Policy Debate: Should there be a market for human organs?

A new system is needed, one that commercializes organs in a global network. By allowing people to contract for the exchange of organs for monetary consideration, the market opens up financial incentives that increase the available supply of organs.
~David E. Jefferies, "The Body as Commodity: The Use of Markets to Cure the Organ Deficit," International Journal of Global Legal Studies, vol. 5, no. 2

A medically invented, artificial scarcity in human organs for transplantation has generated a kind of panic and a desperate international search them and for new surgical possibilities. Bearing many similarities to the international market in adoption, those looking for transplant organs are so single minded in their quest that they are sometimes willing to put aside questions about how the organ [or ‘the baby’ in the case of adoption] was obtained. In both instances the language of "gifts" , "donations", " heroic rescues" and "saving lives" masks the extent to which ethically dubious and even illegal practices are used to obtain the desired " scarce" commodity, infant or kidney, for which foreigners (or "better off" nationals) are willing to pay what to ordinary people seems a king’s ransom. With desperation built in on both sides of the equation -- deathly ill "buyers" and desperately needy "sellers" -- once seemingly "timeless" religious beliefs in the sanctity of the body and proscriptions against body mutilation have collapsed over night in some parts of the third world under the weight of these new market's demands.
~Nancy Scheper-Hughes

Advances in medical treatments have resulted in a dramatic increase in the number of organ transplants performed each year. A limited supply of organs, however, prevents many individuals from receiving organ replacements that could either save a life or substantially improve the recipient's quality of life.

In the U.S., all states have enacted a variation of the Uniform Anatomical Gift Act of 1968. Under this law, individuals are able to specify that some or all of their body may be donated after their death. The original version of this Act neither allowed, nor prohibited, the sale of human organs. The revised Uniform Anatomical Gift Act of 1987, however, prohibited the sale of human organs.

Restrictions on the sale of human organs in the U.S. came about as a result of markets that appeared in the early 1980s for kidneys that were harvested from living donors in return for a fee. Kidneys were sold primarily by the very poorest members of society. The National Organ Transplant Act of 1984 prohibited payments to those who provided organs for transplantation. While this Act was primarily designed to prevent the sale of organs from living donors, it also prevented the possibility of individuals selling the right to harvest their organs after their death. (The sale of replenishable tissue, such as blood, hair, and sperm, however, is allowed.)

While donors cannot legally be paid for providing organs, there is a very active market for human organs. Organ procurement organizations, operating as local monopolies, collect organs from voluntary donors and then provide them to hospitals that provide transplants. While the National Organ Transplant Act prohibits payments to patients, it allows organ procurement agencies to receive a fee for the removal and transportation of organs.

Opponents of market-based allocation systems argue that individual income and wealth would determine who receives and who supplies organs. They argue that decisions concerning who should receive a transplant should be based upon medical criteria rather than on income and wealth.

Supporters of a market for human organs argue that the chronic shortage of organs for transplant could be reduced or eliminated if donors (or their survivors) were paid for the use of their organs. One popular suggestion is the use of a futures contract in which an individual sells the right to harvest his or her organs if they are suitable for transplant at the time of the individual's death.

One concern that is often raised is the growth of an international black market for organs. Those countries that have a surplus of organs are generally those in which there are the least restrictions on trade in organs. Allegations of human rights violations associated with the acquisition of transplant organs in these countries are not uncommon. Numerous (often well-supported) allegations have been made suggesting that China has executed prisoners to satisfy the demand for organs.

• U.S. Department of Health and Human Services, "Donate Life"
  http://www.organdonor.gov/
  This site provides a discussion information on the organ donation process in the U.S.

• National Organ Transplant Act of 1984
  http://www.nyodn.org/organ/l_legispass_4.html
  The National Organ Transplant Act of 1984 banned the sale of human organs in the U.S. and established the current mechanism for distributing donor organs.

• Uniform Anatomical Gift Act
  http://www.law.upenn.edu/bll/ulc/fnact99/uaga87.htm
  This document contains the text of the Uniform Anatomical Gift Act (as revised in 1987). This Act establishes the conditions under which individuals can use donor cards to donate organs.

• National Attorneys' Committee for Transplant Awareness, Inc., "Organ and Tissue Donation and Transplantation: A Legal Perspective""
  http://www.transweb.org/reference/articles/donation/nacta.html
  This document provides information about the laws governing organ donation.

• Transweb.org, "Top 10 Myths About Donation & Transplantation"
  http://www.transweb.org/myths/myths.htm
  This webpage attempts to debunk many of the myths, urban legends, and misconceptions associated with organ transplantation and donation.

• Michael E. Parmly, "Sale of Human Organs in China"
  http://www.state.gov/g/drl/hr/rm/index.cfm?docid=3792
  Michael E. Parmly is the Principal Deputy Assistant Secretary of State, Bureau of Democracy, Human Rights, and Labor. In this June 27. 2001 statement, he notes that China harvests the organs of executed prisoners. This has resulted in a growing number of transplant procedures being conducted in China. Parmly raises concerns over the lack of due process and consent in this situation.

