Comedian and political commentator, John Oliver, dedicated a 30-minute episode of his television show to our dysfunctional system of organ donation. There were 42,887 organ transplants in the United States last year. However, the number of people waiting for a donor organ, at 103,984 is more than double the number of transplants. It is estimated that 17 people die each day while waiting for a donor organ. The total number of Americans who die each year of any causes is nearly 3.4 million, but less than 2% of deaths occur under conditions optimal for organ donation.
Oliver starts out by saying that organ donation enjoys support from 90.4% of Americans. He goes on to explain that in a recent survey half of Americans responding said they had signed up to be organ donors, at least in theory. This is a good example of what economists call revealed preferences, as opposed to actual preferences. When people say one thing but act in a way contrary to their stated opinion that is what is known as a revealed preference. Most Americans support organ donation, for other people. If Americans were really committed to organ donation, there would not be a shortage, which I will explain below.
Oliver then goes down a rabbit hole complaining some Americans who donate their body to science are duped by for-profit shows and exhibits that use donated bodies for entertainment. He mentions the Museum of Osteology exhibit in Oklahoma with human bones on display. In Portland, Oregon an autopsy was performed in a Marriot hotel, where people paid up to $500 to view it. I’m fine with the former, the latter not so much.
There is a traveling show, Body Worlds, where human bodies are exhibited with muscles, brains and organs dissected and preserved. The Institute for Plastination was founded by Dr. Gunther von Hagens in 1993, after he invented a way to extract the water from human bodies and replace it with a polyester resin. The results are perfectly preserved bodies and tissues that can be displayed for science and entertainment. People donate their bodies and organs specifically to the Institute for Plastination, which owns the show. There are currently 20,000 people who have registered to donate their bodies to the Institute. The institute also uses the technique for medical education. The exhibit is definitely worth seeing if you get the chance.
The United Network for Organ Sharing (UNOS) is the umbrella organization that oversees 56 regional organ procurement organizations. UNOS is a monopoly so it has little incentive to improve or adapt newer technology to better support its mission. The regional organ procurement organizations have their own problems. Oliver claims there has never been an organ procurement organization decertified for poor performance. Whereas you can track a package shipped by the post office, FedEx, UPS or Amazon, no such capability exists for organs. The system to transfer an organ from one organ bank and ship it to another is haphazard at best. Organs frequently arrive too late to be used or damaged. One anecdote described by Oliver was a human heart inadvertently left on a Southwest Airlines flight by a courier, causing the plane to turn back. In another example an organ arrived damaged, with what appeared to be tire marks on the package.
Background: organ donation and transplants are governed by the National Organ Transplant Act of 1984 (from Wikipedia):
The act provided clarity on the property rights of human organs obtained from deceased individuals and established a public-private partnership known as Organ Procurement and Transplantation Network (OPTN). The OPTN was given the authority to oversee the national distribution of organs.
The National Organ Transplant Act also outlawed the sale of human organs in the United States.
Virtually every developed country has rules against compensating people for blood donation. The reason for this rule is that the quality of purchased blood is thought to be much lower than donated blood due to the type of people presumed to be sellers. If you’re an IV drug user, who’s too addicted to hold a job, health officials don’t want your blood in the blood supply chain. You can get paid for donating plasma, however, which is processed to be free of pathogens.
Here is the kicker, something not discussed by John Oliver. The National Organ Transplant Act made it clear that neither the original owners, nor their heirs, have a property right in their organs. Organs are donated and become the property of stakeholders in the organ procurement supply chain. That means everyone else in the supply chain, but the heirs, can profit from their use. This fact alone explains most of the shortage of suitable organs for transplant. If families could earn, say, $10,000 from the sale of organs from their dying relatives, far fewer valuable organs would be buried or cremated.