Let's Put Organs on the Free Market
originally published in the Springfield, Missouri News-Leader, November, 1999
The News-Leader reports that "too many people die waiting for an organ donation" ("Don't fear organ donation," November 3), and suggests that responsibility lies with our "reticence to talk openly and become informed about what is an admittedly queasy subject." That may be part of the problem, but the News-Leader, like other commentators, avoids discussing one obvious and eminently practical solution.
The transplant patient or insurance company pays the doctor who performs the operation, the anesthetist who makes it bearable, the pharmaceutical company that manufactures drugs to ensure the new organ isn't rejected, and any number of other parties who provide goods or services to make the transplant possible. Everyone gets paid -- except for the survivors of the donor.
None of the aforementioned parties performs their work solely out of well-intentioned concern for the health of the patient. They all expect to be compensated. Yet the spouse, parents or children of a recently deceased accident victim are expected to hand over the heart, liver, kidneys or corneas of their loved one as a gift.
There is, of course, some merit in doing so. A lot of people will "sell" their organs or the organs of their loved ones in return for the "payment" of gratitude and the knowledge that they've helped another.
But how many more would take the necessary steps to become organ donors if they knew that doing so would help their survivors make it through the perilous economic times following the death of a family member?
If I offered you a $100,000 "life insurance policy," payable to the beneficiary of your choice, on the condition that you designate your vital organs for transplant use following your death, would you not be more likely to do the paperwork?
At this point in the discussion, I usually run into the objection that the selling of organs is "unethical." Yet no one disputes the right of the physician to pay for her country club membership with fees received for performing the transplant, of the anesthetist for making the monthly car payment from his salary, etc. In what way is it unethical for the recently deceased to have arranged for his or her organs to save a life -- and to make life more bearable or comfortable for his or her loved ones?
A great many people do die every year while waiting for vital organs -- organs that would almost certainly be available in plentiful supply if the prospective donors had an incentive other than good will to motivate their donation.
A Reply to My Critics in re Organ Donation
To Whom it May Concern:
I write a lot of opinion pieces. Some of them are published in various newspapers, webzines, or on my personal webspace. I make a practice of replying -- politely -- to anyone who cares to comment on my writings: a note of thanks for compliments, a polite "agreement to disagree" to those who oppose my views, or a personal attempt to resolve particular questions that are raised in their comments.
For the first time, I've found myself stymied in this practice. Recently I submitted an op-ed on organ donation to the Springfield, Missouri News-Leader (this piece was also sent out to the Tilting at Windmills e-mail subscription list and
A few days later, the newspaper published a reply from a person whom I am unable to contact. The writer, Stephanie Scott of Clever, Missouri, does not appear to have either an e-mail address or a phone number listed under her own name. Nonetheless, the reply raises questions and issues that I would like to address; and since the News-Leader doesn't exist for the purpose of printing an ongoing exchange between its readers on specific issues, nor does it have a forum for such exchanges on its website, I am electing to reply in this article, which I will e-mail to the News-Leader for forwarding if possible, and which will be posted on the Tilting at Windmills site.
Since I have been unable to contact Ms. Scott to secure permission to reprint her letter in toto, I will excerpt here, attempting to adhere to the "fair use" criterion. Those who wish to read her letter whole can find it on page 9A of the Wednesday, November 10, 1999 issue of the News-Leader.
First, I will deal with Ms. Scott's immediate reaction to myself and my article. Scott characterizes herself as "disgusted and appalled" by my ideas. I apologize for any discomfiture the piece may have caused, while pointing out that the remainder of her letter establishes that she did not understand those ideas as I wished them to be understood. That, of course, is my fault -- a writer should convey his or her ideas in a manner that makes the reader understand them. Once again, I apologize.
On the other hand, Scott is only partially correct when she states that I "Undoubtedly ... [have] not been in the position to make the donation decision, nor can he comprehend the impact of that decision."
I have not been in the unenviable position of disposing of a deceased love one or his or her organs. I have, however, been in the position of deciding whether or not to donate my own for a bone marrow transplant. A perfect candidate was found before it even came down to testing my marrow for compatibility, but the possibility nonetheless existed, and I had, in fact, decided to do so if necessary. Unfortunately, the transplant was too late to save my uncle, who died of leukemia.
