The economics of organ donation

Conceptually, economics is a fascinating field to me, and it’s an invisible factor that’s often overlooked by the mainstream media and by independent writers and bloggers. Naturally, for every action, there are consequences, no matter if the decision is a policy decision or a financial decision, or something in between. The threads that connect everything to everything else are some of the most interesting facets of the world we live in. Healthcare is certainly no exception.

The authors of Freakonomics (an excellent book, by the way) have covered the economics of organ donation in a New York Times article from July 9, 2006. (“Flesh Trade: Why Not Let People Sell Their Organs“) All jokes about people selling kidneys on eBay aside — which has been tried — there doesn’t seem to be anything inherently unethical about doing so. While I wouldn’t sell one of my kidneys (though I might give one away) I don’t see anything wrong with the practice for those interested in doing so. Levitt and Dubner agree, noting that the practice could help alleviate the organ shortage:

One case of repugnance is far from settled: the dispute over how human organs for transplantation should be allocated — and, perhaps, even sold. If you happen to have a failing heart or liver or kidneys, you will almost certainly die without a transplant, but if you aren’t lucky enough to get an organ through an official registry, you can’t legally purchase one at any price. So instead of a free market in organs, we have a volunteer market. Some people agree to give up their usable organs once they die. In the case of a living donor, someone sacrifices a kidney or a portion of a liver to a recipient, most likely a family member.

In the space of just a few decades, transplant surgery has become safe and reliable (to say nothing of miraculous). But success breeds demand: as more patients get new organs, more patients want them. In 2005, more than 16,000 kidney transplants were performed in the U.S., an increase of 45 percent over 10 years. But during that time, the number of people on a kidney waiting list rose by 119 percent. More than 3,500 people now die each year waiting for a kidney transplant.

To an economist, this is a basic supply-and-demand gap with tragic consequences.

The kneejerk reaction for many is “No way should that be allowed!” but when you really get right down to it… why not? Besides offending sensibilities — the human body is sacred and shouldn’t be sold at any price — are there any real moral or ethical arguments that can be made against saving lives and making a buck on the side? There aren’t any that spring readily to this health professional’s mind.

Saving lives and making a buck on the side is how medicine works. Altruism is wonderful, but it doesn’t pay the bills and put food on the table. Naturally, that doesn’t mean that Americans will be embracing the idea anytime soon, so Alvin Roth, the economist who has studied the problem, came up with a way around the repugnance factor: The New England Program for Kidney Exchange. The program doesn’t buy or sell organs, but it’s the next best thing: a kidney swap program.

NEPKE uses a computer program to find cases where the donor in an incompatible pair can be matched to a recipient in another pair. By exchanging donors, a compatible match for both recipients may be found. You can learn more about the program here.

It’s nice to see business and economics providing unique solutions for real medical problems. While I don’t expect we’ll see an eBay for organs anytime soon, I wouldn’t be surprised to see legislation regulating the “market” — for lack of a better word — on human organs to change sometime in the next decade as the demand for organ transplants increases while the supply remains largely unchanged.

[tags]Medicine, organ donation, economics[/tags]

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