Saturday, January 9, 2010

Alex Tabarrok on the Human Kidney Shortage

In this morning's Wall Street Journal, Marginal Revolution blogger, George Mason University economist, and friend of Cyclingprof Alex Tabarrok has an excellent article on the shortage of human organs, particularly kidneys. As a kidney donor myself, I applaud his attention to this important issue, and agree entirely with his perspective. Here are a couple of the more interesting, even surprising, points he makes:
[I]n 2007 there were just 64,606 kidney-transplant operations in the entire world. In the U.S. alone, 83,000 people wait on the official kidney-transplant list. But just 16,500 people received a kidney transplant in 2008, while almost 5,000 died waiting for one.
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Only one country, Iran, has eliminated the shortage of transplant organs—and only Iran has a working and legal payment system for organ donation. In this system, organs are not bought and sold at the bazaar. Patients who cannot be assigned a kidney from a deceased donor and who cannot find a related living donor may apply to the nonprofit, volunteer-run Dialysis and Transplant Patients Association (Datpa). Datpa identifies potential donors from a pool of applicants. Those donors are medically evaluated by transplant physicians, who have no connection to Datpa, in just the same way as are uncompensated donors. The government pays donors $1,200 and provides one year of limited health-insurance coverage. In addition, working through Datpa, kidney recipients pay donors between $2,300 and $4,500. Charitable organizations provide remuneration to donors for recipients who cannot afford to pay, thus demonstrating that Iran has something to teach the world about charity as well as about markets.
I would make couple of further points about laws prohibiting the sale of human organs. First, as Alex notes, such laws are not terribly effective; up to 10% of transplanted kidneys now are obtained through black market transactions. Second, laws prohibiting organ sales are typically justified on moral grounds, but it needs to be asked (apparently over and over again) whether it is more immoral to sell organs - particularly those organs, such as a second kidney, that donors can easily and healthfully live without - or to deprive those who might die without organ transplants. In my view, the answer to the second question is obvious: protecting the supposed virtue of donors is far less important than protecting recipients' lives. The laws should be changed to permit market transfers of organs, including kidneys and parts of livers, which donors can easily and healthfully live without.

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