PPE Interview Text - Organ Market PDF

Opinion: The moral case for paying kidney donors Opinion by Scott Sumner. The Washington Post, Dec. 30, 2015 Scott Sumner is a professor of economics at Bentley University and director of the Program on Monetary Policy at the Mercatus Center. A recent study in the American Journal of Transplantati...

Opinion: The moral case for paying kidney donors Opinion by Scott Sumner. The Washington Post, Dec. 30, 2015 Scott Sumner is a professor of economics at Bentley University and director of the Program on Monetary Policy at the Mercatus Center. A recent study in the American Journal of Transplantation just reached what to many people may be a shocking conclusion: Taxpayers would be able to save thousands of lives and about $12 billion per year if the government started compensating people for kidney donations. According to the study, “these numbers dwarf the proposed $45,000-per-kidney compensation that might be needed to end the kidney shortage and eliminate the kidney transplant waiting list.” For economists who have long advocated for the creation of a market of organ transplants, this news is not surprising. Shortages occur when regulations hold prices below equilibrium — that is, where the demand of a product and supply of a product meet. Often the result is simply inconvenience, as with the shortage of apartments in New York or the long gas lines in the 1970s. But in terms of kidneys for transplantation, regulations lead to more than an inconvenience. The prohibition of payment to organ donors has led to a kidney shortage leading to the preventable loss of 5,000 to 10,000 lives each year. The cost of treating people with kidney disease is so high that an organ transplant market would not merely save lives, but would actually save money as well. According to the study, “the net benefit from saving thousands of lives each year and reducing the suffering of 100,000 more receiving dialysis would be about $46 billion per year, with the benefits exceeding the costs by a factor of 3.” Given this “win-win” situation, why hasn’t an organ market been created? The main reason is that many people find the idea to be morally repugnant. Yet the two most common arguments against paying people for organ donations are both flawed. One concern is that an organ market would exploit those with fewer resources. The impoverished or low-income would be more likely to donate organs for money, as $45,000 means much more to a poor person than a rich one. However, this exploitation argument seems at odds with the moral calculus we use to justify most of our lives. Our entire economic system is based on rewards for doing things, and it’s always true that those rewards will mean more (per dollar) to a poor person than a rich one. Working in a coal mine is certainly more unpleasant and dangerous than working in an office. Does this mean that coal miners are exploited? And recall that people both rich and poor donate even without compensation. If paying for kidney donation is unfair because it would appeal more to the poor, then much of the economy we rely on daily would have to be rejected on similar grounds. In a market economy, we tend to assume that people who voluntarily enter into an exchange will benefit from that transaction. There may be exceptions (say, a heroin 1 addiction). But as far as I can see, organ donation should be more like the decision to work in a coal mine — a rational decision to improve one’s economic situation at a modest but acceptable health risk. Many other objectors have the moral intuition that there is something unethical about turning the human body into a commodity. Economists have a hard time countering this argument, as our moral framework tends to be somewhat blind to non-utilitarian considerations. But can we always trust our moral intuitions? During the Middle Ages, lending money at interest was viewed as immoral. Just a few hundred years ago, life insurance was viewed as repulsive — like wagering on the death of one’s spouse. I’m old enough to recall when homosexuality was widely viewed as unnatural, and the notion of gay marriage went against the moral intuitions of even a fair number of politically liberal people. Before doubling down on a policy that we know will cost thousands of lives each year, don’t we need to be pretty sure that our moral intuitions on the issue are correct and not something that will later change, as they so often do? I don’t know about you, but when I think of all the actual suffering caused by this regulation, I find it hard to justify not giving individuals a choice. Our body parts shouldn’t be for sale Francis Delmonico and Alexander Capron. The Washington Post Dec. 29, 2015 Francis L. Delmonico is a Harvard Medical School professor of surgery at Massachusetts General Hospital. Alexander M. Capron is a professor at the University of Southern California. Organ transplants have extended and improved the lives of more than a million patients over the past 60 years. This is a testament to the dedication and creativity of medical professionals as well as to the generosity