THE WASHINGTON RUMOR MILL has it that the president's commission to consider bioethical issues such as, but not limited to, cloning, is about to issue its report on the possibility of creating a market for human organs. And the word is that the bioethicists have decided that it is a bad idea to allow donors to sell hearts, lungs, livers, and other vital organs to patients desperately in need of transplants. Another triumph of bureaucratic and well-intended thinking over economic good sense--and a lethal one at that.
No one denies that there is a horrendous shortage of organs, or that thousands of people die every year waiting for heart, liver, kidney, or lung transplants. The solutions proposed by experts are appeals to altruism, a campaign to persuade potential donors that doctors will use their parts in an acceptable way, and better organization by relevant governmental and medical institutions to funnel organs to needy patients. Some even propose the innocuous-sounding "presumed consent", which would allow doctors to extract organs from any person who did not have sufficient foresight or knowledge of what the medical profession had in mind for him, and therefore neglected to file a formal objection before dying.
Altruism is fine and better organization is always a good thing. But using so-called "presumed consent," known in other contexts as a "negative option," was long ago rejected by authorities charged with protecting consumers from unscrupulous vendors who quickly send unwanted merchandise when consumers neglect to just say "no." Why organ snatchers should be allowed to engage in a practice frowned on in the case of gadgets is difficult to understand.
As is the refusal to consider increasing the supply of organs by paying donors. As things now stand, potential donors have to be sufficiently altruistic to overcome the psychological horror of the prospect of having their corpses chopped up, in most cases in order to save the lives of persons they have never met and do not know. And surviving relatives have to give their consent to what is considered a rather gruesome process, with no tangible reward--and at the moment of grief for the departed.
Assume, instead, that everyone were offered a significant sum for his or her organs, the payment to be tax-free. Surely, the organ shortage would be ameliorated. And the price could be raised until the shortage disappeared. After all, we don't expect people to donate their homes to the homeless at the time of their death. Why should we expect all save a very few to contemplate the harvesting of their organs with no benefit to their immediate heirs?
Where would the money come from? It will take a period of trial and error to determine just what price will produce a sufficient number of organs to reduce the needless deaths created by the present system. Depending on what the cost of a program that rewards donors for their contribution to the lives of others turns out to be, either the government could fund this purchase program--a better use of funds than many of the items contained in congressional pork barrels--or the recipient could pay if able, with payments spread over his newly extended life. Or some combination of the two methods might be devised to produce a means-tested finance program.
Indeed, if we can begin to think about this issue in a clear-headed way, we might consider the advantages of establishing a genuine, ongoing market in organs. If someone in need of a kidney transplant can locate a donor willing to provide a kidney at a risk doctors find acceptable, what is the argument against allowing consenting adults to strike a bargain that benefits both? That practice is now quite common in many countries, adding years to the lives of the buyers, and undreamed-of wealth to the donors and their families. The fact that the buyers are rich, and the donors poor cannot obscure the fact that both parties are better off when the transaction is completed.
No one can deny that the world would be a nicer place if everyone thought only of how his death could be made useful to others. And if those in charge of allocating the scarce supply of organs were all-wise and uninfluenced by the level of contributions needy recipients have made to their hospitals' capital drives. But wishing won't make it so. Neither will appeals to altruism. As for "presumed consent," it is so close to outright theft that it should never be acceptable. Meanwhile, people die for lack of organs.
We can only hope that the president's bioethicists have a solution that not only satisfies their souls, but also saves the bodies of people not in a position to engage the experts in a debate, the goal of which should be to develop a method to increase the supply of life-saving organs. If anyone has a solution better than the one here suggested--pay for what you get--he or she should put it on the table.
Irwin M. Stelzer is director of regulatory studies at the Hudson Institute, a columnist for the Sunday Times (London), a contributing editor to The Weekly Standard, and a contributing writer to The Daily Standard.