in danger.
The argument, however, could be made for proscribing suicide (whcih, apparently, it stupidly is): protect the individual (and society) from his own will-power.
Both are incoherent positions. In the Liberal Age, and in a country that believes in Rights, an individual must be entrusted wiith knowing--and indeed FORCED to know (law is the best way to reflect the demand society imposes for this, I think Aristotle discovered that)--, on the most basic levels (I'm not talkiing about tobacco/cigarette poisoning) about the consequences of his actions. They;'re already offering prisoners benefits for organ donations in some countries.
I recommend a trial run on this. And I'm a libertarian/conservative.

"Still another criticism of markets in organs is that people would be kidnapped for their organs, and that totalitarian governments would sell organs of prisoners. This would happen, but not likely on a significant scale since the source of organs offered for sale could be determined in most cases without great difficulty."

Per my fuzzy recollection, years ago in a class I asked a tax professor a hypothetical question about deducting a loss on one's taxes if one had an organ stolen. Per my fuzzy recollection, the professor said there could be no loss deduction because the basis in the organ was $0.

The tax ramifications of this are interesting. Would the seller pay tax on the proceeds from selling his liver or kidney? Would the seller pay tax at the capital gains or ordinary income tax rate? If capital gains, what is the cost basis in the organ? If someone donated an organ, would the donor be allowed a tax deduction for a charitable gift?

More people than one might expect may fear organ stealing. Some of it may be fear and not based on fact or reality - I do not know. More research or information on a black market for organs, if any exists, would be interesting.

Science Fiction author Larry Niven had an interesting take on the future of organ transplantation: something to the effect that demand for organs was so great that the government imposed organ donation as a penalty for recidivist misdemeanor criminals (such as: running three red lights in a single year...) I never did like reading his works with heavy influence from "The State", it didn't feel like a fun place to live.

Recently, an enterprising young Texan in need of a transplant conducted an extensive, and costly, ad campaign for a donation - it worked for him. If you're dying, you really don't have much to lose, even if the world thinks your billboards are in bad taste.

In today's world, the super-rich have access to whatever organ transplant needs they might want to fill. They may have to relocate to countries where donations are legal, but with enough money, you can hire good doctors to do a trans-oceanic housecall. Organ procurement can be costly in some cases, but don't believe that it's impossible.

Comoditization of the organ market would increase timely access for the next few stratum of wealthy below the super-rich. I think it would be a good thing, but I wouldn't want my insurance premiums to increase to cover the cost of the benefits (which Posner argues would be negligible, on the order of 10% of the total operation, but this ignores the follow-on costs of keeping the transplanted Frankenstein alive after the operation.....)

Professor Becker,

Regarding the argument that allowing a market might lead to more kidnappings, this sounds somewhat analagous to kidnappings (and killings) of pregnant women for their babies. It rarely happens. On the other hand, it seems many doctors are more concerned with preserving organs of dying patients (during emergency situations, for example) than with actually trying to save the patient. This is one reason I didn't check "organ donor" on my drivers license. Have you any data on this?

A grotesque and glib market-is-always-right argument. There are a myriad of principal/agent issues that suggest this view is simplistic. Are the trades voluntary and what sorts of incentives will drive alternative treatment technologies if you can readily rely on a down-and-out human desparate for cash? Oh yes, and let us dismiss the counterargument that you are making this desparate person worse off by denying him or her the opportunity to trade. Its wrong because people make bad judgements and can be coerced. Its also wrong because it reduces morality to individualistic utilitarianism which is one approach to human life not a law of nature.

What's happening to thinking in US economics? What is it so homogenised? What is economics becoming a pervasive free market ideology that essentially vulgarises Adam Smith but isn't backed up by modern theory? I looked today at the program for the January AEA meetings and the apparent uniformity of offerings is just sad. But the repetitive theme is reproduced in this post.

Professor Becker is correct in his assumption that free markets in human organs are unlikely to be legalized. I suspect this issue will be solved in the future by stem cell research leading to the ability to 'grow' human organs from organ cells.

The "commoditization" counter-argument seems to be a form of negative externality. Those stopping the creation of a legal market for human organs get good feelings in supporting their belief in a mystical value of human life, while facing only a fraction of the cost (the probability that they will need an organ).

Regardless, as the market is unlikely to be legalized, an alternative is for the opt-out system to be used and those who choose to opt-out (within ten years of when they go on a waiting list) cannot get a donated organ unless the supply becomes greater than the demand (unlikely).

Frog has also heard that a way to get moved up a waiting list to make a donation to the hospital. The hospital then perceives the person to be more likely to benefit from the transplant. Anyone have a source for this beyond hearsay?

"In the same way, many poor persons in the US would have organs that would not be acceptable in a market system because of organ damage due to drug use or various diseases."

"poor persons in the US" could be perfectly healthy persons from poor countries who are in the U.S. to sell their organs, perhaps on tourist visas paid for by doctors or their agents. The cost of paying such poor and healthy donors to travel to the U.S. is nothing compared to the handsome fees that would be earned by the doctors or their agents. Even more likely would be for some country or region, say Hongkong, which is close to populous and poor countries and in which a reasonable medical infrastructure is already in existence, to become a world center for organ selling and purchasing. Donors and donees would travel to such world centers to complete the transaction. Organs could be listed on E-Bay together with information that are relevant to the conditions of the organs such as the diet, age, weight and height of the donors for the donees to bid up or down the going price. The inevitable result: systematic and discriminatory exploitation of citizens of one country by another. Sounds like a capitalist hell to me.

