The system for organ donation in the United States does not work well. About 3.5 million people die in the U.S. each year and many are potential organ donors. Yet, there are thousands of people on waiting lists for donor organs and thousands die waiting every year. According to the Washington Post:
That system has long been criticized as inadequate: Nearly 104,000 people are on waiting lists for organs, most of them kidneys; 22 people die each day awaiting transplants, with poor and minority patients generally faring worse than affluent and White people.
The United Network for Organ Sharing (UNOS) is a quasi-governmental nonprofit that runs the organ donation program. Created in 1984, it is a monopoly created by the government to run the U.S. organ donation system. Congress is now looking to break up many of its functions and require competitive bidding by the firms competing to take over the various functions.
There is bipartisan support for reform due to perceived mismanagement and waste of organs that are never used. For example, Senator Ron Wyden (D-Ore.) said, “For too long, it’s been clear that UNOS has fallen short of the requirements for this contract and the expectations of Americans waiting for a transplant.” His colleague and frequent collaborator, Senator Charles Grassley (R-Iowa), said “The system is rife with fraud, waste and abuse, corruption, even criminality.” This from the Washington Post:
In August, The Post reported that the Senate Finance Committee investigation had found 70 deaths and 249 diseases over a seven-year period after mistakes in the screening of transplanted organs.
The Post also detailed how the first uterus transplant in U.S. history failed in 2019, for example, because the organ came from a donor infected with a life-threatening fungal infection.
Of all the stakeholders involved in organ donations, distribution, procurement and transplant, the only stakeholders not allowed to profit are the estates of the owners of donated organs. Organs are worth zero, worth thousands, tens of thousands or hundreds of thousands of dollars depending on where you fall in the process. If you’re the original owner they’re worth $0.00. The Donor Alliance has this to say about why organ banks get donated organs they later resell for thousands of dollars:
According to the Health Resources and Services Administration, “One reason Congress made this law was to make sure the wealthy do not have an unfair advantage for obtaining donated organs and tissues”. (Source: OPTN white paper on bioethics—Financial Incentives for Organ Donation, June 30, 1993).
As an economist, that logic is nonsensical. If people were allowed to sign cadaver cards committing their organs to firms who pre-bid on them, there would be so many organs the poor would fare far better. Organs would be cheaper, easier to access with no need to ration them because organs would be plentiful. Besides, the rich already have easier access to organs for transplants. Remember how Apple CEO Steve Jobs managed to get a liver transplant despite liver cancer that made him an unlikely candidate? This from a 2009 CNN article that came out shortly after his surgery:
This week it was reported that Steve Jobs, the CEO and cofounder of Apple, underwent a liver transplant two months ago. One detail concerning Jobs’s transplant seemed odd: The surgery took place at a hospital in Tennessee, some 2,000 miles from Jobs’ home in northern California. Why Tennessee?
The problem — or the advantage for some patients — is that not all OPOs [organ procurement organizations] are created equal. Some regions contain nearly 15 times as many people as others, and their waiting list times vary widely.
The reason that some people might be able to get transplants more quickly is that they’re standing in more lines. Nothing prevents someone from being evaluated and listed at multiple transplant centers. As long as a patient has the wherewithal to fly around the country — and be available at the drop of a hat if a liver becomes available (this is where the private jet comes in handy) — a patient can, in theory, be evaluated by all the transplant centers in the country.
According to an article in the Medical Futurist:
The world is a giant supermarket where you find price tags on literally everything. A rare butterfly can cost up to a grand on eBay, an acre on the surface of the Moon is available from $24.90 – although we strongly discourage you from actually buying it –, and your organs are also for sale.
If you could harvest every organ and chemical in your body, you could make $45 million. But in reality, Medical Transcription estimates, the average price of a human dead body is more likely to fetch around $550,000 (with a few key body parts driving up the price).
If you have wondered how the laws on organ donation came about, I would argue that the above sentence is key evidence. Your body parts are worth more than $500,000. Why are the prices so high? Part of the reason is scarcity, but 3.5 million people die in the United States every year. With 3.5 million potential cadavers why are organs scare? The reason is the estates of those 3.5 million decedents are not allowed to make anything off donated organs. If dying patients were allowed to sell their organs for, say, $10,000, soon organs would no longer be scarce. Perhaps with a huge increase in the supply, the organs from a cadaver would only be worth $10,000, down from $550,000 under the current system. The current system seems tailor-made to drive up the cost (and profit) from donated organs by making them scarce.