The Boston Globe’s Jeff Jacoby writes that the Steve Jobs liver transplant, and the fact that he may have put his name on the list of several states in order to ensure maximum odds of getting a liver, is a reminder of how horribly broken and dysfunctional this current system is.

What we need is a market mechanism to compensate and encourage organ donors:

No one would dream of suggesting that medical care is too vital or sacred to be treated as a commodity, or to be bought and sold like any other service. If the law prohibited any “valuable consideration’’ for healing the sick, the result would be far fewer doctors and far more sickness and death.

The result of our misguided altruism-only organ donation system is much the same: too few organs and too much death. More than 100,000 Americans are currently on the national organ waiting list. Last year, 28,000 transplants were performed, but 49,000 new patients were added to the queue. As the list grows longer, the wait grows deadlier, and the shortage of available organs grows more acute. Last year, 6,600 people died while awaiting the kidney or liver or heart that could have kept them alive. Another 18 people will die today. And another 18 tomorrow. And another 18 every day, until Congress fixes the law that causes so many valuable organs to be wasted, and so many lives to be needlessly lost.

The fact that we have so many people waiting for kidneys, waiting on expensive and painful dialysis, is proof of how bad the system is, since healthy people don’t need two kidneys, and since having only one kidney doesn’t increase your own odds of getting sick (kidney failure strikes both at the same time, typically).

Rather than delve into all the details of how it would work in practice, let’s just consider some common objections to organ markets, and why they’re all so hollow.

A market in organs would discourage altruistic donors. While there are some noble souls who donate, it’s ridiculous to be more concerned with the donor, than the recipient. What’s more, organ donation after death is only vaguely altruistic, since the cost to you, as a dead person, is nil. And in fact, the current system is highly discouraging towards the true altruists, those who donate an organ while still living. For more, you must read Virgina Postrel’s account of donating a kidney.

A market in organs devalues human life. This is another one of those objections — like the one about altruism — which favors the theoretical over the real. A system that needlessly leaves some folks on dialysis, or desperately trying to game the organ donor list is one that doesn’t respect people — real, living people.

The financial crisis should have disabused us of our faith in markets. It’s true, markets fail and can expose the worst of greedy, risky human behavior. But greedy, reckless people exist in any system, and there’s no reason to think they disappear under our current system.

There will be a black market in human organs. This exists now. A legal, transparent market would do nothing to make this situation worse.

It would hurt the poor, who would be cajoled into selling organs. If all objections fail, say that the poor will get hurt under a market system. That’s possible, but there aren’t many industries or areas where vulnerable people aren’t, well, vulnerable. That’s not a reason to throw the baby out with the bathwater. That’s a reason to build in safeguards — and if you beleve that the existing, highly-regulated organ donation system works, there’s no reason you can’t build in some logical regulation to the market system so that the poor aren’t told they’re being given a free appendectomy, while in reality having their livers taken out.

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My comments

1.  Years ago, I found that in an unfortunate, tragic situation of someone dying in the ER, with healthy organs, physicians were reluctant to bring up organ donation to grieving families. This may have changed, but I concluded that if families/the patient’s estate was to be paid, doctors might be more comfortable asking, and families might be more likely to agree to donating the organs. Imagine – this is an incredibly difficult, heart-breaking situation, and anything that could provide greater motivation for any of the parties could result in more donations. 

2.  How much? A sum that would cover "death" expenses seemed reasonable.  Think about it, the doctors get paid, the hospitals get paid, why shouldn’t the donor get paid too?

3.  In the case of live donors, the issue is more complex than with dying donors.  Physicians have a duty to do no harm to either individual, and the surgery to remove an organ is not without costs and risks. 

4.  "A market in organs devalues human life." This argument has been repeated over and over but there’s no substance to it. If one person is dying with a healthy kidney and one could be saved by a kidney transplant, then facilitating a consensual transaction to save a life is valuing life. 

5. There are horrifying black markets in human organs now. By structuring an open, legal and intelligently regulated market in the U.S., it may be possible to decrease the number of people resorting to black markets in other countries where there is little or no protection for donors (often not even volunteering donors).