Dubiously Free Trade, Game Theory, Individual v. Collective, Live and Learn

Things We Should Be Allowed To Do – Part 1: Sell Our Own Organs

We live in a country where we can lawfully slander a celebrity, but may not sell a kidney to save someone’s life.

By precedents set in the court system, we may defame and defile a celebrity because they have achieved “public figure” status, but may not sell a kidney for some hybrid incentive of monetary gain and altruism; one that, oh by the way, will save a person’s life.

For a public figure to win a libel suit, they must prove that a statement was “absent of malice”. In other words, that the statement was published with “knowledge that the information was false” or “with reckless disregard of whether it was false or not.” Funny, though, reckless disregard does not encompass mere neglect in following professional standards of fact checking. The precedent was initially set in the newspaper world of 1964. With the digital economy, information is published continuously all over the interwebs, in multiple mediums. Rumors are passed on as reporting, if you’re lucky. Sometimes today’s journalism is just downright lies. You can see how this muddies the libel waters even more. Public figures, because of the string of libel suits that have failed, have largely given up on protecting their name in the courts. Particularly as it relates to defamation in the blogosphere.

So lawfully feel free to spew out any hatred toward Jon & Kate or the personal sh*t storm of Mel Gibson & Oksana Grigorieva. But forget about saving someone’s life with your kidney for monetary gain.

Libertarians in particular always wonder how much control we have over our own bodies. Rarely, though, is the question extended to post-death. If your body is donated to science after you pass, you have no control over what happens to you. And some extreme things happen. Mary Roach chronicles the rigors the human cadaver is put through in Stiff: The Curious Lives of Human Cadavers. And it’s not curious in an Altoid sort of way. Roach (appropriate last name for the author of such a subject) describes all the ways in which cadavers are used for experimentation and testing. Some such ways include leg and foot segments used to test footwear for the effects of exploding land mines, and plastic surgery seminars with doctors practicing face-lifts on decapitated human heads. Ever wondered how fast the human body decays underwater? Forensic scientists can tell you. One University professor recommends in Stiff that the most ecological way to dispose of corpses would be to drop them in dungeness crab tide pools. Check out the book, which is wonderfully witty and ironic in the face of a macabre topic.

However, if you want to donate your body to science and humanity while still alive, you’re not allowed to do so for profit. That dirty word…profit. The same profit (much more actually) that is already made on the black market for organs, with procedures often occurring in much more dangerous settings. If a person donates a kidney for motive of pure profit or pure altruism, does it really matter? Someone’s life is going to be saved. If you brought the underground organ market above ground, and put in some common sense regulations for safety, more people might live to tell the tale.

In 2005, 85,790 patients died as a result of kidney disease in the United States, also called end stage renal disease, or ESRD. The current annual cost of ESRD in the U.S. is approximately $23 billion. More than 485,000 Americans are being treated for ESRD. Of these, more than 341,000 are dialysis patients and more than 140,000 have a functioning kidney transplant. When it comes to kidneys, each hour they are outside the body reduces the transplant’s success due to deterioration of the organ. It also increases the patient’s recovery time.

Dorry Segev, MD, Johns Hopkins associate professor of surgery, had this to say about poor distribution of kidneys for transplantation:

Every year, 5,000 patients die waiting for a transplant and another 2,000 become too sick to transplant. Of the 10,400 kidneys [held outside the body for more than 36 hours], it’s likely that 1,200 we would have been able to have transplanted faster and thus, 1,200 people would have had better outcomes. Somewhere between another 500 to 1,000 would have been distributed in a more efficient way that they would have been used instead of discarded.

Uh oh, was the word efficiency in there. Now what makes the distribution of scarce resources (I don’t know, like a kidney!) as efficient as possible? Oh yeah, free markets and profit incentives.

Dr. Segev’s research stems from the 39,035 adult kidneys recovered from donors between 2005 and 2008.

The libertarian approach would be to legalize the organ commodities market. They would postulate the following: “this is my body, and if I can’t decide what to do with it as long as I don’t harm others, is it really my body anymore?” The same rationale is commonly applied to legalizing drugs. But with selling an extra kidney you don’t need to function, you’re not risking becoming an addict or otherwise dead weight on society. You’re simply taking some of your own resources that you don’t need, and selling them to someone who absolutely needs them to live. You make some money, and they get to live on in as productive a life as possible.

Another increasingly common live donor transplant is for the liver. Living donor liver transplantation (LDLT) takes advantage of the regenerative capacities of the human liver. The option is once again a necessary one as there is a great shortage of cadaver livers for patients on waiting lists. End stage liver disease, like cirrhosis or hepatocellular carcinoma, can be remedied by taking a piece of the donor’s healthy liver and transplanting it into the recipient. This is one of the most expensive treatments in medicine. Even Apple CEO Steve Jobs had to leave his home-state of California for Tennessee where the wait for liver transplants is considerably shorter. As transplant surgeon Dr. James Pomposelli points out: “There’s no question there are patients chasing organs rather than the organs coming to the patients.”

