Carpe Diem

Let’s legalize it – compensation for organ donors – and save thousand of lives

My AEI colleague Sally Satel makes the case above for making it legal for organ donors to receive  compensation and argues in favor of the motion “We should legalize the market for human organs” at an Intelligence Squared Debate in NYC in 2008.

The chart below illustrates very “graphically” the serious and growing kidney shortage in America – the number of registered patients on the waiting list for kidneys is approaching 100,000 patients (98,463 as of October 25, 2013, data here), while the number of kidney transplant operations has been stuck at about 16,500 for the last decade. As a result of the severe kidney shortage in America, largely because kidney donors cannot legally receive any form of compensation, 13 people on the waiting list died every day last year, and another 7 were removed from the waiting list because they became too sick to receive a transplant and were likely close to death.

kidneyBottom Line: The federal ban that makes it illegal to compensate kidney (and bone marrow) donors is another example of what I have documented as the “fallacy of the special case” – the flawed support for exceptions to economic reality and the market’s pricing process (e.g. minimum wage, ticket scalping laws, rent control, etc.). In this case, what is so special about kidneys or bone marrow that justifies a federal ban against allowing a scarce resource to be allocated by market forces and market pricing?

We’re allowed to receive compensation for selling our hair, blood plasma, sperm and eggs, so why should kidneys or bone marrow (which regenerates) fall into a special class that prohibits market exchanges? Banning compensation for kidneys and bone marrow is a sure death sentence for thousands of Americans – for example, see this report on a Stanford professor who died this week because she was unable to find a bone marrow donor – and ending the ban on donor compensation would save thousands of lives for many of the patients on the growing waiting lists for organs like kidneys. Let’s legalize compensation for organ donors. 

HT: Hitssquad

21 thoughts on “Let’s legalize it – compensation for organ donors – and save thousand of lives

  1. Looking at it from a monetary perspective:

    A kidney transplant costs about the same as dialysis for about 18 months. The transplant immunosuppressants and follow-up care, for a Kidney on a year basis, is approximately the same cost as three months on dialysis.

    Most of the cost of End Stage Renal Disease (dialysis) is billed to medicare and/or medicaid. Many ‘living’ on dialysis are also collecting SS disability. Ultimate they find they have the strength to return to work, upon receipt of a a kidney transplant.

    [Full Disclosure: I've been through the process. I personally never stopped working. However, most I met doing dialysis, for any extended length of time, no longer had the strength to work;they were totally dependent on SS disability payments. It seemed to me that those of us that transplanted in less than a year retained productive employment ]

  2. I have long thought that by using free-market compensation we could effectively pre-pay for health insurance, without then resorting to socialized systems. How much is a healthy body worth in parts? Eyes, heart, kidneys…etc. Perhaps a macabre question, but I’m sure the insurance companies and hospitals know the answer. When viewed as an investment, to help offset basic healthcare premiums, healthfulness would become participatory. So, people who take better care of themselves might could qualify for better subsidies (lower costs or better benefits) for a lifetime of better healthcare. Likewise, individuals who decide to be living donors could, I would think, subsidize themselves to SIGNIFICANTLY better health programs. This isn’t FORCING people to do anything, but it would be REWARDING them for helping VOLUNTARILY. The current laws make this an impossible idea, undebatable.
    In my eyes the tragedy of the status quo is not only are their so few donors and not just the tragedy of the lost lives that contribute to most of the donation, it is that the dead contributors (heroes, in my mind) and their families are the ONLY groups who do not benefit from their offerings. Doctors, hospitals, insurance companies, politcos…they sure all profit. And yes, the recipients, but there aren’t many out there that could afford these treatments alone.

    • You know the snopes tale about how someone wakes up in a tub of ice in a foreign country and discovered their kidneys are stolen?

      That could be a problem if we pay for donations here. I guess this is a case where I would want to see some government regulation on tracking the body parts and making sure they come from ethical sources.

      • You know the snopes tale about how someone wakes up in a tub of ice in a foreign country and discovered their kidneys are stolen?

        Ya, I know it’s false, and it’s about someone losing 1 kidney. If you’re going to all the trouble to steal one kidney, why not just take them both and save the trouble and expense of icing down the donor?

        Of all the things to worry about, organized kidney thieves probably isn’t one of them.

        I suspect that anyone performing a kidney transplant would want really good documentation on the chain of custody, starting with the donor.

  3. While there are some major pros and cons for monetarily compensating for ‘living donations’ of some organs, the problems mostly go away for donations after death.

    If the estate of the donor could be compensated, I feel this would encourage a large spike in donations that are otherwise missed since the family would see a benefit, sometimes very badly needed now. Even if this compensation could only be applied toward funeral or memorial expenses, this would still be a major incentive.

    • Robyn

      If the estate of the donor could be compensated…

      That won’t be possible until we all take those “organ donor” stickers off our driver’s licenses, and anonymous donations are no longer available free.

      • The supply/demand numbers say otherwise.

        Another form of compensation might be in the form of tax credits for the estate. Frankly, I think those of us donating blood regularly ought to be getting Federal/State tax credits NOW, as we may for other monetary or property donations to recognized charities. I suspect the Red Cross would see an up-tick in donations, especially around the end of the year.

        • Robyn

          The supply/demand numbers say otherwise.

          If you want to force action on a market in organs, you have to quit giving them away for free, even though the supply of free ones is insufficient.

          Another form of compensation might be in the form of tax credits for the estate.

          Why should government even be involved in a market for organs?