• BBC News, "Kidney Sale on Web Halted"
  http://news.bbc.co.uk/1/hi/sci/tech/437504.stm
  This September 3, 1999 BBC News article describes the posting of an offer of a kidney for sale on eBay. It is noted that the price of this kidney rose from $25,000 to nearly $6 million during the week while this item was listed.

• OrganSelling.com, "Pennsylvania Reimbursement Plan"
  http://www.organselling.com/pennsylv.htm
  This page contains information about a plan in Pennsylvania to provide up to $300 towards the food and lodging cost for an organ donor or the donor's family. Links to other resources concerning this plan are also provided. (The original plan was to provide $300 toward funeral costs, but this was modified to avoid legal problems.)

• National Center for Policy Analysis, "Pennsylvania to Reward Organ Donors' Families"
  http://www.ncpa.org/pd/regulat/pd050699c.html
  This May 1999 online news summary article describes the orginal proposed program in Pennsylvania to encourage organ donations. Under this plan, the state pays $300 towards the funeral expenses of organ donors.

• Gary Becker, "Should the Purchase and Sale of Organs for Transplant Surgery be Permitted?"
  http://www.becker-posner-blog.com/archives/2006/01/should_the_purc.html
  Gary Becker examines the arguments for and against organ sales in this January 1, 2006 blog posting. He notes that approximately 3,000 individuals died while awaiting kidney transplants and 1,500 died while awaiting liver transplants in 2000. Becker argues that the potential costs associated with a market for organs are small relative to the expected benefits in terms of lives saved.

• Richard Posner, "Organ Sales"
  http://www.becker-posner-blog.com/archives/2006/01/organ_salesposn.html
  Richard Posner, in a response to Gary Becker's blog posting, raises some additional issues associated with organ sales One of the options he suggests for consideration is the sale of a right to harvest one's organs after death.

• Donald Boudreaux and A.C. Pritchard, "Organ Donation: Saving Lives through Incentives"
  http://www.mackinac.org/2482
  In this October 4, 1999 online article, Donald Boudreaux and A.C. Pritchard argue that economic incentives should be used to induce individuals to donate organs. Their suggestion is a relatively modest payment of $10 to $25 to individuals who sign organ donor cards. They suggest that the cost of such a program could be covered by the American Red Cross or a similar organization. Under their plan, charitable organizations that pay individuals to sign the donor card could be compensated by a health insurer whenever an organ is provided by one of these individuals. Boudreaux and Pritchard argue that such a system would provide a Pareto improvement that would benefit potential organ donors, charitable organizations, hospitals, and the recipient of the transplanted organs.

• Charles T. Carlstrom and Christy D. Rollow, "The Rationing of Transplantable Organs: A Troubled Lineup"
  http://www.cato.org/pubs/journal/cj17n2-3.html
  Charles T. Carlstrom and Christy D. Rollow discuss the system of rationing transplantable organs in this online article appearing in the Cato Journal. They argue that the persistent and growing shortage of organs is the result of the rationing system that is used for allocation purposes. Carlstrom and Rollow suggest that the situation is analogous to the long gas lines that appeared during the price controls on gasoline in the 1970s. The cost of this rationing system, they suggest, is that 10 people awaiting organ transplants die every day. They argue that a market allocation mechanism would save many lives by increasing the supply of organs.

• Organ Selling Homepage
  http://www.organselling.com/
  This website contains an extensive collection of links to resources dealing with the economic and ethical issues associated with the sale of human organs. The sponsors of this website argue that monetary incentives for organ donations will save many lives. Documents on this site include a transcript of the 1983 House of Representatives hearing on the issue of a ban on organ selling, including both the pro and con sides of the argument.

• Libertarian Party, "Online human organ sales: save lives"
  http://www.bmstahoe.com/Libertarian/onlineorgans.html
  This page contains a statement by the Libertarian Party on its position concerning organ sales. They argue that individuals have the right to dispose of their own bodies. It is also argued that market incentives would eliminate the chronic shortage of organs, thereby saving lives.

• Ronald Bailey, "The Case for Selling Human Organs"
  http://www.reason.com/rb/rb041801.html
  In this April 18, 2001 article appearing in Reason Online, Ronald Bailey argues that allowing the sale of organs would eliminate the growing shortage of donated organs. He notes that the only person who is not compensated as part of the transplant process is the organ donor.

• Organ Keeper
  http://www.organkeeper.com/
  This is the website of an organization that argues that payments to organ donors should be allowed. They note that everyone else involved in the process of providing organs for transplant purposes is compensated except for the actual donor. It is argued that compensation would eliminate the shortage of transplant organs.

• Organs Watch
  http://sunsite.berkeley.edu/biotech/organswatch/
  This is a website for an organization that examines the ethical issues associated with organ transplantation.

• Vidya Ram, "International traffic in human organs"
  http://www.flonnet.com/fl1907/19070730.htm
  Vidya Ram discusses problems associated with organ sales in this March 30-April 12 edition of Frontline. He suggests that low-income individuals are often pressured to sell organs, primarily kidneys. Ram argues that organ sellers in low-income countries have often experienced significant health problems after organ removal.

