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Common objections, and our answers to them
- 1. Human organs should not be viewed as commodities.
- 2. It'll discourage people from donating,
and taint the whole process with greed.
- 3. Poor people will sell one of their kidneys, and
end up with health problems that are not only a tragedy for them, but something the rest
of us have to deal with
- 4. People will start killing each other, and
selling the organs to unscrupulous organ brokers.
- 5. Isn't there a danger that, under your proposal,
we'll have so many organs that doing all of the transplants will bankrupt our health care
system?
- 6. It doesn't cost anyone anything to give
up their organs after they're dead, so why should they or their estate receive any
compensation?
- 7. How much is a given organ worth? $3000
doesn't seem like very much money in a free market organ selling system. I can envision
that higher or rising market prices for organs could lead to prohibitive expenses for
recipients with less resources, i.e., only the rich could afford an organ under such a
system. Wasn't there an organ offered on ebay for over a million? Why give one away when
you can sell it for much more?
1. Human organs should not be viewed as commodities. [This
is the justification given by the U.S. Senate when
they banned organ selling in 1984.] But they already are
commodities, in the sense of being desired objects that are routinely transported from
one place to another. Here at the University of Pittsburgh Medical School,
transplant surgeons carry human organs around in Igloo containers, and these organs have
come from all over the country. Is it morally preferable to allow patients and
their families to undergo unrelenting mental and physical suffering, followed by certain
death for thousands of them each year, just so we can maintain a pristine, fairy tale
notion that the human body is literally priceless? [back]
2. It'll discourage people from donating, and taint the
whole process with greed. It is true that some people who now donate would
prefer to receive some monetary compensation when they give the gift of life. But
doctors and hospital personnel already earn a very good living from the process. Why
should those who actually provide the organs be the only ones who don't receive any
monetary compensation? And, frankly, I wouldn't want to have my life depend entirely
on a stranger's generosity when it could more reliably depend on their own self-interest. [back]
3. Poor people will sell one of their kidneys, and end up with
health problems that are not only a tragedy for them, but something the rest of us have to
deal with. No. We're proposing only to
legalize monetary compensation for cadaver organs, not
for organs from the living. [We note, however, that the latter is already happening
for kidneys and bone marrow, and even for removal of part of the liver, which can
regenerate. If a greatly increased supply
of cadaveric organs is not enough to meet the demand, we'd find nothing wrong with
exploring monetary compensation for regenerable organs from the living, or even for a
kidney, since that does not jeopardize one's health.] [back]
4. People will start killing each other, and selling the organs
to unscrupulous organ brokers. Murder will continue to be illegal,
with all the risks associated with it. And, because there would soon be no shortage
of organs under our proposal, monetary incentive for such illegal activity would be
minimal. In addition, hospitals would have no need to deal with shady organizations.
Besides, there's actually a greater likelihood of people being killed for their organs
under our current system, due to the huge shortage. (In fact, there have been credible reports that
prisoners in communist China have been executed on a timetable that allows their organs to
be harvested and sold to buyers overseas.) [back]
5. Isn't there a danger that, under your proposal, we'll have so many organs that doing all of the
transplants will bankrupt our health care system?
ANSWER #1: quoting Al Gore from a July 29, 1983 U.S. House
hearing (p.14): "The biggest irony in this whole issue is that the studies
indicate that the cost of terminal care for the long period of time these children and
other patients survive up until the point of their death - the cost of that terminal care
- exceeds the cost of the transplant which would save their lives and avoid the cost of
the terminal care."
ANSWER #2: Hmmm...that actually COULD be a problem! Maybe we should get government
out of the health care field entirely, and let people deal with one another on a free,
voluntary basis to satisfy their needs, much as we do with our other important needs, like
food, clothing, shelter, etc. If government were to let us keep more of our own
money, we'd be able to afford to pay for routine medical expenses out of pocket, and
insurance could easily cover those rare but costly procedures like organ transplantation. [back]
6. It doesn't cost anyone anything to give up their organs
after they're dead, so why should they or their estate receive any compensation?
