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Nobel Prize Winning Economist: Legalize Sale of Human Organs
retroworks writes "Dr. Gary Becker (University of Chicago) and Julio Elias (Universidad CEMA, Argentina) wrote a thought-provoking editorial in last week's WSJ, arguing that the prohibition on voluntary sale and trade of human organs is probably killing people. In 2012, 95,000 American men, women and children were on the waiting list for new kidneys. Yet only about 16,500 kidney transplant operations were performed that year. 'The altruistic giving of organs might decline with an open market, since the incentive to give organs to a relative, friend or anyone else would be weaker when organs are readily available to buy. On the other hand, the altruistic giving of money to those in need of organs could increase to help them pay for the cost of organ transplants.' Paying for organs would lead to more transplants, the article maintains. 'Initially, a market in the purchase and sale of organs would seem strange, and many might continue to consider that market "repugnant." Over time, however, the sale of organs would grow to be accepted, just as the voluntary military now has widespread support.'"
Over time, however, the sale of organs would grow to be accepted, just as the voluntary military now has widespread support.
Over time, however, the sale of bananas would grow to be accepted, just as the Lil' Orphan Annie Fan Club now has widespread support. Wait, what? Oh, they're trying to draw a parallel based on efficacy, as opposed to such piffling concerns as morality. TFA goes on to say "Whether paying donors is immoral because it involves the sale of organs is a much more subjective matter, but we question this assertion, given the very serious problems with the present system." but problems with the current system don't excuse problems with the proposed system.
"You're right," Fisheye says. "I should have set it on 'whip' or 'chop.'"
The buying and selling of human organs is a very, very bad idea. May as well grow humans for the body bank if we are going to go down this route. And just like you have theft of other sold goods how long would it take before organ theft became the new wave of crime?
This is a sig. This is only a sig. Had this been an actual sig you would have been informed where to tune for more sigs.
The biggest reason why there is an organ supply problem is that there is no incentive for people to give up their own organs. The solution is to create a donor list: if you are on the list you will receive organs before none donors in the event you need one; if you are not on the list then that is your right, but its unethical to expect to receive an organ when you yourself are unwilling to donate. This respects freedom to choose, but it also respects that organs are not completely free; if everyone was willing to give their organs, there wouldn't be a supply issue.
Because it's exploitative, the way the act of performing surgery is not. Compare to how selling yourself into slavery is illegal, even though theoretically it's "your own body".
I think allowing the sale of cadaveric organs is reasonable; right now, hospitals and doctors effectively enrich themselves and frequently engage in fraud and nepotism. Getting that money to the family of the deceased is a good thing.
I draw the line at for-pay live organ donations. Taken on their own, they are likely to be beneficial to both recipients and donors. However, once there is a large market and medical facilities for for-profit live donations, the risk of criminal activity in this area becomes much larger, including blackmail and other forms of coercion, and that worries me.
Making a market for it, something for rich people could pay (even for cosmetic or fashion reasons, you can drink a lot, because anyway you can replace your liver with a new one) a lot, and poor people on economical troubles, extortion, threats, or media manipulation (to name a few) would sell, is something that will become corrupted very fast. What some countries are doing is opt-out organ donation on death, while that have no market around it should be free of abuses.
Organlegging: Technology needed to deal in illicitly obtained body parts.
Bill Christensen wrote: As far as I know, Niven was the first writer to really work with a topic that is just starting to become a problem, thanks to drugs that make transplantation viable.
davecb@spamcop.net
That strikes me as a MUCH better solution. Well, not quite solution, but it would help a great deal.
Part of the problem with trying to use market ideas to improve the situation is that available organs will always be in VERY short supply. The number of bodies that are actually in a condition to have organs harvested per day is pretty small (except for organs that can non-fatally be removed like kidneys), while demand is pretty high. No matter how good the incentive is, the supply will simply never be there, which means the market would shift to only the very wealthy being able to afford them while today the availably across the economic range is pretty good.
It's not repugnant to perform the transplant and sell a medical service. What's repugnant is to coerce a man in difficult financial position to sell parts of his body that are essential to his well being and survival. It's a lesser form of selling one's own life for the benefit of the rich fuckers of the world.
