Organ Selling

Organ Selling is a website dedicated to ending the organ shortage and the attendant needless suffering and death each year of thousands of prospective organ transplant patients simply by allowing monetary compensation for cadaveric organs, which will greatly increase the supply.

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Our proposal and how it will save lives

We propose that Congress pass the following bit of legislation: "The National Organ Transplant Act of 1984 is hereby amended to permit monetary compensation for cadaveric organs."  Click here for our May 2003 letter to Congress.

The essential facts:

The proposal is to allow monetary compensation for cadaveric organs, i.e., organs that are removed after death - specifically, after brain death. We are not proposing to allow monetary compensation to living donors, although we discuss it as an option below, and have excerpted an article in which this was proposed and defended.  Thus, there'd be no need to fear that poor people would sell one of their kidneys just to put food on the table. (This is not the place to get into a discussion of poverty and economic justice, but here are some of our favorite links regarding fundamental questions about economic justice and the only true remedy for poverty.)   Neither is there any need to fear that some people might be killed for their organs. Organs for transplantation, unlike bodies to be used for anatomical dissection, must be removed in a hospital while the person's heart is still beating. One would have to have almost an entire hospital staff complicit in murder - people who have nothing to gain and everything to lose from such behavior.  Thus, fears about a new breed of "body-snatchers," at least in this country, are totally unreasonable.

How the cadaveric market will work, in detail

A cadaveric organ market could work in several ways.  One would be a future's market, where individuals would sell the future rights to their organs for money now, to be enjoyed while they're still alive. (This could take the form of reduced health insurance premiums.) Because only a small percentage of people would actually yield usable organs, the amount might be fairly small - several hundred dollars, and a few thousand at most. This may not be the most efficient sort of market.  The other is an after-death market, whereby the families of brain-dead potential donors could receive some form of payment after the death, either as cash given to the deceased's estate, or in the form of reimbursement of funeral and/or hospital expenses.

Organ brokers would pay  Who'd pay for the organs, or for the future rights to them?  Organ brokerage firms, which would act as intermediaries between buyers and sellers, i.e., between those who need organs and those who provide them.   Many similar organizations exist today (about 110 existed in 1983), called Organ Procurement Organizations, but they are prevented by law from offering monetary incentives to potential donors.

Living donor option  If, contrary to our view, a free market in cadaveric organs proves insufficient to meet the demand, we see nothing wrong with allowing living donors to be compensated for donating renewable organs, such as a portion of their liver, bone marrow, or even a kidney, given that survival rates for people in this country with one kidney are the same as for those with two.  (Supposedly, one only needs the output of half of one kidney to survive.)  From the standpoint of the doctors involved, such an alternative would be morally justifiable only if the cadaveric market was already being completely utilized, and still found to be unable to provide a sufficient number of replacement organs.  This is so because a doctor's first duty is to do no harm, and there is always risk associated with being a living donor.

Furthermore, we note that our current system allows friends and/or relatives to donate a kidney to a loved one.  Why is it an acceptable risk, or a moral act, when the motive is love for the recipient, and not an acceptable risk or a moral act when the motive is love for those whom the money would benefit?

Future's market  As mentioned above, this would have healthy people selling the (hopefully!) far-distant future rights to their organs.  Organ brokers could make one payment of a few hundred or thousand dollars, buying the rights for a lifetime, or yearly payments of lesser amount, in effect leasing the rights for a year. Such yearly payments would have the advantage that people would have to remain in touch with the organization, and the amount of payment might even be made contingent upon the physical condition of the seller. After death, the deceased's relatives might object to the organs being removed, and could be provided with an option of making repayment, with interest, to the brokerage firm, subject to the firm's consent. Or, the organ brokerage firm might insist that the contract be honored.

This future's market, or "pre-payment" approach, can be thought of as "reverse insurance" - the brokerage firm pays lots of people a relatively small amount of money, in the knowledge that a few of them will pay off bigtime (in usable organs).  With health insurance, the reverse happens - lots of people pay the insurance company a relatively small amount of money, in the knowledge that, for a few unlucky ones, there will be big-time medical expenses which the insurance will cover. (This interesting reverse relationship is part of what makes reduced health insurance premiums for those who agree to donate organs (upon death) what some experts consider the ideal mode of transaction.)

One advantage of the future's market is that it moves the time of decision-making to long before the actual time of death, when the deceased's relatives are grieving and least able to make a rational decision. [Note: organs are generally taken only from people who have undergone brain death, but whose bodies are still functioning. In order to maintain the organs in a usable condition, the body must be kept on life support until the organs are removed.  Asking a family to make a decision at a time like this, when they've just been told their loved one has suffered brain death, is a very touchy proposition.]

[For a more detailed, expert discussion of  such futures markets, click here.]

After-death market Post-death payment contracts could be entered into in several ways.  One way is that the person dying could make the arrangement, with the money to be paid to their estate after death. Or, the dying person's family and/or legal heirs could make the arrangement if the dying person is comatose or otherwise unable to make a decision, with payment also going to the estate. 

Already, here in Pennsylvania, a pilot program has been proposed that will permit payment of hospital and funeral expenses (only $300 according to the official press release, but said to be up to $3,000 by a state legislator), with the money going directly to the hospital and/or funeral home. Since there is already some legislative movement in this direction, reimbursement for hospital and/or funeral expenses may one day become the major financial incentive, and one which greatly increases the supply of life-giving organs. This would not be a true market, with competing buyers and market-driven prices, but it would be better than what we have now. (Two problems I see with the proposed Pennsylvania plan are that, 1) the $300 reimbursement may be too small to make much difference - but maybe not - and 2) the money comes from state taxpayers, not from health insurance companies.)

A true market in cadaveric organs would result in payment of the organs' full market value, a combination of their usability and scarcity.  For those with many usable organs, the payoff for their estate could be considerable.  If the estate heirs so choose, the money could go to charity.  Or, the donor could designate a charity of choice beforehand.   (With freedom, all things are possible!)

The main advantage of this latter type of market is that the higher monetary rewards for those with known, usable organs would tend to induce a much greater degree of organ retrieval.  But, in my view, even reimbursement of funeral expenses will be enough to nudge many reluctant families to "do the right thing."  (I think most of the reluctance is due to a sense that doctors and hospitals are making lots of money, while the family and deceased are being taken advantage of.) 

Regardless of which of the above arrangements becomes the most popular, with such a wide variety of monetary incentive structures available, the shortage of organs would quickly come to an end.



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Last updated: September 30, 2004.