A legal non-monetary market for organs exists in the United States. It's called LifeSharers. Anyone can participate for free at http://www.lifesharers.org.

When you join LifeSharers you agree to donate your organs when you die, and you also agree to offer them first to fellow members. In return you get preferred access to the organs of all other members.

This is an excellent trade. By giving up your organs after you can't use them anymore, you increase your chances of getting an organ if you ever need one. Given that more than half of the people who need a transplant die before they get one, this is a significant benefit.

By creating a pool of organs available first to members, LifeSharers creates an incentive for non-donors to donate and to join LifeSharers. This incentive gets more powerful as the number of members increases.

LifeSharers uses a form of directed donation that is legal under federal law and under the laws of all 50 states. Parents can enroll their minor children. No one is excluded because of any medical condition.

"A legal non-monetary market for organs exists in the United States. It's called LifeSharers."
Every person on organ donation waiting list has strong incentives to join LifeSharers while healthy people have much weaker incentives to join this program.
I think Profesosr Becker's argument can be boiled down to organ donors motivated by altruism compared to organ donors motivated by altruism and organ donors motivated by monetary considerations. It's simple to show that the second alternative provides more organs than the first.

Markets are a good solution to this problem; however, exchanging money for organs is problematic as discussed. One suggestion that I've seen before, but not here, is that people who have "opted-in" for organ donation would go to the head of the line if they themselves, or their immediate family, needed an organ donation.

It would be interesting to get an overview and explanation of the various types of people that need kidney and liver transplants. Perhaps some of this situation could be addressed though additional prevention measures or prevention incentives?

It seems that this will increase the benefit of suicide attempts.

Markets are indeed a good solution for the problem. It'll decrease the waitings going on for a long period.

A case study on the effect of a market for organs could be done in South America.

There, you can walk in and get any transplant you want if you have the cash.

But, there are indeed many kidnappings, and there is organ stealing even at hospitals. People walk in for an appendicitis surgery, wake up without a kidney.

There are also pregnant women who get killed for their unborn babies, to be sold at the adoption black market.

Yes, you could regulate that all organs have to prove their procedence, and so on, but then it would not be a real "free market".

I myself have no position on this topic as I might need a transplant some day, and traveling there is always an option. But it is disgusting to think the costs on so many innocent people this market imposes.

It is impossible to me to decide on the desirability of legalizing a market for organs without contemplating the moral dimension.

Hey guys! The NSA leak cries out for some erudition. LET"S GET ON IT!

The big question is who gets to opt-out.

My understanding is that in the states *even* if you have choosen to donate organs if a family member objects no organs are donated (I don't know what happens if you have a card but they can't find a family member). This is particularly problematic as it relies on family members making the deciscion at the point where they are least able to make a good judgement.

If these opt-out countries also allowed other family members to object after death I could understand why it might not get enough organs. However, my intuition is that if one had a system which required any person not wishing to donate their organs to register (say online or by mail) in advance I can't imagine their would be a current organ shortage.

Thinking briefly about the matter I'm inclined to oppose a true market in organs not because I'm squemish about offering people money for organs but because I don't think the shortage should be allowed in the first place. While a few people really believe organ donation interferes with their afterlife most people just feel a bit uncomfortable about it. Thus we have a situation where utility would be dramatically increased by demanding that everyone give up their organs. Basically (whatever it's history in common law http://www.yalelawjournal.org/archive_abstract.asp?id=310 ) I'm not a big fan of the right to destroy.

Pragmatically I think this would work best as a government tax credit for organ donation. If this is done in a revenue neutral fashion it effectively amounts to a fine for not donating one's organs. Thus only those people who *really* value not donating organs won't donate while we will still get enough organs for transplants. True, a fixed government tax break doesn't have the same flexibility of a freely floating market set price it also avoids many of the dangers of that route. More importantly though the ability of congress to raise other taxes to compensate prevents the 'payments' for organs from becoming a stealth 'tax' on the medical sector (transfering money from them to organ donars).

In short it seems clear that the utility gained from the benificery of a transplant/research body is greater than the utility lost by whatever percent of the population would have to donate. So I'm all for the government acting to put us in the higher utility state but if implemented as a payment it would risk draining funds from medicine rather than just detering people from not donating organs. Besides a tax break for organ donation (a non-revocable year long commitment) seems a lot more politically possible than payments for organ donation.

In my other post I suggested that a system of tax credits given to individuals making year long commitments to organ donation would be a better system. I wanted to add a few more words about that specifically in response to the points in your article.

First though let me point out that *any* system of compensation for organ donation is going to require a nationwide database for this purpose. The hospital needs to know right away whether or not they can harvest organs and even if family can be contacted how can they know this isn't expressly against the patients request. So as to avoid the severe anguish a person who believes he will not enter heaven because his family will donate his body for the money it needs to be possible for a person to say they don't want to donate. Therefore no matter what the system we need a nationwide databse where hospitals can look up someone's status as an organ donor.

Now a system where hospitals literally paid for organs would need to involve compensating hospitals when they were net donors of organs. Thus in this situation there is an incentive for illicit harvesting and for unscrupulous hospital employees to purchas organs from disreputable sources and divert the payment to themselves. I doubt it would be a big problem but by incentivising through personal tax breaks we completely avoid it. Since no one would have any inventive to produce organs, they would only be urged to commit to donating them on death, this also avoids the problem of rash deciscions.

So in short I think your argument shows that a market would be a better option than the current system but I don't think you showed that it is a better option than other types of incentivation (taxes).