Iran is the global leader in organ transplants, believe it or not. The leader of medical advance in the Middle East, Iran performs the greatest number of kidney transplants every year, which should alleviate any concerns that a legalized organ commodities market would result in a drastic decrease of altruistic donations, or more importantly, net donors. In Iran, the donor receives $1,200 from the Iranian government, payment for medical expenses, as well as remuneration from the patient, generally negotiated in a government-brokered meeting between the patient and donor. For poor patients, a charitable organization provides payment.

Finally, let’s remember the debt-ridden society we live in. All levels of society need to pay down their debt burdens. If someone wants to swap a kidney for some extra income, the same way people do every day at blood and sperm banks, why should the government stop them? Likewise, live donors should be remunerated for liver donations. As with many prohibitions, we should be allowed to sell our own organs. Outlawing an organ commodities market results in deaths every day. According to the Department of Health and Human Services, 16 people die each day because of a shortage of organs. Whether it is the lack of efficiency in distributing organs once they’re outside the body, the dangerous black market this prohibition creates, or the vast shortage of organs for those in need, it only makes sense to legalize this marketplace. Eventually we will genetically harvest new organs for transplants, and far less people will die of organ failure. Waiting lists will hopefully become a thing of the past. Until then, selling organs in a legal commodities market is an economic activity we should be allowed to do.


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3 thoughts on “Things We Should Be Allowed To Do – Part 1: Sell Our Own Organs

  1. ChrisA says:

    I have already donated my kidney to someone. Had they offered me money to save their life I would have refused it. I would not be able to deal with the thought I only saved their life for money! What about the guy drowning in the lake, does he hand over his wallet first before I will jump in and save him.

    If people are allowed to sell their organs mainly the rich will benefit. There will be underhand offerings of more money. What happens when the small minority get one of the risks from donating? Will they be allowed to sue the hospital or do they sue the person who got their kidney.

    More education is what is needed to get more people to sign up to organ donor register. Education in schools so youngsters grow up knowing they need to sign that register. More education for people who through their own ignorance/fault have developed kidney failure i.e. through unhealthy lifestyle. Why is the onus on healthy people to donate their kidney.

    Iran is praised for its system of having virtually noone on the kidney transplant waiting list because they pay donors. But what they don’t also make readily available is the thousands of people in the outlying villages who have kidney disease and are not even on the waiting list.

    Personally I find it offensive to be offered money to save someone’s life.


    • I certainly respect your opinion as a live organ donor. I would encourage education about the organ donation process and healthy lifestyle choices as well.

      A few thoughts: Most people would not give up their own organ based solely on money. It would usually be a hybrid incentive of altruism and monetary gain. It’s simply too personal and powerful not to have a sense of altruism about the act.

      Having a legalized organ commodities market would not inhibit people like yourself who are offended by the idea of a monetary exchange. People in your camp could feel free to donate their organs, while others chose to be part of a marketplace. Just as some people donate their rare AB- blood while others choose to sell their blood.

      What I find offensive is the reality that thousands of people die every year because of shortages, and others are left with worse outcomes because of poor distribution. If you think it’s crass to offer someone money for a healthy kidney or piece of a liver, I would counter that it’s slightly more crass to not offer that option, and watch people die.

      As far as the rich benefiting…they already benefit more from every medical option than the average person. If someone you know has ever contracted cancer, I’m willing to bet he or she didn’t jump on a private jet to Rochester and go to the Mayo Clinic. If they did, they are among the lucky few. Apple CEO Steve Jobs doesn’t wait for livers in California. He goes to them in Tennessee, as mentioned in the piece. Whatever extra advantages the rich gain would not take away real advantages for the average person, particularly if it’s a government-ran or regulated exchange.

      Like every risky surgery, patients must sign consent forms which limit the liability of the MD. If something goes awry and they sue, well, that’s the same issue we have in a litigious society, why doctors have to pay out massive sums for malpractice insurance, and one reason why practicing medicine simply isn’t what it was 25 years ago.

      I would encourage donations and a legal marketplace. Many people, of which you may be one, feel that altruistic donations would fall off a cliff if a legalized commodities market was born. My question to you would be: had selling organs been legalized at the time of your donation, would you have elected not to donate your organ as a result? Considering many instances involve a close friend or family member, I sort of doubt it. Regardless, if someone down the street is selling their organ, and I’m offended by the notion, that would not effect my decision making. I’d donate just as I always would.


  2. Scam says:

    “Personally I find it offensive to be offered money to save someone’s life.”

    So people should be banned from engaging in voluntary trade because you are personally offended by it? There are plenty of things that offend me. That doesn’t mean I want bureaucrats to go around making those things illegal. The fact is that individuals know what is best for themselves, not a politician and not you. If one individual thinks they will be better off saving someones life by donating while also receiving monetary compensation for that act, than no one should have the right to prevent that from happening. It is that mentality of politicians thinking they know what is best for the little guy that ends up hurting everyone, rich and poor, and results in thousands of unnecessary deaths a year. It is simply and beyond question, highly immoral.


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