of both living and deceased organ donors. Nonetheless, the rising rate of kidney disease means that some patients won’t get the transplant they’re waiting for. That shortage of organs has led to proposals to lift the prohibition on payment that has been part of U.S. organ donation law since 1984. But buying organs would be wrong. And aside from being wrong, it would also harm existing, voluntary donation programs and be ineffective in increasing the supply of organs. There are better ways to increase the number of organs donated than paying for donations. In recent decades, thousands of organs have been bought from the destitute around the world, for transplantation into the social elite in their own countries or “transplant tourists” from other nations. This has tarnished the reputation of organ transplantation and led to poor medical outcomes. In all countries, it is the poor who sell organs as a way out of their financial straits — usually only temporarily. 2 Sales of kidneys by living “vendors” — “donor” is the wrong term — undermine efforts to build robust programs of voluntary, unpaid organ donation from living related donors and deceased donors. In country after country, the same phenomenon occurs: Financial incentives “crowd out” voluntary donation. Kidney patients have no reason to turn to relatives and, more important, governments have no need to develop the infrastructure and public support for deceased donation when organs can be obtained from poor strangers. For example, Iran — the only country that has a government-sanctioned program of paying donors — hasn’t eliminated its waiting list, which is proportionately larger than in the United States. When kidney sellers are surveyed a year or more after the removal of their organ, they report much worse health and regret having sold a kidney. The highest rates of transplantation are found in countries like Spain and Croatia that have well-organized programs of unpaid donation. The principle of non-commercialization of human organs has been enshrined in professional statements, such as the Declaration of Istanbul, and international legal instruments, such as the Council of Europe Convention against Organ Trafficking. Since that convention opened for signature in March, 16 countries have signed on to update their criminal law to include its provisions, which include organ purchasing and surgeons’ use of purchased organs in the definition of “organ trafficking.” A number of policies adopted by developed nations provide a model for ensuring that live organ donors do not bear financial burdens. For example, Principle 5 of the World Health Organization’s “Guiding Principles” on organ donation clearly states that “[t]he prohibition on sale or purchase of cells, tissues and organs does not preclude reimbursing reasonable and verifiable expenses incurred by the donor.” As WHO explains, covering donors’ costs, “including medical expenses and lost earnings,” is appropriate because they may otherwise “operate as a disincentive to donation.” Indeed, during the recent recession, the rate of living kidney donations decreased in the United States because some potential donors could not afford to bear the expenses associated with organ donation or did not meet the requirements for programs that cover some of these financial costs and losses. The existing national laws and international agreements all recognize that reimbursing donors for the costs of donating is permissible, as these costs are not inherent in the gift of the organ itself. Covering these actual costs merely makes sure that donors are not worse off financially after their gift, as opposed to improving their financial situation. Unfortunately, the current U.S. program is inadequately funded and unduly restrictive. Removing all financial disincentives to becoming a living kidney donor would result in more transplants and fewer patients on dialysis, thus saving taxpayers a great deal of money. The Department of Health and Human Services can help all organ procurement organizations become more efficient and effective. For example, transplant programs are understandably concerned that their performance will be unfairly judged since no adjustment is made for using organs from higher-risk donors. Such organs are 3 therefore discarded even when some patients with multiple health problems would willingly accept them as a better alternative to dialysis. HHS can also promote practices that show our collective respect for, and gratitude to, voluntary living donors and the families of deceased donors for their generous solidarity with patients in need. If U.S. law is changed to turn human organs into commodities, organs will be obtained from the poorest and most vulnerable — not only in our society but also from around the world. Countries with pervasive poverty that have recently adopted anti-sales laws would find it impossible to resist the pressure to repeal their own regulations. That would doom their nascent deceased donation programs and make transplantation less an emblem of medical ingenuity and more an engine of exploitation and injustice. 4