Heck, if you want you could even rig a tax credit to avoid giving the poor the most inventive to donate and make it a percentage rebate. I can't understand why anyone would think this was a good idea but I think the whole idea of saying it is unfair to offer payment for something because the poor will take it seems absurd. The only way it could make sense is if you believe the poor are so stupid that when presented with these options they will make the wrong choice. If you believe the poor would *rationally* choose to donate organs for the money it isn't the payments for organs that are the problem but their initial economic circumstances. If it is rational to prefer money over organs that means the lack of money was a *worse* state than the lack of an organ.

Niven's "Organlegger" stories were set in the near future,his stories about the State hundreds of years farther.I"m a liitle worried about the sale of organs,not because I worry about someone being kidnapped as a donor.(The purported donor and the organ could be easily HLA typed to make sure they're identical),but because of the reductio ad adsurbum a person's worth is their body parts.On the other hand ,I do believe lives would be saved and it's not more intrusive than having poor females serve as egg carriers.
Heinlein carried the sci-fi even farther in a novel tiitled(I believe),"I Shall Fear No Evil".This concerned an elderly multi-billionaire who needed a body for the first brain transplant.They put out signals for someone of a certain tissu: type.the murdered donor was his secretary. To summarize,this isn't like expecting only amateur athletes to compete in the Olympics.I think this is too objectivist.And how I hope Corey doesn't agree with me.

The lack of any moral or religious insight by Mr. Becker and most of the posters is laughable. Sale of organs (or children, or slaves) is not an issue that can or should be evaluated solely by free-market or individual utilitarian concepts.

The minimizing of exploitation of the poor is also troubling. Would poor people and rich people be equally likely to sell organs? Obviously the incentives are far different. Is it just that poor people will sell their organs, but be unable to afford transplants for themselves or their families?

consider this article on obesity, diabetes, and transplants:

http://www.argusleader.com/apps/pbcs.dll/article?AID=/20060103/NEWS/601030306/1001

Whenever one group of people gets to make decisions for another group of people there is a high probability that the decision making group will have no objection to inflicting severe harm on the other group if the decision making group thinks that there might be even a slight benefit to themselves.

If little old ladies were allowed to decide how airport security should treated young Muslim men then the Muslim men would most likely be subjected to horrific inspections (if they were allowed to travel at all). The solution to this problem is to subject little old ladies to the same searches that young Muslim men are subjected to even though little old ladies really aren't very dangerous in this respect.

When it comes to organ sales, there is the problem that rich people are going to be buying the organs and poor people are going to be selling the organs and , in practice, it is the rich people who have the power to dictate the terms of the sale. The solution to this problem is the same as for airport screening: require randomly selected rich people to sell their organs to the government at the going rate and give these organs to randomly selected poor people who need organ transplants.

Even though terrorism is way down the list of things that are likely to harm the average person, terrorism gets enough media attention that people think it it is very likely to harm them. Even if only a few rich people were required to sell their organs at the going rate, if it got enough media attention rich people would think it was very likely to happen to them and they would be careful to make sure that the terms of organ sales were fair.

I'm curious why organ sales creep so many people out. It seems clear to me that we could run it in such a way that kidnapping and organ theft essentially never happened (every donated organ carries an embedded, impossible-to-remove serial number in each cell). In the least objectionable version of the idea, you'd get paid something for agreeing to have your organs harvested at death--I just don't see how that would lead to exploitation of anyone. In a harder version of the idea to get accepted, anyone could sell a nonessential organ now. This means taking some personal risk and doing something unpleasant and maybe seriously painful for money. Maybe nobody's noticed, but there are plenty of people accepting that kind of transaction every day--the world's full of hard, unpleasant, and dangerous jobs.

I think one issue many people miss is that there's already lots of money in the organ transplant industry. The hospitals and doctors don't mind making money off every step of the transplant operation. It's just the donors that don't get paid. So if your concern is that the doctors will pull the plug on your respirator a little early so Bill Gates will get a fresher replacement kidney, that concern exists today, too. If your concern is that your worthless son in law will be trying to hawk your organs on e-bay while you're in the hospital with pneumonia, that's potentially creepy, but it sure seems like the sort of thing we can deal with within the law.

The belief that a market in organs would lead to "organ stealing" is as idiotic as believing that "organ stealing" would be done by patient relatives today under the non-compensated system. If I showed up at a hospital today with a liver in my bag, would they take my word for it and implant it in someone? (Keep in mind the hospital makes money from the operation alone.)

By ignoring basic economics, opponents of organ markets ARE KILLING PEOPLE TODAY who are going without needed organs.

I don't think that an organ market could exist without a level of regulation (just as today's non-compensated donor system requires regulation). It would have to ensure informed consent of the person selling their organ.

Regarding slavery, I consider it slavery that I am unable to sell something that belongs to me, namely my organs. Slavery is about lack of individual freedom. My liver is not an individual. I on the other hand am an individual.

Note that Egg Cell sales are legal today. They involve risks as well.

Organ sale should be treated very differently from the sale of other personal items because, from the donor's point of view, a sale is an irreversible process. Once a kidney is removed from a live body, that body will never be restored to the original state. A wedding ring may be sold in a financial crisis and be purchased back at a later stage when the crisis disappears. The same cannot be said about a vital organ such as a kidney.

Regarding slavery, I consider it slavery that I am unable to sell something that belongs to me, namely my organs.

Since it is legal to give away one's organs, the greatest harm that a person can claim by not being allowed to legally sell their organs is the fair market price of their organs.

In a free market the price of organs is likely to be only a few thousand dollars (and each organ can only be sold once). If denying someone this profit constitutes a severe hardship for them then they have bigger problems than the inability to legally sell their organs.

