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A Simple Solution to the Shortage of Organs

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"The infliction of cruelty with a good conscience is a delight to moralists." So said the philosopher Bertrand Russell (1872-1970). That well characterizes our national and state governments that have enacted laws prohibiting the commercialization of human organs. An ethically debilitated society thereby compels thousands of anguished patients to die unnecessarily hoping and awaiting for organs now senselessly squandered by a moralizing, quasi-theocratic society and a self-righteous medical guild, -- all, of course, with a good conscience.

A decade ago in an article published in an international journal I insisted that it is justified and necessary to buy and sell human organs (Medicine and Law, vol. 7, 1989). A few years later I expanded the idea

by proposing an unfettered and well-regulated auction market as a better, indeed the only practicable, solution (Medicine and Law, vol. 11, 1992). Now the State of Pennsylvania is risking infringement of the immoral federal ban by offering to pay $300 to any family whose member donates organs at death. However laudable that gesture, it is an unspeakable affront to human dignity in general and to the family and the memory of the deceased donor in particular. Only an ethically addled government could be that stingy with a good conscience.

 

It is almost impossible to price arbitrarily and fairly such valuable things as human organs. They obviously have different values, based primarily on availability. Kidneys, being paired, tend to be the least expensive and in the past in some foreign countries have sold for as much

as $45,000 each. Livers are unpaired and more difficult to remove from a donor; they should cost more. Hearts and lungs must come from brain-dead donors whose hearts are still beating; they are the most expensive, especially lungs which are fragile and vulnerable to infection. Trying to establish prices through thousands of individuals one-on-one negotiated transactions (or haggled deals, one might say) would be unseemly, chaotic, and essentially unworkable.

The solution lies in the ordinary supply-demand mechanism with minimal modification, of an organized auction market. The most valuable and essential item in transplantation is the procured organ. It legitimizes the whole endeavor. To insist that it be the only altruistically donated thing in an extremely expensive, capital intensive undertaking is absurd, while all

medical personnel, hospitals, laboratories, and suppliers are very well paid. Any procured organ is more valuable than the surgeon's skill, if for no other reason than because it is in shorter supply than is the skill. Therefore, in any commercial arrangement the price of a vital organ should be higher -- much higher- than the surgeon's fee.

Disregarding theoretical arguments in my two published articles, in brief here are the foreseeable advantages of an auction system (which should be at least national in scope and preferably international). A successful high bidder, who may or may not be considered wealthy, would not begrudge and would gladly pay the high price of a timely organ. The introduction of a strong, even irresistible monetary incentive would increase enormously the willingness of the next of kin to permit donation. That would activate the huge dormant source of organs which is lost every year through improper motivation for donation by families of approximately 90% of more than 20,000 potential donors. In a very short time an ensuing oversupply of organs offered for auction could lead to plummeting prices and even to the fortuitous consequence of essentially altruistic donation now so passionately advocated. The major portion of any price paid would go, by established formula, to the donor's family. Other substantial allocations would cover, wholly or in part, medical fees and cost of hospitalization and materials; would fund research; and would establish a special auction fund to bid on behalf of poor or indigent patients.

Other less obvious advantages are noteworthy. Private funding through auction would help ease the financial and litigious burdens of organized health plans and would eliminate the need for demeaning solicitation (or begging) for funds to aid uninsured families. More surgeons would work more often to hone their skills, improve their results, and earn higher incomes in the process. There would be no extra cost to taxpayers; and otherwise idle money would filter through and help stimulate the economy. All this can be accomplished with the potentially huge amount of money accrued through consistently highest possible prices for multiple organs in a now greatly expanded (if not maximal) pool of donors.

Other than the wounded psyche of certain dogmatic critics, who

of course moralize with a good conscience while thousands die, where's

the disadvantage? Invariably "sanctity" of the human body is involved.

