Organ Transplants

Peter Van Doren

The Washington Post recently reported on a congressional hearing about the system that procures and delivers organs for human transplantation in the United States. Organ procurement organizations (OPOs) have government contracts that make them monopoly providers of such services. No OPO has ever lost its contract regardless of performance.

Regulation has published several book reviews and articles that analyze and critique the current organ procurement system. Alvin Roth is a Nobel‐​prize winning economist whose work helped design the current organ matching system. Phil Murray explains that work in this review. Roth understands that hospitals, because they earn revenue on transplants, have an incentive to keep their “easy‐​to‐​match” pairs outside the official organ matching system and refer the “hard‐​to‐​match” pairs to the system. The problem, of course, is that when transplant centers withhold easy‐​to‐​match pairs the number of people nationwide who can be matched is reduced. The problem can be fixed by rewarding hospitals with more matches based on the number of easy matches they refer to the system. But Roth recognizes this is not likely to happen because hospitals would have to admit that they are “strategic players in competition with one another,” which would contradict the non‐​profit ethos of the current system.

Another anomaly in the existing system is described by Ike Brannon. Some transplant candidates get to bypass the kidney list: those who need transplant livers. Patients with an impaired liver usually have impaired kidney function, but that typically is the result of the failing liver; a liver transplant usually restores the patient’s original kidneys to health. Almost 10,000 people die each year waiting for a kidney. The shortage is exacerbated by taking another 2,000 kidneys out of the system and giving them to liver transplant recipients, many of whom benefit little from the kidney. Bypassing of the kidney transplant list by liver patients is questionable policy.

Why not explicit markets for kidneys rather than non‐​profit procurement centers? Many people harbor animosity toward the sale of human organs. Jason Brennan and Peter Jaworski, in their book Markets without Limits, provide an overwhelming case against this animosity. They argue that if you may do something for free, then you should be allowed to do it for money. “There are legitimate moral worries about how we buy, trade, and sell,” they write, “but no legitimate worries about what we buy, trade, and sell.” Adding money to a transaction never turns an otherwise moral exchange into an immoral one.

”If We Pay Football Players, Why Not Kidney Donors?” makes the same case as Brennan and Jaworski using football as an example. Ethicists who oppose compensating kidney donors claim they do so because kidney donation is risky for the donor’s health, donors may not appreciate the risks, and donors may come from disadvantaged groups and thus could be exploited. But few object to paying largely minority professional football players who face much greater health risks than kidney donors and have much less counseling and screening concerning that risk. If we ban compensated organ donation, then we should ban professional football as well.