Chris Laurel:

Thank you for posting the letter. You make interesting comments. Hopefully people listen. Torture is not a great idea, and we still do not have Bin Laden. Focus.

However, you may want to consider ways to be more concise yet convey the same message.

I wish there was a way to concisely peel the many layers of the onion of the problems our country must begin to face.

Unfortunately, our lack of attention spans has created a situation where our problems and solutions no longer conform to sound bites. I believe this was George Bush's selling point, that he had those. We see where that gets us.

yong, I do not see why organ sale should be treated any differently. Isn't the renting out of one's labor and time an irreversible process too? I believe the disquiet about the vendors of organs being predominantly the poor lies in the fact that despite all the economic and social differences between man, our similar biological makeup at least provides a reminder of our common humanity. To "deprive" the have-nots of their organs seems to touch a nerve with those who hold this mentality. Ultimately, however, we have to consider the practical utility forgone in donating a cadaver organ and my belief is that such utility is negligible, which explains why people usually do not make the effort to opt-out in an opt-out program.

there is the problem that rich people are going to be buying the organs and poor people are going to be selling the organs

A number of commenters have made this objection. These commenters overlook the role that insurers play, which is to smooth costs over time and across populations. As with medical procedures currently available, insured persons only pay up front a fraction of the cost of each procedure. Public health sets a low price but rations via waiting lists. There is no reason to believe that these institutions will not purchase organs for their clients and make organs available to as much of the population as other high-cost procedures like heart surgery are now.

Forcing the market for organs underground penalizes the poor because it eliminates insurers and public health providers from the process. Only those capable of paying the full cost of the procedure can then participate.

In the current system, some people miss out on health care. But this is not a reason to abandon any existing procedures: to do so would needlessly condemn people to ill-health and an early death. Eliminating the market for organs is costly in precisely the same way.

BC,

Organ sale can bring irreversible harm. Consider the following scenario. A poor man sells his right kidney in order to cover some financial emergency. He spends the money and the emergency disappears. Then his left kidney is damaged when he gets hit by a car from the left. He is now facing death but no longer has the money to pay for a transplant, a situation he would not have faced had he not sold the right kidney.

There is no reason to believe that these [insurance] institutions will not purchase organs for their [poor] clients and make organs available to as much of the population as other high-cost procedures like heart surgery are now.

That's a good point. I would definitely be more comfortable with the sale of organs if it was subsidized to the extent that organ transplants were equally available to everyone regardless of their financial resources.

Under the current health care system in the United States it is unlikely that people who would need a (one-time) payment of a few thousand dollars badly enough to sell their organs would be able to afford a level of insurance that would provide them with organ transplants.

On the other hand, if the government were to completely subsidize organ transplants (including purchasing the organs) then that would undermine any free market aspects of organ sales.

The question of the sale of organs goes to the heart of property rights and the meaning of “property” itself. There are a variety of definitions of “property,” but they mostly fall under the rubric of either “attribute” or “possession.” To argue that either aspect applies better to ALL situations than the other is to argue for the absurd. It would be like arguing whether man’s altruistic or selfish impulse should be made to predominate in his character (or in deciding ALL matters of public policy), or whether “extroversion” (understood here to mean, “gregariousness”) is better than “introversion” (understood here to mean, “personal reflection”) in judging ALL matters related to “mental health.” These are all ontological scales that apply in varying degrees to all situations--and which exhibit attributes that accrue various benefits and detriments depending on HOW, rather than IF they are applied. This is especially true of “property.”

Attribution vs. Possession is a valid basis for an ontological dichotomic scale related to the concept of “property” in that we usually assign the relational concept of “property” based on the degree of “legitimacy” involved, which is itself intimately related to the issue of personal privacy and its effects on outward (public) policy. Immanuel Kant argued well that policy should be guided by matters that are not restricted by their unilaterally “private” nature. Thus, it is considered illegitimate to pass tithing laws in order to support a priesthood based on some individual private religious experience, but it is legitimate to pass tax and funding laws to maintain a court system to resolve disputes and preserve public order.

The Attribution side of a “Property Scale” would have the greatest legitimacy as it would more closely be based on demonstrable factors related to the subject matter itself. (For instance, water has the attribute that it freezes at 32 degrees F at sea level—this is a “property” of water.) The “possession” side of the scale, while still legitimate, is less so in that assigns property-ness based on assignment “drivers” (“reasons for” possession) rather than attributes intrinsic to the subject itself. Thus, the “properties” of water are higher on the “Property Scale” than one’s having “earned it,” which is in turn higher than one’s possession of “property” due to his divine right as a king. The former properties (of water) are more publicly legitimate than the latter two, which are based on “private” possession.

Although Spin can blur the public’s perceptions of the particular scale level of a given “property right”, the underlying dichotomic scale of “property-ness” remains intact as a valid concept. This said, we are dealing with two points on this scale, set in paradoxical conflict, when we discuss that matter of organ sales.

People will do what they can with what they possess. This doesn’t make it right—or wrong. But there are consequences-and far-reaching economic externalizations, the nature of which cannot be escaped except through the “spin” factor. An organ is an attribute of the human body, and medical science (while having achieved much) is still in the stone ages when it comes to understanding WHAT the human body is. This is also true of human society, of which humans (and their bodies) are a part—and, it is held by most people to be a given that the social sciences are likewise stuck in the stone ages—even more so than the so-called “hard sciences.”