But transplantation is a medical procedure having no real or justifiable connection with the theological myth of sanctity. Ask the parents of an

infant with an implanted baboon's heart if they feel that their infant's body

has been rendered profane. As an adult with a purchased implanted kidney if he or she is or feels less "sacred." Will a transplanted pig's heart blaspheme a human adult who bought it? The real immorality is to nurture and sacrifice innocent pigs for their organs (which certainly will be costly) while callously letting available human organs rot because to commercialize them would be a "sin." Furthermore, the myth of sanctity is invoked forcibly and immorally through law to prohibit a healthy adult, with fully informed consent, to sell a kidney to save an adult's life, or to sell a piece of liver to save a child's life. It is ethical today for a parent to donate a piece of liver to the child; but if there were no parents or relative to donate, moralizing critics would preserve "sanctity" and doom the child by prohibiting a stranger's sale of the life-saving fragment.

One should not forget that blood, too, is an organ; and transfusions are life-saving transplants bought for many years from countless sellers. Even gametes have been commoditized, with sperm samples priced at an average of $50 each. Now human eggs have been sold for as much as $35,000 each, some being offered for $50. Such use of gametes essentially represents whole body transplantation! Yet all this commercialization is practiced and even extolled without an iota of concern over "sanctity" by its beneficiaries and society at large.

Some critics contend that an auction market would be unfair to

the poor. As already mentioned, a considerable amount of money raised through auction would be used to bid for the poor. If that's not enough to quell concern, then here is a fool-proof solution: a successful bidder would receive the life-saving organ only by agreeing to buy an organ, any vital organ, through the auction market for a poor recipient high on the waiting list. If, for example, the successful bidder in need of a heart were very wealthy, he or she might pay perhaps half a million dollars to guarantee having the heart, and in turn bid and pay perhaps thirty thousand dollars for

a kidney to be given to a poor patient. I am sure that no wealthy bidder with life at stake would balk or even flinch at this, for the rich, relatively tolerable added cost of such compulsory beneficence.

Potential donors are numerous. As pointed out above, only about one of every 10 families of brain-dead patient (whose hearts are still beating) opts for donation of all vital organs. Patients whose hearts have stopped beating (so-called NHBD or non-beating donors) now can donate at least kidneys and livers. In addition, some of the almost 4,000 men and women on death row in the U.S. want to donate organs when they are killed and to have most of the resultant money from any sales given to the families of their victims. Could there be more genuine or more meaningful retribution?

An auction plan for organs can be well organized, well controlled,

and smoothly operational. The dire warnings of perpetually alarmist

critics paralyzed by the "slippery-slope" bugaboo merely project their keen

awareness of their own latent and facile corruptibility. Did the nation, and the world, slide down that slope through decades of paying for blood to transfuse? This pet platitude of dissembling hypocrites is anathema to rational solutions. Dr. Samuel Johnson (1709-84) said it well: "Nothing

will ever be attempted if all possible objections must first be overcome."

The lives of 62,000 Americans now waiting for organs demand an attempt

to auction them, no matter what the objections.

An auction market probably can function best if it is free of absolute governmental, political, academic, sectarian, or plutocratic control. It is best left to the common sense of ordinary citizens aided by the organizational and operational guidance and counsel of medical and social economists with impeccable integrity, competence, and experience. The input of those with expertise in commodity and stock markets would be helpful, if not indispensable.

The time is long past for treacly rhetoric and half-hearted, futile measures. The noted sociologist Friedrich Engels (1820-95) put it succinctly: "An ounce of action is worth a ton of theory." We've now had more than a ton of theory and less than a gram of action. So-called implied consent laws, which have been debated in the U.S. and enacted in Europe are intentionally deceptive and ipso facto unethical; they in effect sanction the theft of organs. Coercive required request laws infringe the autonomy of medical personnel by compelling them to query family members about donating; and this immoral measure has failed. So, too, has pure altruism failed. Sacrificed pigs from sanitized sties are not yet available. Their organs will be costly, and it will be unethical to use them while ignoring

the ample supply of human organs that, if given a chance, could cost less.

Until progress in technology and tissue culture yields the mass production

of industrially and biologically fabricated organs – which is not on the immediate horizon the current overwhelming demand for them must be

met through a supply maximized by the right inducement for donation. Fabricated organs, without a doubt, will cost more than any surgeon's fee.

We're facing a worsening crisis. The current organ procurement system is creaking badly. What it needs is the "grease" of money, and plenty of it. That calls for a couple of tons of bold and effective action now, -- auction action!

9/12/99



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