Because it's an issue of consent. They are charging for labor and skill. Consent is hard to establish in the case of organs, and it arguably matters much more than with something like a car, or even a house. Is consent present when an unemployed single mother sells a kidney for 30,000 dollars? How about when a guy sells one to pay his credit card debt? Should bankruptcy court consider your organs assets when you file? What about education? 22 year old with 60000 in non-dischargeable debt sells organs to pay off lenders? Do we want people selling organs for capital to start businesses (with a high chance of failure)?
And what happens when the price of organs goes down, because there are so many poor people with this one valuable asset to sell and they sell in large numbers? If the market crashed, it would die, because nobody would be willing to sell, and good luck getting a donation when you can buy one on the market.
A surgeon charges for his services. What makes selling organs disgusting is the idea of treating the human body as hunks of meat that are priced based on their quality. From a philosophical standpoint it is dehumanizing. From a religious standpoint it is offensive (I'm an atheist though, so maybe I should have skipped this point). From a social standpoint it can be devastating - imagine people starting selling parts of themselves if they need, or just want the cash.
From a pragmatic standpoint it's alarming to think that a mugger now has a financial incentive to butcher me, rather than just taking my wallet and moving on.
It's a bad idea because it will make easier to exploit people. "Go to the ospital, sell a lung, come back, give me the money or several bad things will happen to your family." Suddenly people which were safe because they don't have anything to steal are not safe anymore.
Oh yes and this would give rise to a new species of business plan: Groom the favelas and ghettos of this planet for the illiterate and hopeless, get them to sign a binding agreement, harvest the organs and then export them to the U.S.. If not legal in the country of origin, just fly them to whatever clinics they may have a contract with, harvest there and dump the human trash back where it belongs. This would solve the organ donor problem for just a nominal fee - and give all those valuable business students a great way to earn money... On the other hand those entities could promote organ donor-ship and try not to mess it up like in Germany (where hospitals manipulated the lists to get their patients/the highest bidder to the top of waiting lists and where organ donations have now dropped to an all-time low as a consequence of the scandal).
The solution is to create a donor list
Actually, this solves nothing. The vast majority of people will never need an organ replaced, and it is something they just don't think about. Most people are non-donors because it is an opt-in system, and they haven't made the effort to check the box. A far better solution is to make donating the default, and require people to check the box to opt-out.
Another solution would be to repeal motorcycle helmet laws. Most motorcyclists are young and healthy, and death by a good clean head injury often leaves plenty of other organs intact and available for donation.
My agreeing to accept $X for my estate (family/cause/etc) for my liver/cornea/whatever is no more "exploitative" than any other transaction.
I think most people arguing against a market in organs are mainly against compensation to living donors (for their second kidney or whatever), and would be less opposed if compensation was restricted to the families of dead people.
At least in the US, this is 100% wrong. If you donate a kidney and later need one, you are automatically at the top of the list to receive one.
Everyone knows money motivates people. There are other considerations in the prohibition against the sale of organs.
This is why we don't let economists run the world.
What is evil? I like the AD&D definition - a scale of more and more willing to allow harm to others for your own benefit. Of course, what is seen as harm that matters is the rub.
Would an open organ market save lives - oh, yes, and prohibiting it does cost lives - so one could certainly argue like here that the prohibition is evil.
But allowing such a market will create a society that allows much more willful harm for profit. Right now, organ illegal organ harvesting exists, but is somewhat rare and difficult to make a safe profit from. The legal 'market' is based on donations - so there is no prohibition on the act of getting organs, there's just more people with failing organs than people dying with healthy organs.
The results of allowing an organ market would be an opening bubble resulting in increased harvesting amongst the ethically 'invisible' (poor/isolated), and a greatly increased demand for 'donors' either desperate or false (in order to launder organs). Some of this will be caught, but much of it would become institutionalized.
The endpoint would be a lot of poor people across the world dead and permanently disabled, a lot of wealthy and older people living a few months longer, a relatively few children of the wealthy saved, and a HUGE number of people financially invested in the organ market through their banks and mutual funds.
This last part is the big evil thing - markets always, ALWAYS demand more - more organs, more secrecy, more profitability. They thrive on multiplying evil in terms of harm ('externalities') in order to create better profit ratios.