The hashing process of millions of years of evolution has gone into the process of the development of the human body. Likewise, human society has also undergone a similar development whose relation to the individual’s human body is integral, though not at all clearly understood. Mary Shelly was right in admonishing us to take responsibility for our creations. It would be foolish at this point in the history of our scientific development to begin a policy of “allowing” persons to buy and sell body parts based on the legitimacy of “possession” as this would fly in the face of our lack of knowledge about many of the very basics of the body’s attributes. Where does the Mind lay? Do we have a soul? What is the organic epistemology of human “reason and experience” of the world? Are we machines? Are we living souls? Are there Uber-men who have the right to buy and sell their fellows and their fellows’ bodies? What would be the basis of such a right, except that possession has been misguidedly raised to the level of an intrinsic absolute? We cannot even begin to answer these questions with anything more than our fantasies.)

Though I am the first to regard as “divine” those rights granted by reason to dispose of what we understand (as we understand it), I am opposed to the cavalier disposal of what we don’t understand out of some misguided ideology of “property rights.” Granted, Karl Marx was an idiot in this realm—but so was Ayn Rand. In dealing with matters on the “Property Scale” it is better to defer to “attribution” over “possession,” and to behave with the discretion that such deference would demand in the face of a lack of knowledge. Just because we own a building, with certain rights based on the “possession” of same, does not mean we have the ability to jump off its roof based on those same rights without regard to the attributes of gravity. Likewise, if we start cutting off body parts in order to sell them; we are using possession as a “right” that trumps attribute.

We posses our bodies, but we do not posses them in isolation. As we do not understand even the rudiments of the consequences of turning our most private possessions (our bodies) into commodities, we should be cautious of how move into this Brave New World. What we do know is that commodities essentially lose their value relative to other “goods” and become fully fungible—not a fate I wish to enjoy. We also know that our unique human dignity as individuals is a human attribute that, when reduced to being a mere possession, eventually becomes a commodity. Only commodities should be commodities.

Posted by Bill Churchill

The core question everyone seems to be circling around is whether or not a market in organs would create a substantial risk of organ theft. I think the answer is a qualified yes, but even if it is a no one must still consider the harm of public fear of organ theft.

Of course I don't think the sort of urban legend scare stories (man found in bathtub missing kidneys) are realistic dangers. While possible I also think the idea of healthy people truly being murdered for organs is also unrealistic. All of these methods of organ harvesting are less efficent than just going to a poor country and paying people. Also harvesting organs is not something one does with an exacto knife and some ice.

HOWEVER, there is a real risk of more subtle forms of organ theft. If there is a market for organs someone is getting paid to provide them, the most obvious canidate is hospitals since this is where people die but in any case the hospital is going to end up being compensated for providing the organs. So what happens when a hospital makes money by being a net organ donor? Is their subtle pressure on the doctors to get more organs donated, do they get bonuses for more organs?

I think the idea that being an organ donor now means your doctor is somehow going to let you die is pretty absurd. I suspect this preception exists because sometimes a doctor will know that a person has no hope of surviving and starts suggesting donation to the family who isn't emotionally able to accept their loved one's death is a medical certainty. However, if doctors start having financial interests in or job pressures relating to organ donation this gets to be a bit more plausible though still highly unlikely. In any case though this fear serves to diminish the supply of organs so even if in reality there is no danger of doctors making deciscions that are worse for the patient but better for the organs just by raising the spector of it causes problems for a market in organs.

What I suspect would be more likely is theft not by killing the person but by munging their records to make them an organ donor. Sure you might have some national database of donors and only these people are supposed to have their organs harvested on death but once their is a financial interest corruption enters the picture. What prevents people from harvesting organs from someone who doesn't agree and pretending they are from a valid donor who died in the same hospital?

In short there are all sorts of corruption and diversion possible once there is a market price for organs. It isn't the scary stuff of urban legend organ murders but it still has the possibility to cause devote families severe pain and just the spector of influencing medical deciscions may scare away many potential donors. Still I agree with the poster who pointed out that not encouraging donations with money is effectively murdering thousands of people a year. So if our only choice was creating something like a regulated market in organs and leaving the system as it is now I would agree with Becker. Luckily, though, I think my proposal of giving individuals who make a binding commitment to donate their organs if they die inside the year a tax break avoids these problems while still achieving all the benefits.

In fact I actually think registering on a tax form is likely to get the *most* organ donations for a given price. I don't know about everyone else but I would be willing to check a box on my tax returns agreeing to donate organs without much thought but if I had to sign a contract with a private organ donation company I would be much more hesitant. Also since I have to fill out my taxes every year anyway I'm no discouraged by the effort involved as I would if I had to go make seperate arrangements.

The minimizing of exploitation of the poor is also troubling. Would poor people and rich people be equally likely to sell organs? Obviously the incentives are far different. Is it just that poor people will sell their organs, but be unable to afford transplants for themselves or their families?

So when I first saw these concerns about the rich and the poor I thought they were ridiculous. The fact that the poor are more likely to sell their organs than the rich is no different than the fact that the poor are more likely to work in the fields picking fruit or other hard and dangerous jobs. The burden on the poor is their poverty not their option to relieve that poverty by organ sales. Unless you think the poor are just stupid the reason they are selling their organs for money is because having the money is a better situation for them then having the organ.

I think we like to pretend that it is the program that offers poor people money for organs, or money to be sterilized or whatever that is the horrible burden inflicted on the poor. If we admit that being poor is actually worse than having only one kidney then we have to face up to all the pain we cause by not being more generous to the poor.

