Commentary
You Need A Kidney And I Need The Money
An osteopathic family physician's personal perspective on legalizing organ selling.
People are still dying for organ transplants these days. Literally. Nationwide between January 2,
1988 and February 28, 2003 there were
a total of 248,897 organs transplanted
(Organ Procurement Transplantation
Network-OPTN data 4/2003.) The numbers have been increasing annually from about 12,000 in 1989, up to about 20,000 in 1997, and reaching 28,848
by the end of 2002.
On January 1, 2003, there were over 85,000 people waiting for at least one organ. That number has decreased by almost 4,000 people (as of the writing
of this article) possibly due to having received a transplant that has not been recorded in the OPTN data bank, or
due to death while on the waiting list.
Population Explosion
The world’s population is rapidly reaching critical mass. In industrialized nations such as the US, food is plentiful and easily available for most (although hunger is a problem in many parts of
our country) and this contributes to the numbers of people populating our country and others.
The population explosion combined with the technological advances that keep people alive longer, albeit not necessarily healthier, have created a drain on the
organ donating system.
Illegal Organ Sales
The selling of organs is illegal
(National Organ Transplant Act.) This
law was enacted to supposedly ensure a fairness in the distribution of organs, so that there would not be a disparity of organ transplantation between those
who can afford the organs and those
who cannot. Get real.
There already is a disparity in our healthcare system. There are millions of uninsured people in our country, people who cannot afford healthcare insurance, for whatever reason. Among those who
do have insurance, there is still a disparity of what services these people can obtain. This is due in part to high deductibles,
tier structure of available pharmaceutical products creating higher co-payments
for third tier products that makes those products out of reach of many insured people, and “non-approval” of these procedures by HMO insurance plans.
This puts procedures financially out of
reach of many subscribers to these restrictive plans.
Transplant Cost
Even with the illegality of organ sales, the transplant will cost the recipient for the first year of care, on average, between $65,000 and $302,000, depending on which organ is transplanted.
The average cost of organ retrieval itself by the Organ Procurement Network is $15,500 per organ. The annual follow-up charge may be up to $21,000, not including the required anti-injection medications.
Even with insurance, some insurance companies routinely deny coverage, or approve coverage only after a lengthy battle. Then by the time the organ is found, it is too late for the patient.
Many uninsured people who need
an organ fall through the cracks in that they make too much money to qualify for indigent care, but not enough to foot the transplantation bill in its entirety. Where
is the equity?
Brokerage
The system has another strange quirk. People are allowed to donate, without remuneration, any organ whatsoever they please, whether alive or after death. It does not appear that the laws against organ
sales were enacted to protect the potential donor, and they certainly don’t protect the potential recipient.
So whom does the law protect? I personally don’t think it protects anyone, and it actually causes harm in that it unduly delays urgently needed organs until, in many cases, it is too late for the potential recipient.
If organ sales were legal, licensed brokers could find organs and match recipients willing to pay for it. A brokerage would make sure that the person who paid for the organ would actually receive it, as opposed to say, adoption scams where the prospective parents pay all costs associated with the biological mother’s pregnancy
and her living expenses and then the birth mother reneges on the agreement. This would, unfortunately, raise the cost of the transplant to the recipient.
Internet Organ Service
Another option would be to have an Internet organ finding service, where one could list an organ and the corresponding sales price. Safeguards could be imposed
so that there would not be coercion of a “donor” to sell an organ, nor wholesale mugging of innocent parties whose organs could be taken from their bodies and sold.
The cost of the actual transplant process could then be negotiated between the recipient and the hospital as well as
the transplant team. A middle class person without insurance but possessing a modest retirement fund could then find an affordable transplant. Let’s face it, this is
a person that would not be able to get a needed organ any other way.
Also, if some rich person has already had a transplant and needed another one for any reason, perhaps society would be better served by having that person finance their own transplant, instead of draining the system a second time. Now this is equitable.
So here were are. I have massive student loan debt, but two good kidneys and I only need one. You have no kidneys, but more money than you need, especially if you are dead. Let’s make a deal.
Buyer Beware When It Comes to Organs
An osteopathic family physician's personal perspective on legalizing organ donation.
Not long ago I took the position
that it would be acceptable to genetically engineer body parts
to ease the shortage of donated organs
in America. It would be great to have a commercial repository for custom grown parts to replace injured or defective ones. This is presently a pipe dream though
and we are faced every day with the reality that there are far fewer donors than potential recipients.
In a free market society, this represents a tremendous business opportunity, because demand far exceeds supply. It is also true that the greater the demand for a product the higher the price can be demanded for that product.
It is not much of a stretch to ascertain that only those who can afford the service will get the service. Those people who do not have insurance or other large financial reserves would be passed over for patients that are more affluent.
Like we sadly found out with the
blood banks of the 1970s when money is involved, donors tend to assume the role of a used car salesman pawning off unsound merchandise as being sound. Like a Robin Cook novel, we would see unscrupulous business profiting on the misfortune of others.
The need for a greater supply of anatomical parts would again lead to exploitation of the less fortunate. People
could donate their body parts for money, and bidding would become commonplace. Imagine instead of telemarketers calling
to sell you aluminum siding they will be calling to solicit your islet cells. Market pressure to deliver organs by a certain deadline or in a certain volume may force companies to take short cuts to maximize profits.
The American Red Cross is a great example of how volunteerism has kept potentially dangerous tissues safe for
many decades. When money is paid for a product (be it natural or manufactured) it is subject to different rules than a donated one. The best way to insure safety and equal access to anatomical parts is to treat them as gifts, and not as commodities.