FEW ordeals could be more distressing than waiting for a replacement kidney, lung or even heart, knowing that your life depends on receiving one. In the US alone, more than 6000 people die every year while waiting for an organ transplant, and in the UK last year the figure was over 400. Many others endure great pain and distress, often in hospital on life support, while queuing for available organs. In 2003 in the US, only around 20,000 out of the 83,000 waiting for transplants received them 鈥� a tragedy by anyone鈥檚 standards.
What makes this suffering all the more tragic is that much of it could be prevented, and many more lives saved, by changing the way organs are donated. The change is controversial, but it is simple enough: make it legal to buy and sell organs on the open market. At a stroke this could significantly increase the number and quality of available organs, and so reduce suffering and save lives. This, surely, is the bottom line.
How would it help? For a start, it would allow families to sell the organs of a deceased loved one rather than just donate them. The knowledge that their families would benefit could persuade many more people to become organ donors. But it would also open up more intriguing possibilities. For example, some people might consider a contract in which they agreed to give up their usable organs on their death to a particular buyer and have the money paid to their descendants.
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Others might wish to sell a redundant internal organ, such as a kidney, while they were still living. This could be seen as a valuable way of improving their life circumstances; indeed, some might view it as heroic 鈥� saving the life of another, at some risk to themselves. Each of these cases is little different to the current system of organ donation apart from the financial compensation that donors and families would receive. And it could go further: you could have a barter market in which people could trade in redundant internal organs 鈥� a slice of healthy liver for a healthy kidney, for example.
Many people may consider such proposals morally repugnant, but I believe such feelings are misplaced. Let鈥檚 look at some specific criticisms. A common challenge is that an open market would exploit the poor; that it would coerce poor people into selling their organs, something that in better circumstances they would not consider. But why would the market necessarily be exploitative? People would be free to negotiate a bargain in which both parties win: on the one side a life is saved, on the other a family is lifted from poverty.
鈥淧eople would be free to negotiate a bargain in which both sides win鈥�
The fear that unscrupulous entrepreneurs would convince people to part with organs for less than the market price is, I believe, also misplaced. Unlike illicit trading, a legally regulated market should not suffer from such behaviour. For example, it should be possible to set minimum legal prices for organs to ensure that sellers are properly compensated. Countries would have to decide how best to regulate the international organ trade, but this shouldn鈥檛 be a huge challenge since they already regulate international organ donations.
Another reason why a legal trade would discourage unscrupulous practices is that in legitimate markets, kindness and personal recognition are often crucial for business, allowing partners to build up trust. Customer satisfaction and professionalism lead to profits. Transplantation needs skilled services; hospitals, as providers of highly qualified surgical teams, a suitably sterile environment and medical follow-up, have professional incentives to encourage virtuous tendencies in the market. Surgeons would be unlikely to put their reputation at risk by dealing with black-market traders or con-artists.
Critics of organ trading may claim that only the rich would be able to afford organs, and that the poor would have to wait in line for state-funded transplants. But this is unlikely for several reasons. First, since the market would increase the number of organs, making transplantation more readily available, it would reduce queuing time. As it is usually the poor who wait longest for scarce medical resources, it would benefit them most of all. Second, meeting the medical needs of patients who are waiting for transplants is very costly. By reducing waiting times, the market would also very likely save money for public health insurance programmes. Third, even within a market, private individuals could still donate organs for free out of charity to family members or others in need.
It is time to stop the hand-wringing and consider the facts: the current system of organ transplants is not working, and a market for donors and recipients could help save lives and considerably reduce suffering. Proper regulation would be essential to ensure that the system benefited all those in need, regardless of their income, and that it did not exploit the poor. If we fail to take this opportunity, patients will continue to languish on waiting lists until they run out of time.