However, I realized that the commentaters worried about the poor may be imagining a market in organs differently than I am. In particular if we not only pay people to donate their organs but also allow people who need organs to bid on them there is a danger that the poor will end up on the short end of the stick. In particular if the price of an organ rises above the price insurance companies are willing to pay those without sufficent financial resources may be left out in the cold.

For these reasons I think there are big problems in allowing the purchase of organs to work as an unrestrained free market. If it turns out there is a greater demand for organs than supply medicaid and insurers can't pay arbitrarily high sums for organs and people will be forced to shell out of their own resources. Instead I was imagining a fixed maximum price that could be paid for an organ (e.g. the price that medicaid and insurers would be covering) and then a free market in aquiring these organs (e.g. various companies paying people some fraction of the final price to donate).

Anyway I think some of the confusion comes from a misunderstanding of what type of free market in organs we are considering. I was considering one with a fixed maximum price like the one above. This is one of the reasons that I suggested the government should just directly provide tax breaks instead of allowing a market. Once the government is capping the max price as well as who gets to recieve the organ there seems to be little benefit in not directly paying the providers for the organs rather than going through a market of middlemen.

However, if other people are considering the type of free market where the organ consumers are free to bid arbitrary amounts for organs I have serious objections. First of all such a situation is likely to amount in waste. For instance old rich people getting a kidney when they will only live another year at most. Of course current organ donation already results in waste (I don't even know if they demote you for being old or otherwise likely to die as they should) but this would only increase it. More importantly though is the deep feeling of unfairness and hate people would feel if rich people got organs while the poor did not. I think the harms of this are clearly enough that we should first try to pursue other approaches to get sufficent organs.

Ohh and in response to another poster how is this an issue which can't be analyzed in a utilitarian way? You can analyze anything in this fashion, utilitarianism is just a moral framework which says one ought to maximize happiness. Either this is right, in which case it ought to be applied in every situation, or it isn't right. I think perhaps what you meant was that this is an issue where a correct utilitarian analysis would have to look at many more issues than just how many organs are donated and who gets them. As my arguments above illustrate I agree with this point and think people's emotional reactions to these issues are significant enough that they can't be disregarded. However, just because we consider the impact of organ donation on people who have strong religious feelings about it doesn't mean we have to take those feelings seriously. In other words we can just count up how much suffering people experience when they believe various things without needing to take those beliefs as serious contenders for truth.

A number of commenters have made this objection. These commenters overlook the role that insurers play, which is to smooth costs over time and across populations.

You're assuming that poor people and wealthy people are equally likely to have health insurance. In fact, millions of Americans are uninsured, and those most likely to sell their organs would be least likely to have insurance to pay for their own transplants.

Some of the arguments in favor of a market do not reflect medical reality, which I point out as a practicing academic nephrologist. First, it is far from certain that contracting to donate one's organs after death will actually increase the supply of donatable organs, since most people do not die in a manner (brain death on vital function support) that permits successful organ donation. Thus, it may be argued that paying for living donations is more likely to be successful, but that would likely do little to satisfy the need for organs necessary for life, such as hearts. Finally, there is another problem with inducing the poor, which in our society includes large numbers of members of racial minorities. This is the fact that there is a fairly substantial likelihood that these individuals will need all the function of the organ that they can retain, having high rates of disease in the common transplantable organs, such as kidney & liver.

lincoln: Thanks for the Niven correction - it's been over a decade since I read them.

One point that I feel is being overlooked here is the increased cost to society of performing organ transplants in the first place. The transplant itself is costly, but as far as I know, most major organ transplants (not cornea, but kidney, liver, heart, etc.) require the recipient to go on a more or less permanent regimen of immunosupressants. Never mind that the recipient was probably in the liability column on health care costs vs insurance premiums in the first place. Can these organ recipients really return value to society in excess of what they will be costing?

I'm all for respect of the elderly and passing down of wisdom and so on, but Darwinianly speaking, these folks might be unlucky - but on average they will represent a group that hasn't made the best choices in their life to end up in the state where they need a lung or liver or heart, or all three.

Comoditizing organ transplants would have the effect of increasing the quantity of organ transplants practiced, I'm sure that I don't want to look forward to a future where I will spend my retirement savings paying for spare parts from the young and less fortunate, my choice to opt out, but I'd rather live in a society that expends that kind of effort on bettering this world and exploring others, rather than extending life a few more years at any cost.

For the record, I would sell my liver to pay off my college and law school loans. This is not because I am destitute but because the loans are a significant and long-term financial burden, and I believe that donating part of my liver to save a person's life would be a merely physical and ultimately less significant burden. In addition, the burden of undergoing surgery would be offset by the emotional benefit of having done a terrifically good deed.

So it seems to me that those who view these hypothetical organ sales as inherently exploitative need to reflect on the basis of their assumptions. In fact, I believe that the poor would actually be somewhat less likely to sell their organs than better-educated and wealthier persons, for the following reasons:

1) The poorer are less likely you are to have regular interaction with medical professionals, and are therefore less likely to trust them and to credit their expertise. I think of my grandparents, who were poor and more or less terrified of doctors. I doubt they would ever have considered selling their organs for this reason.

2) The poorer a person is, the less likely they are to be well educated. This means less ability to assess the potential risks and benefits of an organ sale--and less chance that the person will go to the trouble to seriously consider the option.

In closing, I would like to cite the well-known fact that the vast majority of sperm donors are med students. I'm not sure anyone knows why this is, but I would wager that it is because they are educated, comfortable with the hospital milieu, and possess more status than money. (Again, note the incentive of mitigating staggering educational costs.) Finally, their product is desirable from a genetic/social status standpoint. I think the participants in a market for organs would for the most part be similarly higher-status, though not necessarily wealthy.

if the government were to completely subsidize organ transplants (including purchasing the organs) then that would undermine any free market aspects of organ sales.

