Category Archives: Economics

A discussion paper on making organ trading legal.

Every year, we see governments, health authorities and non-profit organisations bemoan our low rate of organ donation. According to DonateLife as of 2 December 2010, there are 1,663 patients on the transplant waiting list. In 2010, there were 799 total transplant patients. This means that current people on the waiting list will need to wait nearly 2 years to receive a transplant. During this time they suffer from a severely reduced quality of life and possibly death.

When I see such a mismatch, I begin to wonder why this is so. Donating your organs is such an altruistic commitment that gives life to another. Obviously, there is a gap between what people need (ie. live saving organs) vs what people are willing to give. There are a number of ways to reduce this gap:

More education: this entails public service announcements pleading with us to donate our kidneys, hearts, lungs and other organs. The onus is still on the individual to voluntarily “opt-in” to the donation system.
Opt-out: Make everyone donate by default unless you specifically “opt-out”. This has a default position of “somebody else has a right to your organs after you die”. We, as a default, should have a natural right over our bodies after death just like we have rights of our property after death.
Allow Organ Trading: For those that can afford it, people should be able to buy organs in an open, but regulated, market. For those that cannot afford it can access the current donation system, get subsidized by the government or receive charity from non-profit organisations. More on this below.
Organ Trading as Public Policy

My Liberal Democrat colleague, Phillip Lillingston, and myself (I must say that Phillip is the real champion and original author) are constructing an organ trading public policy for the Liberal Democrats. Below is a discussion piece on the subject.

Introduction

The Victorian Health Minister is currently arranging a parliamentary committee to examine the possibility of making post mortem organ donations default positive instead of default negative. This is due to the fact that terminally ill people suffering organ failure die due to the lack of available organs.

Currently if an Australian is terminally ill and needing an organ transplant all he can do is go on a list unfortunately longer than that of available organs. That is unless someone close to him may like him enough that they would be prepared to voluntarily donate an organ even though it will have a small effect on the donor’s long term health.

If an otherwise dying person is lucky enough to find such a friend willing to donate she or he still has a 30% chance of disappointment due to the fact that all potential donors and their recipients are not tissue or blood group compatible.

Only 309 Australians donated organs in 2010 while there were 1700 people on the official waiting lists at any one time. A post mortem donation of organs from a single body often goes to as many as four people, so even though people die every year due to inability to receive donated organs the figure is not as high as the above statistic. initially implies.

No hard statistics are readily available but Victorian Health Minister David Davis has been quoted in the Herald Sun ‘Auto Organ Donors’ 14th Feb 2011 as saying that changing Victoria’s consent laws on organ donation will save hundreds of lives. . This extrapolates into nearly one thousand lives across Australia. This does not mean that the honourable minister is necessarily correct with regards to the results of legislative change but only that there are many Australians dying from organ failure.

Having a universal default position of organ donation as a remedy still entails many problems.

The donation has to be confirmed by relatives of the deceased, and apart from religious considerations, many people in a state of trauma on the death of a loved one find it very difficult to agree to have that loved one immediately cut up into pieces.

As a solution to this problem why not simply introduce a law declaring the absolute proprietary right of a person to his or her own body? People would have the right to voluntarily donate or sell their organs, blood and other body tissues, to be delivered pre or post mortem in a regulated but open market.

What are the advantages of an organ market?

There would be a greater incentive for people of all ages to agree to donate upon death if they knew the post mortem payment would go to their estate and thus to the loved ones to whom they had willed their assets. A death of a loved one, primarily the families bread winner, is particularly devastating. The option for the surviving family to receive some level of financial support from the deceased organs will provide some financial assistance in their time of need.
Live donations (such as for kidneys) would increase and thus reduce fatalities of those suffering organ failure.
One can’t predict what the eventual market price for a an organ but would be but it is reasonable to believe that if it is going to save a life of a person of a first world country it may be up to $100,000. If even half of that, it is still a substantial amount of money for an impecunious person who may well find the possible loss of five years of life expectancy a fair exchange.
A voluntary donor who previously was thwarted due to blood or tissue incompatibility could now simply sell his organ to the highest compatible bidder and then with the proceeds purchase a compatible organ for his friend.
Reduces the unsavoury aspects of the human organ black market.
Responses to commonly asked questions about an organ market

It’s exploiting poor people.

It’s OK for poor people to voluntarily donate an organ now. Why should it suddenly become a crime if the poor now actually get paid for their services?
Isn’t it for poor people themselves to decide whether or not they wish to be “exploited”? Are you saying that people in the lower socio economic ranks are not only poor but also uninformed and thus need politicians to say what contractual arrangements they may or may not enter into? Who are politicians to decide that people poorer than themselves can’t find their own ways to make some substantial income?
If a building tradesman should decide to head up to Queensland to make some money by cashing in on the high prices now paid to carpenters to rebuild following the cyclone damage, is his “exploitation” of Queenslanders’ current problems a crime?
If in a hypothetical situation a wealthy person with a rare blood group was needing an urgent organ transplant and the number of potential and immediately available donors had decreased to just one, and the price offered was $1,000,000, who then would actually be exploiting whom? If then it was the potential recipient, do we still make the trade illegal so as to prevent the wealthy person from being exploited?
It decreases the number of voluntary donations.

Statistics in Iran, where it is legal, don’t reveal that.[Reason Magazine, ‘Kidneys for Sale, June 2008]
Those who only look at organ donation as a voluntary action might still be tempted to donate if they decided to donate to only those who could not otherwise afford to buy one.
Alternatively those who might feel repulsed by accepting money for such an action could donate their payment to their favourite charity.
Donors will very often suffer health problems later in life due to the organs they have given away.

The only difference between the current legislation and the proposed is that money is involved. It is hard to imagine how the addition of money can make things worse for the health of the donor.
Many jobs have ‘danger money’ allowances attached to the employee’s remuneration, either implied or overt. The worker gets paid extra to compensate for the fact that his/her life is at a greater risk.
Gullible people will rush in to donate from the lure of a large amount of money only to discover in later years that their health may be affected a lot more than they realised.

As with the current system, no one can walk into a hospital off the street, sign a form and then lay down on the operating table. People wanting to give organs must take legal counsel before signing so as to aid them in understanding the full ramifications of what their decision will be. Apart from exceptional life and death situations, there probably would be a mandatory cooling off period of two weeks between agreeing and operation.
However one must also remember there are always two parties involved. Is it still better for a totally innocent potential recipient to definitely die than for the possibility that an irresponsible person makes a negligent decision with regards to his health?
This will be a law that can only benefit rich people. How can a poor person suffering organ failure be able to get his hands of $50,000 to $100,000 for a transplant?

People can still donate their organs or sell at below market rates, if they wish to assist low income people.
If the ailing person is well known in his or her community it is also possible that charitable organisations may come to the rescue. However even when that is not the case, are we to embrace the less that noble principle that if the ailing poor cannot be saved then we must ensure, for the sake of equity, that the ailing rich must also die. Continue reading →