          Frankly, I think those of us donating blood regularly ought to be getting Federal/State tax credits NOW…

          And those of us who regularly help little old ladies across the street should get a tax break too.

          Don’t get me wrong, I’m totally in favor of people reducing their tax burden as much as possible, in any way they can. But unless spending is reduced to compensate for that tax break, someone else will have to pay the difference, or as is currently fashionable, more money will need to be borrowed to cover the reduction in tax revenue.

        • They use to allow payments for blood donations in some states, but that all shut down with AIDS. Folks were squeemish drug addled homeless dudes would come in and donate a gallon at a time (Just kidding about the gallon) and it would be filled with parasites, and disease.

          Studies show that the paid donations are actually cleaner than general donations. It is guessed that folks who donate for money take some care of themselves (even though they might booze up with the money that night) because they know if they get some disease, then they will lose a source of money.

          Also I would say the 60 day wait for whole blood is a bit long. The body regenerates all blood cells in 23 days. Once a month seems reasonable to me.

      • Why mouse around. Offer $10K for a kidney period. If the person is brain dead – after being hit by a bus, he is still capable of collecting $10K it would just go to the estate, just as his last paycheck would.

  4. Regardless of how one feels about selling organs for cash, one must be aware of one simple fact:

    Outlawing it does not make it go away. Rather, it just puts it into the hands of outlaws.

    Outlawing drugs didn’t make them go away. It just put all the power into the hands of bad people, and we all can see how well that’s turned out.

    Outlawing abortion didn’t make it go away. It just forced people to turn to backroom doctors and get very dangerous procedures.

    If the goal really is public safety, then it would make sense to remove the power from the bad guys, not give it to them.

    By legalizing organ sales, we can guarantee that the transaction is voluntary, sanitary, and safe. By keeping it outlawed, we can make no such promises.

    By legalizing it, it can be controlled (unless, of course, big government proponents are admitting that regulations are useless?).

    • “Outlawing abortion didn’t make it go away. It just forced people to turn to backroom doctors and get very dangerous procedures.”

      And legalizing it made it safer? Good thing we have great people like Dr Kermit Gosnell doing the abortions so our daughters are safe!

      • State regulations of abortion restrict access making the procedure more expensive and less safe. Many of those who went to Dr. Gosnell did so because state regulations eliminated safer options.

  5. The chart below illustrates very “graphically” the serious and growing kidney shortage in America

    Really? That’s the pun you chose? I’m judging you right now :-)

  6. Mark,

    Thanks for the Hat Tip. It always feels good to see my submissions posted here.

    As a sometimes plasma “donor” myself, I can tell you that plasma is never actually sold in the United States. It is only ever “donated”. The money the “donors” receive is technically compensation for the “donor’s” time only. The “donation” is supposed to be out of the goodness of the “donor’s” heart — but I have never met a “donor” who personally considered it anything other than a plasma sale. All of us “donors” were there for the money, only.

    So, even plasma isn’t legal to sell, yet.

    Also, please thank your AEI colleague Sally Satel for me for doing a great job representing the economically-literate side of the debate. I only wish more people had watched that video.

    • When I lived in Iowa, I donated plasma for the “sale” but have donated platelets and blood for free (they get plasma from these donations as well)

      But I do have to say, if they offered me $30 bucks every time I donated blood, I would be much more regular about it. And I would guess if they didn’t just offer $30 – but they offered money based on the shortage level(we need more blood this week $10 bonus), and even money based on blood type (My A+ blood may have made the grade, but is common and worthless compared to O- or some of the rarer blood types) or if you are CMV negative which makes the blood more useful for aids patients and babies!

      The do offer a program now where you get something like 100 points per donation, and if you collect 1000 points you can get a token flashlight, collect 10000 points and you can get a jacket with the bloodbank’s logo. I liked it better when they handed out T-shirts saying I donated blood. Now that my bloodbank doesn’t do that any more, I have less incentive to donate (really – I used to go for the t shirts)

      The really crazy part is they charge $350 a pint or so for the blood. Giving the donor $30 bucks would be a drop in the bucket.

      • But I do have to say, if they offered me $30 bucks every time I donated blood, I would be much more regular about it.

        You’ve already indicated your price is a lot less than $30, based on your T-shirt comment. :)

  7. I don’t think this is so much a anti-Economic issue as it is a moral issue. Folks are just aghast at the notion that someone would sell half a liver. It should be done out of the goodness of your heart.

    With plasma donations, it is interesting. States allow/ban them as well. It seems to me like the more liberal the state the less likely it is to allow paid plasma donation. CA forget it, Texas, Iowa, OK.

    I donated plasma for awhile in Iowa, until they forced me to stop, because I was exposed to someone else’s blood. – Yeah at the next table at the donation center a nurse was using a fault clip/clamp, and they sprayed blood from the table next to me onto my face.

  8. I was just thinking – with regards to blood payments – who would be most against it. I would guess the American Red Cross. Currently if I tried to run a private business collecting blood, I would ask for people to voluntarily donate to me. Folks would say forget it, why would I freely give my blood to a greedy corporation – I’ll donate at the Red Cross.

    Red Cross sells blood for about $150 a pint (I was wrong about 350 above) and has a near monopoly on the market. IF a private company would come in and offer $30 a pint, then the Red Cross would suddenly have competition. Red cross isn’t exactly the most efficient about how they collect things (You should see a plasma donation center if you want to see efficiency) and would suddenly have private competition.

    Hmm, I wonder if it is the Bloodbanks themselves who don’t want to allow payment for blood.

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