Actually the supply side effect persists with government subsidies. Because organ donors are paid, undersupply can be relieved. Provided government pays a price for organs high enough to clear the market then government intervention, though unnecessary, fixes a problem.

Bill Churchill

There are two fundamental problems in your thesis. One, while you point to uncertainties, you don't identify any outcomes from allowing an organs market so serious as to justify (with certainty) killing thousands every year by banning it.

Two, if trade in organs is permitted then people uncomfortable with the uncertainties, as you are, are entitled not to participate.

Since many thousands certainly die each year as a result of banning organs markets, the benefits of a ban should be large and fairly certain. You haven't said what they are.

GregW

You're assuming that poor people and wealthy people are equally likely to have health insurance.

Actually I didn't asume that. Nobody has explained why public health care will not purchase organs on their patients' behalf. Public providers already fund other expensive operations. You may object to this tiered system, but that is unrelated to whether trade in organs should be allowed. If you believe organs trade should be banned because not every one has insurance, it follows that all high-cost surgery should go.

Joe Merchant

Can these organ recipients really return value to society in excess of what they will be costing?

Yes. Because those opting to participate in the system bear the cost of doing so. They will only participate if they value a longer expected life more than the cost.

Joe Merchant:

Wouldn't the same argument about seriously ill people being expensive apply to any medical treatment that left people needing expensive maintenance care? Two obvious examples (at least one doctor is taking part in the discussion, he can surely come up with many more) are AIDS and diabetes. In both cases, I gather there are reasonably effective treatments for extending the patient's life, more-or-less indefinitely, but they involve continuous monitoring by doctors, continuous use of medicines, and high expected health costs.

Indeed, old age is another example. You'd probably save a lot of resources if you'd politely drop dead at age 65, since by then you're unlikely to contribute much more to GDP, but you're likely to need expensive medical care. But maybe you think you exist for some reason other than to produce resources for others....

In response to: “Posted by ben at January 6, 2006 02:44 AM”

You state that I “don't identify any outcomes from allowing an organs market so serious as to justify (with certainty) killing thousands every year by banning it.”

This is typical of modern political (attack) “rhetoric” in that it puts words in my mouth rather than addressing the issues I have raised. Though I do not agree with what appears to be this person’s position on the issue of the traffic in body organs, nowhere did I justify “killing thousands every year,” nor anything else positive about the marketing of human life other than to state that it is important that we don’t just jump into such a serious cultural and international policy overhaul without giving the issues involved their due (i.e., thorough) consideration.

What we are talking about here is the trafficking in the sale of body parts—parts that any physician worth his salt will admit we know little about in any wholistic sense. Yes, their sale can save lives. Yes, they can be (and have been) sold already.

We do not consider the cow when we eat the hamburger. However, though I am a meat eater, I will not eat a fellow human if I can possibly avoid it. I hope that I will never have to make that decision—or have such an “alternative” easily and cheaply available--There are usually other more creative means of sustaining life and its quality, while preserving the dignity of all involved. I hope I am not the kind of person who would do such things to my fellow human beings—or to otherwise treat my fellows as beings less “deserving” of life based on some ideological claptrap.

What is at issue here is not whether there should be a “ban.” Bans are merely the policy expressions of the underlying will of a critical mass of a public constituency (in whatever form that critical mass is realized). People wil1 do what they will do in spite of “laws”—and what they will do will shape laws. The problem is whether we will reach a critical mass that pushes us towards the Brave New World that Huxley and Hugo warned us to avoid—one in which life is but a cheap commodity.

We cannot buy and sell the fact that we are all responsible for our individual philosophies and decisions, and that our level of humanity is derived from the quality of our decisions and the issues that we consider important in arriving at them. Our decisions matter. Our collective decisions are but an aggregation of our individual decisions. We can begin to address the problem of organ shortages by donating our own organs upon our death—as I have. We can buy and sell organs—which I have not (and hopefully will never) do. We can not escape who we are—and who we are is intimately connected with how rashly we decide issues. I never want to know that an eye I may have received came from someone who sold it to get a few weeks wages to feed their family or buy medical care for their grandmother. I am not such a “God!” We must preserve our humanity and an occasional sense of revulsion to the type of cavalier attitudes that would rashly pass laws that destroy that humanity.

Revulsion is a good thing—it has been naturally selected for in most societies and its presence is a sign of the prosperity that underlies the availability of choices in the face of hard alternatives. The market works, but ONLY within limits and according to its nature. It should never be held up as a utopian panacea that answers all situations. Like anything else in nature, it has its upside and downside—its successes and its failures. When we turn it into an over-reaching paradigm, we risk blinding ourselves to a wider reality—to a wider humanity.

Culture presupposes community—as well as individuality. The issue of the sale and purchase of that which makes us human is not a right-wing or left-wing one. It is not an issue of religion vs. secularism. Such are all cool-aide peddling arch-philosophies,(ala, Jim Jones in Guyana), that have hurt too many people throughout history.

We must strive to not loose our humanity in a world where anyone will try to sell us anything—including each other—for dinner.

Posted By: Bill Churchill

Bill Churchill

You use the word "we" often, but shouldn't it be "I"? Otherwise what you are doing is taking your values and refering to them as humanity's, implying that a preference for organs trade undermines humanity. Since I am a part of humanity, why is my value set, which says such trade (regulated to avoid excess) is ok, any less a part of humanity than yours?