The whole pattern is just far to evil for me.
I'd suggest putting more money into single-organ cloning (there's been some amazing developments lately), but if there's one thing the market process is HORRIBLE at, it's doing scientific research - it always seems to abandon anything long term, treats it only as marketing, and destroys far too much (to prevent helping 'competitors'.) Taxes, though a limited kind of evil, tend to be much more productive over time for the same result.
Ryan Fenton
Crime should be illegal. (That's sarcasm.) The specifics of a criminal's threat are essentially meaningless. Somebody who is deranged enough to use violence or the threat of violence to get money will do so regardless of what specific mechanics are available. What's stopping these people from kidnapping loved ones and sending back body parts until the ransom is paid? That's a pretty classic one. Deranged, violent criminals are going to be deranged, violent criminals no matter what. The merits and detriments of a proposal such as this need to be evaluated outside of a context of law breaking, because, unsurprisingly, law breakers don't care about laws. That's kind of what defines them.
I support the Slashcott and will not be reading or commenting from 2/10/14 to 2/17/14. Beta is steaming pile of dog shit
The real solution is already known: organ donation should be opt-out by default. Studies have already been conducted that organ donation is above 80% or so in countries that adopt an opt-out default, and only 20% or so in an opt-in system. Most people simply don't take the time to opt-in, but they similarly wouldn't take the time to opt-out.
Higher Logics: where programming meets science.
The solution is to create a donor list: if you are on the list you will receive organs before none donors in the event you need one/
Not everyone who would benefit from a donation can be a donor. Those most in need of a donor are unlikely to find a place on your donor list.
if everyone was willing to give their organs, there wouldn't be a supply issue.
This isn't simply a problem of supply and demand but of time and place. Doubling the pool of potential - not actual - donor organs doesn't mean you have doubled the number of successful organ transplants.
I think most people arguing against a market in organs ... would be less opposed if compensation was restricted to the families of dead people.
Depends on how they wind up dead.
Agreed, but we should not make things easier for them. Legal sales of organs open up too many exploitation scenarios. That's enough for me to keep it illegal without even starting to discuss about the ethics of the thing.
An open market to sell yourself into slavery also legitimizes your ability to chose that sort of life, that doesn't mean most people using it are not coerced. Financial coercion is just as good as physical coercion for taking a man's liberty away. There's no "free choice" between selling your organs and dying of hunger or seeing your children suffer because you are unable to provide for them.
The black market argument is morronic. There's a black market in just about every despicable activity we can imagine, say child prostitution. Should we legalize child prostitution because we already have a black market choice on the matter ?
Wow, it looks like the mere idea has generated a visceral reaction. Generating awareness of the kidney shortage is perhaps what bothers people most. But I think they make a legitimate case, as follows.
1) It is a mathematical certainty that the current system will not produce the number of kidney donations needed. So as yucky as liberalizing the trade may sound, people on the front lines need people like these economists to be discussing the matter.
2) The authors bring up a very good point that the current restriction creates a bottleneck. One can only donate a kidney once. Most people therefore hold off, not knowing the "future value" of the kidney (e.g., if a closer friend or family member may need the donation). However, many of us who may be unwilling to contribute 100% to someone would possibly consider donating $500 or $1000 to someone. The current system makes a "kickstarter" donation system impossible. And if I'm paid for a kidney, and can put the money in the bank to draw interest, knowing I can buy another kidney back if necessary, it might make me more likely to give one up.
3) For all the hand-wringing about the poor people who will feel the pressure to sell a kidney, there is a very legitimate argument that those poor people should decide on their own if they want $50,000 for a kidney. What merits the state's law against them selling something they own? And what about poor people who need a kidney? Do they stand a better chance if there are fewer incentives, and fewer kidneys?
Stand down, /. mob. At worst, this discussion brings up the inconvenient subject of donation.
Gently reply
Rich people don't donate organs in exchange for money. EVER. Poor people do. So yeah, let's help those economically poor people become even poorer in body and hasten their exit by letting them sell off pieces of themselves, and good riddance.
"Another solution would be to repeal motorcycle helmet laws."
