"Man is a clever animal who behaves like an imbecile." - Albert Schweitzer

***

Introducing Incentives in the Market for Live and Cadaveric Organ Donations
Gary S. Becker, Julio Jorge Elías

"Proposals to pay for organs, even from cadavers, have been sharply criticized on several grounds. One of the most common is that payment is “immoral” because it involves the “commodification” of body parts. Individuals who make this argument deny that people have the right to control the use of their bodies.

If women can get paid to host the eggs of other women and bear their children- as they can in the United States -why cannot men and women get paid for selling their organs to save the lives of others? Surely, the moral considerations involved in allowing pay for organs that save lives are no weaker, and for many persons would be stronger, than those involved in allowing pay for the use of wombs to create lives.

Table 5 considers the most important arguments that have been advanced against payment for organs by comparing that system with issues raised by a voluntary army. The first row and first column discuss the claim that monetary payments for organs is undesirable because that involves commodification of body parts. But the voluntary army used by the United States and many other nations allows the commodification of the whole body since volunteers expose themselves to injury and death if they are sent into conflict. Not only has the voluntary army been considered a success in the United States, but several European nations- such as France- that originally favored the draft have been shifting to a voluntary army.

The sale of organs has also been opposed because poor individuals probably would be the main ones who would sell their organs. But should poor individuals be deprived of revenue that could be highly useful to them, especially when their organs might save the lives of persons who desperately need to replace their defective organs?

This argument was also made against the voluntary army, that it would become an army of the poor. However, it did not quite work out that way. The very poorest often cannot qualify for the armed forces because they have insufficient education, low test scores, may use drugs, and so forth. Similarly, the organs of poor individuals who use drugs, or have aids, hepatitis, or other serious illnesses would be rejected as posing too large a risk to recipients. So probably the healthy poor and middle classes would actually provide most of the organs for live transplants under a market incentive system. Of course, a quota could be placed on the number of organs from poor individuals, but is that desirable?

It is also claimed that payment for organ donations from living individuals would encourage impulsive and reckless provision of organs, partly because donors would not be able to sufficiently calculate the risks involved. If impulsive donations were a problem, a few weeks cooling off period could be required to give donors sufficient time to change their minds.

... Row 4 of table 5 mentions the opposition to paying for organs because that might reduce the supply of organs from altruistic reasons. Although paying for organs does not prevent persons from supplying organs out of altruistic motives, usually to help relatives, altruism clearly has been an insufficient motive under the present system. Otherwise, the demand for organs would not be so much larger than the supply.

Again, a comparison with a voluntary army is instructive. Critics claimed that it would be difficult to get volunteers at a reasonable price because paying for volunteers would crowd out persons who would otherwise volunteer for patriotic motives. In fact, people have enlisted under a voluntary army for a variety of motives, including patriotism. In particular, military volunteers surged after the terrorist attack on 9/11 because of patriotism.

The long wait for organs under the present system has encouraged the development of a black market in live or cadaveric organs, where donors or their heirs get paid. These transplants are available only to wealthier individuals who usually must bear the total expense themselves. They are also often much riskier because organs are not screened as carefully for disease, are not matched as closely to recipients, and operating conditions and the quality of surgeons tend to be inferior.

Allowing the purchase of organs would essentially knock out the black market in organs, and all its problems of quality control. The purchase of organs would also reduce the advantages of wealth in getting organs since poorer individuals in need of organs who cannot afford the black market would no longer have to wait so long before getting their organs through the Medicaid or Medicare payment system.

But above all, the most effective answer to the critics of paying for organs is that the present system imposes an intolerable burden on many very ill individuals who cannot afford to wait years until suitable organs become available. Increasing supply through payment would largely eliminate this wait and thus enormously improve the efficiency of the transplant market."