Your whole argument, I think, is that such trade offends your morals, society needs a set of minimum moral standards, and we should be drawing the line somewhere above trade in organs. But, because organs trade occurs between consenting adults (or their legal agents) and imposes no tangible externality on anyone else, doesn't your argument fall over the moment an informed, consenting and rational donor and informed, consenting and rational recipient are paired? If it's ok with their morals, what business is it of yours?

I can accept that there is an externality in that people whose ethics are offended by this practice would prefer not to be surrounded by people engaging in this conduct. But I believe this offense cannot be compared with the daily offensiveness of a child needlessly dying because the organ it needed could not be located as a direct consequence of the values you espouse being quite arbitrarily imposed on others.

I am one of the last people who would ever arrogate to himself the right and responsibility of making personal decisions on behalf of others over their objections, and I certainly would not do so based on “arbitrary mores.” Nevertheless, the fact that such mores exist, points to the fact that their existence and content needs examination. This is true because nothing exists in nature (even in “human” nature) that is truly “arbitrary.”

Nature has selected for mores in every society—even “arbitrary” mores. Why? Perhaps they act as a check on the disasters that may arise from our becoming overly committed to the latest fads and “facts”—even fads and “facts” based on valid discoveries. Perhaps our analogy centered thinking modality makes us vulnerable to the abuse of metaphor. The Free Market is, like everything that our minds embrace, a metaphorical construct—and like all metaphors, it too has its limitations—and can, and has been abused.

Metaphors are representations of reality—they are not reality. Herein lies the limits of the minds of men, that to truly embrace reality, you must embrace all of it at the same time from the same “grasp”—an act only possible to an omniscient God (the existence—or non-existence of which is a whole other can of worms that I will not get into here). We cannot escape the fact that life is a koan--an ultimately unfathomable paradox.

I am neither committing to a “ban” on organ marketing, nor am I embracing it. I am merely suggesting that we hold as valid that some of the moral objections that are raised against the idea of it may be valid. I am also suggesting that, we really don’t have enough of a grasp of what these organs ultimately “do” (both to the individual and to his condition as a participant within the social milieu) to arbitrarily commit ourselves to the policy of “marketing” them as if they were automobile parts.

“Reason” usually follows, rather than leads our “grasp” of “the facts”--We often “know” (i.e., understand) things before we “know” (i.e., can communicate) them. We often knee-jerk object to things out of the necessity to maintain a conservancy of the personal and social organism and out of a deep down knowledge that we don’t always have “the rest of the story.” The facts aren’t as “in” about the “free market” in organs as its proponents would have us believe.

What I can say with some certainty is that moral squeamishness has served humanity well in the past. Remember Eugenics? Remember how it was touted as a “science?” Remember the castrations, forced abortions and euthanasia?--Some “science.” Many people were morally squeamish about eugenics when it came out. I’ll take a little old fashioned moral squeamishness over such “sciences” as eugenics any day. We are not above falling victim to our own arrogance about what we “know”—we are not safe from ourselves at times.

Nature has fortunately selected for “mores” in order to restrain (in some measure) this danger. The study of the fact and benefit of the obstructive function of “mores” is a valid study for the science of economics because it goes to the heart of human behavior in the face of new discovery--behavior which should not be summarily dismissed as the meager product of “parochial” attitudes.

Posted By Bill Churchill (January 7, 2006)

Bill, I hear what you are saying. I only want to comment on one part of your response, which is the reference to eugenics.

I share your distaste of eugenics, but your analogy is the wrong way around. Eugenics and a ban on trade in organs share a key property, which is the over-riding of minority individuals' free will by some self-serving group who bears none of the costs of their views. Both practices see the many inflict tremendous harm on the few.

If the source of your moral squeamishness about eugenics is the physical harm and injustice inflicted on its victims, shouldn't you feel the same way about killing people by preventing trade in organs?

Great post, very well thought out!!!

Be sure Mr Becker: Your precious organs won't be stolen or purchased or other.
In fact, Your brain containing this inhuman project demonstrates the signs of Your staggering elderness.

I think that there are much less controversial ways to solve this problem. Simply adopt the "opt out" system for organs, where the persons who would "opt out" where relegated to the end of the lists of transplants, making it (if waiting lists continued to exist) impossible for the opt outs to get transplants (that seems fair!).
As for live donors of non essential organs, well I think a market could be created... something for society to discuss.

In regard to this kind of economic perspective on things, I think it's very interesting and useful, but more like sexual anatomy is interesting and useful to understand sex, but there is much more to it than that.

I recommend that any persons who are interested in thinking about the possibilities for introducing a form of a "futures" market for body organs take a look at my comprehensive Ohio State Law Journal article (55 Ohio State Law Journal 1 (1994)) that argues for such an approach, as well as some earlier work in this area by Lloyd Cohen and by Henry Hansmann.

Greg Crespi

Prof Becker,

In your estimates of the market clearing prices for organs, did you include the endowment effect as a factor?

If people become so attached to a coffee cup that they received just minutes earlier that it makes trades nearly impossible, then it seems likely that one’s very organs could be exponentially more valued. Although seemingly paradoxical from a traditional rationalistic perspective, people may be more willing to give away their organs than sell them.

-ctr

I have a book on this subject that addresses all of teh objections above. It's called *Stakes and Kidneys: Why markets in huamn body parts are morally imperative* and can be found here:

https://www.ashgate.com/shopping/ title.asp?isbn=0%207546%204110%204

nice
مركز تحميل