You could make the same claim for Saudi Arabian oil. It wasn't doing the
Saudi's any good, with their nomadic life, so why shouldn't they let our oil companies
come in and take it for free? Our companies would do all the work. And, so the
argument goes, the Arabs could and should feel good about themselves, as they were helping
their fellow men. But how much gas would we have for our cars if we depended on
Saudi generosity, rather than their own self-interest? And, when you stop to
think of it, the Saudi oil sheiks are less deserving of the payment for their
country's oil than people are for their organs, because that oil properly belongs equally
to all of the Saudi people, whereas individuals are the proper owners of their own bodies.
[I'm indebted to Dave Glasser for this analogy.] [back]
7. This question comes from Dr. L.B. How much is a given
organ worth? $3000 doesn't seem like very much money in a free market organ selling
system. I can envision that higher or rising market prices for organs could lead to
prohibitive expenses for recipients with less resources, i.e., only the rich could afford
an organ under such a system. Wasn't there an organ offered on ebay for over a million?
Why give one away when you can sell it for much more? First of all,
organs are already very costly. The organ procurement organizations we have now are part
of one big monopoly, and their charges for organs (~$25,000 for a kidney) are
set by fiat, not by market processes. Secondly, we're only proposing to change the
procurement end of the system, not the delivery end. Hospitals and transplant surgeons
could still allocate organs on the same "as need" basis that they do now,
largely independent of ability to pay. Thirdly, when you assume that it is immoral for the
rich to receive better health care than the poor, you begin a headfirst slide down a
slippery slope to communism, because, for example, the rich already can afford better
doctors, safer cars, don't have to experience the danger of working in coal mines or
meat-packing plants, etc. Poverty is an
important and relevant issue, however, and I touch lightly on it elsewhere.
Finally, the rich only can use so many organs, and since the supply
would be adequate to meet everyone's needs, the market price could not be prohibitive
(in fact, $300 for partial funeral reimbursement might be
enough to greatly increase the supply.) It is true, however, that if we allow price
to be a factor, the wealthiest patients would tend to get the healthiest organs.
Continuing. Since a true free market requires freedom at
both ends, that means that organ brokers would be free to seek the highest price for their
organs. Because the medical field itself is a monopoly (one cannot practice medicine
without a license, and the medical profession limits the number of doctors), transplant
surgeons and hospitals have no "outside" competition. Thus, they are free to
agree amonst themselves never to pay more than, say, the current $25,000 for a kidney,
without having to deal with the normal market pressure of others getting into the business
who might be willing to pay more for organs, in the knowledge that many patients would be
willing to pay a bit more for a transplant now, rather than waiting an indefinite
period of time for a cheaper transplant via the normal channels. But competition need not
come only from within this country, and we cannot easily control what other countries do.
Thus, such a monopolistic strategy might result in some organ brokerage firms selling
their organs to overseas hospitals that treat only rich patients, and who are thus willing
and able to pay much higher prices for organs in order to get all that they need. We could
continue our authoritarian ways and create laws to prohibit such sales to foreign
hospitals. But that, in turn, might create an incentive for people to go overseas to die,
so that their organs could be sold and their heirs could reap the hefty financial reward.
Shall we then prohibit our citizens from freely traveling the world? God save us from the
control freaks!
Are any such fears justified? I doubt it. Let's look at
that current $25,000 cost for a kidney more carefully. It's certainly conceivable
that a free market price would be higher, since it would have to encompass the price paid
to donors or their estates. But I'd be willing to bet that costs elsewhere in the
procurement system (such as administrators' and/or organ retrieval surgeons' salaries)
would come down substantially, due to competitive pressure, leaving the final cost the
same or, more likely, even less than it is now. (Economists talk about a
"bureaucratic rule of two," which states that a service provided by a government
bureaucracy always costs twice what a free market system does.) [back]
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