Saturday, July 08, 2006

Organ, Organ, Who's Got the Organ?

If you mention organ selling to most people, they picture someone waking up in an ice bath with a kidney missing. But, selling an organ is not as bad as you think. Like most problems in economics--or in life in general--it comes down to the incentives. In this week's New York Times Magazine, Steven Levitt and Stephen Dubner(authors of Freakonomics) write a column calling for a better and fairer way of making sure that people who need organs get them. Right now, organ selling is illegal. People who need organs go on a waiting list and often die before getting that heart or kidney or lung. As Levitt and Dubner point out, "In 2005, more than 16,000 kidney transplants were performed in the U.S., an increase of 45 percent over 10 years. But during that time, the number of people on a kidney waiting list rose by 119 percent." Demand is quickly outpacing supply.

Most of the time in markets, if there is not enough of something--like oil--people will do more to get it. This is how goods and services are rationed in a free market: the people who will give the most for something will get it. So, if people want organs, they should be able to give more to donors (live or dead) in exchange for organs. Right now, the only incentive to donate an organ is knowing that you've done something that helps someone. Think about it: no one would give up an organ to see it in a dump somewhere. If we want more organs, we need more incentives. People who need organs should be able to--through hospitals--find possible donors and offer them incentives. For some donors, that might be a hug. Or some cookies. Or it might be 100k.

There will be people who do not like this idea. As the Freakonomics guys say,"Others fear that most organ sellers would be poor while most buyers would be rich; or that someone might be pressured into selling a kidney without fully understanding the risks." Giving someone an organ--or anything--in exchange for money is just like taking a job. Plenty of people take jobs, in construction, say, or the military, that put them in danger. But they are "free to choose," as an economist would say, to make the decision to take those risks for money. And, as the authors say in the article, why take away from someone an opportunity to make money, to feed their family, that they are perfectly willing to enter into? And, why deny someone an organ?

Of course, not everyone who needs an organ will be comfortable with the incentives. Some people might think that those who would give an organ for money are giving it for the wrong reason. Those people are free to offer donors other incentives, like cookies or a hug, or none at all. The point is that people should be able to enter into any kind of deal that they want to, and offer the incentives that they want. They are free to choose the risks and benefits of doing different things. We wouldn't think of making it illegal for someone to sell a home or car to a willing buyer, so why make it illegal to sell an organ to a willing recipient?

People are still free to choose, but right now, organs are not houses and cars. That is to say, they are made not by people but by nature, inside of the human body. Like oil, organs are things that we need but that we can not make. Economics says that when there are willing buyers, there will be willing sellers, but what if there is nothing to sell? True, there is a limited amount of oil, and a limited number of organs, but we can change the incentives to make sure that the people who need organs most get them. And, some day, the demand will make a supply of a different kind, man made organs. We learned how to make insulin, so why not organs too? If organs were made in a lab, we would never dream of telling people that they couldn't pay for them. So why can't the same incentives be put to use now? The people who need them don't have time to wait.


Anonymous Anonymous said...

To make man made organs they must be grown from stem cells. Stem cell reseach is a difficult and taboo thing in this country and is likely to stay that way. Unfortunantly you cannot fix one thing wrong in this country without fixing almost everything wrong in this country. With some of the politicians that are in office now I doubt much will happen.

3:57 PM  
Anonymous Anonymous said...

Logic and economics are certainly on your side. In fact, organs are already being sold, by so-called middlemen, who impose and collect "fees" when hearts, kidneys, and other body parts are provided to hospitals where transplants are performed. The donors (or their families) don't see any of the money, though, and that's why we continue to call the current system "altruistic." It's probably only a matter of time before organ donors are paid for their contributions. Years ago the sale of blood was also forbidden, but that prohibition was eventually eliminated.

11:26 PM  
Blogger Amy Allen said...

Anon 11:26,
Good point, and thanks for reading.

7:53 PM  
Blogger Greg said...

The doctor makes money off the deal, so does the hospital, the patient needing the organ gains, as well. So it seems that everyone makes something out of the deal except for the person making the sacrifice. What kind of system is that?

3:21 PM  
Blogger Amy Allen said...

That's exactly what I said. People should be able to buy and sell organs.
But, remember that people who give the organs are doing it because they want to, not because they have to. The idea that they are helping someone else is all the "profit" they want. Different people have different incentives.

4:47 PM  
Anonymous Peter said...

I would imagine that if we were able to make organs, they would be pretty costly. A month supply of insulin costs anywhere from $200 to $800 depending on how much the person uses. That's anywhere from $2400 to nearly $10000 a year.

In my opinion, there should be a ban on selling bodily fluids for profit, whether they are made artificially or naturally.

3:28 PM  

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