• Nancy Scheper-Hughes, "The End of the Body: The Global Traffic in Organs"
  http://sunsite.berkeley.edu/biotech/organswatch/pages/cadraft.html
  In this online May 14, 1998 essay, Nancy Scheper-Hughes raises several concerns about the development of international markets for human organs. She argues that a growing international black-market harms economically disadvantaged individuals to provide benefits for wealthy individuals. Scheper-Hughes suggests that kidney sales provide funds for low-income households in India and Brazil. She suggests that the "scarcity" of organs is an artificial need that is created by the "human denial and refusal of aging."

• Payment Subcommittee of the United Network for Organ Sharing Ethics Committee, "Financial Incentives for Organ Donation"
  http://www.unos.org/resources/bioethics.asp?index=3
  This report provides a nice summary of the arguments for and against the use of financial incentives to encourage organ donations. It is suggested that more study of public opinions and attitudes be done before any such plan is implemented.

• David J. Rothman, "The International Organ Traffic"
  http://www.nybooks.com/nyrev/WWWarchdisplay.cgi?19980326014F
  In this March 16, 1998 article, David J. Rothman discusses international trade in human organs. He notes that there have been human rights abuses associated with the provision of organs in several countries, most notably China. Rothman suggests that international medical associations should do more to prevent these abuses from occurring.

• David G. Young, "An e-Transplant Prophecy"
  http://www.neonramp.com/~jryoung/dgyoung/organs.html
  In this December 7, 1999 online article, David G. Young discusses the controversy stirred up by the attempted sale of a human organ on eBay. He predicts that the growing shortage of organs will result in a change in the law that will allow payments to organ donors.

• Th. Gutmann and W. Land, "Ethics in living donor organ transplantation"
  http://www.med.uni-muenchen.de/trans/ethics.htm
  Th. Gutmann and W. Land discuss the ethics of living organ donations in this online essay. They argue that living donor organ transplantation involves complex ethical issues that go beyond the simple Hippocratic Oath. It is suggested that decisions in such cases must weigh the principle of doing no harm to the donor against the overall benefit provided by the transplantation.

• World Medical Association, "Declaration on Human Organ & Tissue Donation and Transplantation"
  http://www.wma.net/e/policy/wma.htm
  This page contains the text of the World Medical Association's October 2000 declaration on human organ transplantation. This document contains a set of ethical principles concerning organ transplantation. In particular, they state that: "Payment for organs and tissues for donation and transplantation should be prohibited."

• Claude Earl Fox, "House Testimony: National Organ Transplantation Policy"
  http://newsroom.hrsa.gov/speeches/foxOPTN.htm
  In this April 8, 1998 testimony, Claude Earl Fox, the Acting Administrator of the Health Resources and Services Administration, discusses shortcomings of the Organ Procurement Network. He argues that the National Organ Transplant Act resulted in improved fairness in organ allocations. Fox argues that a market-based system allocates organs based upon the recipient's wealth rather than medical need. He suggests that the system should be modified to provide equity across geographical regions.

• William Barnett II, Michael Saliba, and Deborah Walker, "A Free Market in Kidneys: Efficient and Equitable"
  http://www.independent.org/pdf/tir/tir_05_3_barnett.pdf
  William Barnett II, Michael Saliba, and Deborah Walker discuss the possibility of a market for kindeys in this Winter 2001 article appearing in The Independent Review. They argue that such a market would provide both equity and efficiency gains. This analysis relies on demand and supply analysis. (The Adobe Acrobat viewer plugin is required to view this document. You may download this viewer by clicking here.)

• Gary Stanley Becker and Julio Jorge Elias, "Introducing Incentives in the Market for Live and Cadaveric Organ Donations"
  http://home.uchicago.edu/~gbecker/..._Becker_Elias.pdf
  In this draft of a 2007 Journal of Economic Perspectives article, Gary Stanley Becker and Julio Jorge Elias estimate the effect of a market for organs on organ availability and price. They find that the current organ shortage could be eliminated with little effect on the overall cost of a transplantation procedure. (The Adobe Acrobat viewer plugin is required to view this document. You may download this viewer by clicking here.)

• The Washington Post, "Kidneys Needed"
  http://www.washingtonpost.com/wp-dyn/content/article/2006/10/14/AR2006101400793.html
  This October 15, 2006 Washington Post editorial argues that incentives are needed to resolve the shortage of donated organs. Three options are recommended:
  • giving higher transplant prioroty to those who volunteer to sign organ donor agreements,
  • providing discounts on driver's licenses to those who check off the organ donor option, and/or
  • shifting from an opt-in system to an opt-out system of organ donation.

• Alvin E. Roth, "Repugnance as a Constraint on Markets"
  http://home.uchicago.edu/~gbecker/..._Becker_Elias.pdf
  In this draft of a 2007 Journal of Economic Perspectives article, Alvin E. Roth examine the effect of repugnance on the existence of markets. He notes that over time, changing societal norms have led to some markets falling from favor while others have become more accepted. He examines slavery, indentured servitude, the market for horse meat for human consumption, and human organ selling as examples of (The Adobe Acrobat viewer plugin is required to view this document. You may download this viewer by clicking here.)