Also ban seat belts in cars and make texting while driving compulsory.
Now they presented us with a spirited defense of high-tech cannibalism. That is no surprise to anyone at the least familiar with those people. The whole profession of economics is morally and intellectually suspect, and the Chicago school - particularly so.
Requirement potential sellers take a lie-detector test, show they are in good health financially and physically...
The point is that people who are in good financial health and well-enough informed to give legitimate consent don't generally choose to risk their lives to sell an organ for cash. Nobody says "I think I'll roll the dice on a 1 in 400 chance of death associated with this hepatectomy because I'd just like to see an extra twenty grand on my bank statement". Such sales will nearly always be to fulfill some unmet financial need or want.
You're also going to have trouble finding physicians and surgeons to carry out these procedures. Contrary to the perception of them as soulless, money-seeking robots, they tend to actually have pretty refined ethical senses. Speaking as a person who has made a voluntary, altruistic organ donation to a loved one, I have to say that I was thoroughly impressed throughout the process by the efforts made by the transplant team to ensure that I fully apprehended the risks associated with the procedure, and that my choice was entirely voluntary and uncoerced (including bribery or payments).
Among other steps, I underwent a psych screening, physical exams with a couple of doctors, and interviews with a couple of the transplant hospital's surgeons. One thing that very much stuck with me was a conversation with one of the transplant surgeons as part of the informed consent process. He told me that these procedures were already very difficult for these surgeons, ethically speaking, because a very big part of their training emphasizes not carrying out procedures that have no health benefit to the patient. For organ donors, the surgery will never make them better; it can only make them worse, and it may kill them. For surgeons, the absolute worst-case scenario in their line of work is to bring a perfectly healthy patient into the hospital, perform a medically-unnecessary procedure, and debilitate or kill that person who otherwise probably had forty healthy years left. The surgeon I spoke to noted that he hadn't lost any patients yet (knock on wood), but that he knew surgeons who had had the experience. He told me that it had changed them; that it had been enormously traumatic.
While it's not too difficult to find transplant surgeons who can reconcile the ethical dilemma in play when a patient is willing to risk their health for the benefit of a child, sibling, parent, spouse, or other loved one, I suspect that you're going to have a lot more pushback when you ask those same surgeons to hazard the lives of healthy people in exchange for mortgage payments or a new car.
~Idarubicin
Seriously, there is no Nobel prize in economics. There is however a prize setup by the Swedish bank hijacking the prestige of real Nobel laureates. Further members of the Nobel family have spoken out against it.
Why not just give people a small financial incentive to tick the "yes, I donate all my organs if I die in an accident" box when renewing their driver's license? Offer $50 of public money for ticking that box, and the number of organ donors would probably rise dramatically without putting anyone at risk of exploitation.
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The banksters and wall street hedge fund managers have taken all the money from the poor, and corrupted the government and have taken all the powers. They have devalued labor to nearly zero compared to the value of the capital, rent and carting. The only thing poor still have left in them to sell to the rich are their organs. They are going to go after that too. They have created enough shills for themselves by giving them Nobel prizes and installing them in Booth School of Economics in the University of Chicago.
sed -e 's/Chuck Norris/Rajnikant/g' joke > fact
This then creates an incentive to transition people from the state of living to the state of dead.
This incentive already exists. There are huge profits in harvesting organs. A kidney transplant can generate $250k in fees. A heart transplant can cost over $1M. It is just that, under current law, none of that money can go to the donor or to the donor's family. The medical system gets to keep it all.
Here is a list of transplant costs, including the cost of "procuring" the organ.
yup, they're economists basing everything around economics.
True, but the proposal is not just economics but economics with a political bias thrown in. For example you could allow selling of human organs to encourage supply while requiring that they are sold to a central agency that then distributes them to hospitals based on where they will be most effective. This would be using economics to encourage supply while still maximizing the life saving potential of those organs by directing them based on medical need and prognosis rather than bank balance. It would probably also work well in the majority of countries which have a national health care system.
While I'm still not sure I really agree with even this it would be one way to use economics to address the stated problem of a lack of supply. Of course it would not let rich people use their money to get preferential access to organs but surely this was an unimportant, unintended side-effect of the original proposal, right?