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Dr. Daniel Sutter: The organ shortage

Over 100,000 Americans await organ transplants and over 6,000 die annually while waiting. From an economic perspective the decades-long organ shortage has a simple cause: paying organ donors is illegal. Price controls predictably produce shortages.
Payment for organs has been outlawed since at least 1948. The 1984 National Organ Transplant Act established the Organ Procurement and Transplantation Network to allocate donations by uniform criteria. Around 40,000 transplants occur annually, with over 80 percent of organs coming from deceased donors.

A price ceiling is a legal maximum price imposed by government on a market. Selling for more than the set price becomes illegal. If the control is less than the market price (called the equilibrium price) and the law is enforced (price ceilings often produce black markets), a shortage ensues. Rent control is an example of a price ceiling.

Prohibiting sales sets the price to zero, which must be less than the equilibrium price. The waiting lists and deaths are real life results of the shortage. Lifting the ban on payment should increase the number of organs available for transplant.

Buying and selling organs has been illegal and deviating from customary practice can make people cringe. This discomfort, though, is temporary; we should require a better reason to continue a deadly prohibition.

Harvard’s Michael Sandel in What Money Can’t Buy notes two objections to “commodification,” or converting something into a good to be bought and sold. The first is fairness, or concern over being forced to transact due to necessity: “A peasant may agree to sell his kidney or cornea to feed his starving family, but … he may be unfairly coerced … by the necessities of his situation.” Fairness also involves whether only the rich could afford organs.

The second objection is corruption, which holds that, “certain moral and civic goods are diminished if bought and sold.” Donation is no longer a noble sacrifice but a cash transaction. And monetary payment could crowd out voluntary donations.
Whether desperate acts are voluntary is debatable. We sometimes do things because we “have” to, even if we acknowledge that no one pointed a gun at us. True voluntariness may require more than an absence of coercion.

Yet money often improves desperate circumstances. Imagine a 35-year-old man providing sole support for a family dying suddenly and unexpectedly without life insurance. In addition to the emotional toll, the family likely faces financial hardship. Payment for the man’s organs could help support the family. Is making the family rely on charity better?
Would only the rich get transplants with payments? Not necessarily. The Organ Network could make payments and still use the current criteria for allocating organs. But any wealthy persons buying organs for themselves would be off the waiting list.

The corruption argument is based, I think, on a view of money as inherently corrupt. But money is just a medium of exchange, letting people buy whatever they choose. Money is a tool of voluntary market exchange, and exchange respects the moral value of all persons.
I could try to obtain a kidney for transplant in three different ways. First, I could say, “I need a kidney, you have one to spare, let me have one.” I could cry, beg, and guilt the person into donating. Second, I could try to take one by force. Third, I could offer to give or do something in exchange.

Beg, steal, or trade. Personally, I think that trade is the best way to proceed. Money just helps people reach mutually agreeable exchanges.

If you oppose payment for organs, remember that simply prohibiting payment saves no lives. Suppose a person’s next of kin will not allow organ donation but would agree if offered payment. Without payment the organs go to the grave and persons awaiting transplant remain desperately ill.

Opponents should offer a solution to the shortage, not merely block one they dislike. Marketing campaigns for organ donation have not worked. Should the government compel the harvesting of organs from the deceased? I think that paying donors provides a great solution to the shortage.

Daniel Sutter is the Charles G. Koch Professor of Economics with the Manuel H. Johnson Center for Political Economy at Troy University and host of Econversations on TrojanVision. The opinions expressed in this column are the author’s and do not necessarily reflect the views of Troy University.

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