Now, on to Scott's assertions on my idea. "To say that my loved one's organs are worth 'X' dollars is ludicrous." I made no such assertion in the article I wrote. As a matter of fact, I did not approach the issue of financial compensation for organs from the viewpoint of the donor's family at all. The approach I took was that of the donor himself: if, I posited, while still healthy, a potential donor was apprised of the fact that his organ donation in the event of untimely death could result in financial aid to his family, he or she would be more likely to take the time to fill out a donor card, state his or her wish to donate in writing, and discuss the matter with the loved ones who would be called on to make this difficult decision after his or her death.
I stand by this assertion. Too many of us refuse to acknowledge the fact that we are going to die some day. It's easy to put off discussing things like funeral arrangements, wills and powers of attorney, and, yes, organ donation. Discussing these issues brings the spectre of our own mortality to the forefront. It's easier to just ignore the issues -- but it leaves difficult decisions to be made by bereaved survivors.
Now, let's talk about Joe Sixpack. He doesn't want to think about headstones and funeral plots. He refuses to go see an attorney and put down in writing which kid will get the guns, which one will get the tools, and which one will get the farm when he passes on. And he isn't going to give a passing thought to whether or not his heart, liver, lungs, kidneys or corneas might save a life, restore someone's sight, or improve the health of someone who lived while he died.
But what if he knew -- what if he was told -- that his wife, whom he loves very much and would want to provide for, would receive needed money in the event of his death? Money that would cover funeral expenses. Money that would make up for the income lost to the family by his passing? Money that might, in some small way, ease the burdens of that wife, those kids?
I think a lot of Joe Sixpacks would sit down, fill out their organ donor card, and talk with their loved ones about that decision. They would be doing it from the natural desire to take care of their own -- and, in the process, they would hopefully be putting something better than money into a different account: an account of lives saved by their organs, which otherwise would have proceeded from the accident scene or hospital room to the crematorium or cemetery.
Ms. Scott states that she would find it offensive to to feel that she traded her deceased loved one's organs for money and that, "If I were approached in that manner, I would have declined."
Let me get this straight, Ms. Scott. You are saying that you would refuse to save a life if your sister's husband, children, elderly parents or yourself were compensated in any way for doing so? You would LET SOMEONE DIE rather than take money for saving his or her life? You are entitled to this sentiment, but it seems rather counter to the compassion expressed in the portions of your letter preceding it.
But, if you insist, we can deal with this: I don't see that there would be any requirement that you accept this money. If you wish to refuse payment, that is your prerogative, and I compliment you on your willingness to help without financial compensation.
Are you, however, claiming the right to impose this solution on all parties? On the widowed homemaker whose household income has just disappeared with her husband's death? On the teenager who won't be able to go to college because of his father's untimely accident? On the father who is burying a daughter he had expected to outlive him, and who doesn't have the funds for a decent cemetery plot, casket and headstone?
Are you claiming the right to impose death on the patient awaiting a liver transplant -- the patient who will die because that accident victim never had an incentive to think about organ donation? Are you claiming the right to impose a life of sightlessness on the blind child awaiting corneas that are buried in the ground? Are you claiming the right to impose continued dialysis on a patient with kidney failure while two perfectly good kidneys rot in a mausoleum?
Next item.
Scott asks if, given the application of my proposal, organs would become auction items, going to the highest bidder. This strikes me as a valid concern, but I think it can be addressed. Personally, I have no problem with "a market in organs." Generally, when a particular item goes onto a legitimate market, the price steadily decreases. In this case, an increased supply of organs, and an increased number of transplants, would almost certainly reduce the costs of surgery as more practitioners performed the lucrative operations. The increased availability of organs would also mean shorter -- and therefore less expensive -- waits in the hospital for patients; and the increase in organ supply would also pay off in shorter post-operative recovery as better matches, requiring shorter regimes of drugs to stop tissue rejection problems, became the norm.
But I don't think we're going to see human hearts on the block at eBay any time soon. More likely, the medical profession will get together and set a standard compensation package. You won't get that heart by bidding $100,000 versus someone else's $99,999. You'll get it by being the next person on the waiting list who is a viable tissue match, and your insurance company will pay $X for it, just as they paid $X for the one before it and will pay $X for the one after it.
The issue here is not one of "need versus greed." We all agree that an increase in the number of organ donors means that more people can get the transplants they need. Whatever it takes to make that increase possible is worthy of consideration. I respect the right -- and admire the sentiments -- of anyone who, acting selflessly and out of love, is willing to donate their organs and who will take the necessary steps to inform their loved ones of this desire. On the other hand, I am not unaware of the powerful effect that money has in causing people to do things they otherwise will put off and possibly never do.
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