Life from Death Denied – Why We Should Legalize Organ Selling

Christian Longo, 37, a death row inmate in Oregon who wants to donate his organs asked, “Why go out and waste your organs when you have the potential to go out and save six to twelve lives?”  Good question.  He even offered to waive his appeals in exchange for the right to donate his organs.  This was a win-win-win deal.  The State saves money.  Longo gets moral satisfaction.  And the lives of numerous patients are saved.  The State rejected the offer.

The government’s unexplainable antagonism towards changes in organ policy is perplexing, particularly because the two groups most affected by the prohibition are sympathetic constituents: the sick and the poor.  As of September 2010, there were 108,725 people on the waitlist for organs in the United States.  The waitlist for organs continues to grow by about 300 people each month.  The number of people waiting for organs is growing faster than the number of available donors.  On average, 19 people die each day waiting for organ transplants.  That totals to roughly 7000 deaths each year as a result of organ shortages—a yearly death toll that more than triples the deaths from Hurricane Katrina.

The sick need organs.  The poor need money.  A simple organ clearinghouse would solve the problem.  The poor would receive upfront money from the clearinghouse while still alive in exchange for their commitment to bequeath their organs to the clearinghouse when they die.  Sick patients would purchase organs from the clearinghouse.  No one loses in this exchange.

The poor lose nothing while alive, but get a substantial sum of money now that could be used to help pull them out of poverty.  In China, where the organs of death row prisoners are sold, livers go for $25,000, kidneys for $20,000, corneas for $5,000, and pancreases for $5,000.  In the Philippines, where organ trading is legal, kidneys have reportedly sold to Western patients for $85,000 each.  Someone agreeing to bequeath every organ in their body to a clearinghouse could easily get $50,000 or more for this promise, without giving up anything in the present.  For people struggling to live from paycheck to paycheck, this amount of money could literally change the course of their lives.

So long as the government enforces the non-aggression principle, there simply is no good reason for prohibiting this type of organ exchange.  The government’s prohibition on organ trading robs the poor of one of their most valuable assets and prevents countless patients from receiving the life-saving transplants that they need.

Government, please get out of the way.

This article was also published in the Chicago Tribune.

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9 Responses to Life from Death Denied – Why We Should Legalize Organ Selling

  1. anonymous says:

    I really am unsure about this entry.

    First off, you start out telling us this story about some convict who didn’t get what he wanted. You fail to mention that he was on death row for murdering his wife and three children. Sure, one could argue that his crime isn’t really the point. But one could also argue that when he decided to kill his family and then stuff them in suitcases and dump them into a bay (and then become a fugitive) he gave up his rights as a free human being (at least that’s how the law goes). Surely, there is no law against the donation of organs by prisoners. As a matter of fact, the reason why Mr. Longo didn’t get to donate his organs wasn’t because the system is opposed to this – instead, he didn’t get his wish because execution in Oregon is done by lethal injection (whether you agree or not with capital punishment is another topic altogether – but irrelevant to this discussion). Without going into details, one of the chemicals used in the lethal injection is Potassium chloride which, when administered causes hyperkalemia and organ failure (including heart and kidney). So, although you failed to mention that as well, it is important to note that Mr. Longo’s request was not honored because his request went against the law. Yes, you could argue that sometimes the law is wrong…and he could have argued the same thing in order to secure his release (by arguing that filicide and uxoricide shouldn’t be illegal). In addition, the ‘Department of Corrections also told MSNBC they are not going to negotiate with a death row inmate about their appeals because such a proposal has been denounced as “morally reprehensible” by organ donation officials and medical ethicists’. So that brings us to the next point… (as an aside though, the decision was made by the Department of Corrections and not the Federal Government…so your point in general is moot).

    In the United States (as well as most western countries) taking organs from persons who are incarcerated is considered to be a very tricky subject (if not downright immoral). In your essay, you mention the fact that China allows prisoners to donate their organs for money. However, ethicists have long argued that this is a very questionable practice (using China as a specific example) given the fact that jurisprudence in said country is tenuous, at best. What is to say that the ‘donors’ actually received the compensation from a government that continues to (illegally) apprehend and incarcerate dissidents and those who the government of the so called ‘People’s Republic of China’ identifies as a threat? What is to say that these ‘donors’ were not coerced or forced (even if they were, in fact, given the money) to ‘donate’ their organs? What is to say that these ‘donors’ received a full psychiatric evaluation regarding their ability to donate their organs (a practice that is vehemently protected by medical ethicists)? Similarly, if this were allowed in the United States, could you be certain that the same questions wouldn’t come up – especially considering that this country is also in the business of illegal detention (see Guantanamo) as well as the infringement of basic prisoner’s rights outlined by the U.S. Constitution (also see Guantanamo or Bradley Manning).

    But anyway, let us get to your suggestion – which also leaves a lot to be desired.

    Yes, the “number of people waiting for organs is growing faster than the number of available donors. On average, 19 people die each day waiting for organ transplants”. The demand exceeds the supply. So then, you suggest that the solution (as a good capitalist would) is to give the organs to the highest bidder. Creating a clearinghouse will allow us to increase the supply (by paying donors for their organs (although at that point – they really aren’t donors anymore…but more like retailers)) so that the rich can pay for the organs whenever they need to (OK – you didn’t say that last part…but it is definitely implied). There are obviously people who can pay $85,000 for a kidney (as evidenced in your essay) – but what about the 40+ million Americans who don’t even have full (or any) health insurance? I’m sure none of those people can go to the ATM and withdraw enough money to buy a new organ. Sometimes the poor don’t just need money (as you so ‘eloquently’ state) – they also need organs. So what happens then? Nobody loses in this exchange – except those who have no money to play this round of Monopoly.

    Somewhat similarly, Medical Ethicists are extremely opposed to establishing a fee-for-service (or, more aptly: fee-for organ) framework of any dimension given the fact that the donation of an organ (as established by the National Organ Transplant Act) must be free from coercion. Coercion? Yeah – you didn’t say that explicitly (I know) but offering someone an “amount of money [that] could literally change the course of their lives” (which is insulting, but we’ll leave this to another day) is definitely a form of coercion in the eyes of the ethicists. If you haven’t yet understood why…I’ll break it down for you: its just too similar to prostitution. “if he wants sex and she wants money – why can’t they just exchange goods”? Yeah true – but we’re all adults here, and we know what comes from dealings like that: exploitation. You get pimps, abusive Johns, child exploitation, etc. So what is to say this wouldn’t happen in this “organ clearinghouse” that you posit? What if some extremely poor family decides that they’re going to sell one of each of their kids’ kidneys so as to dig themselves out of the throws of poverty in order to launch themselves into the ‘American Dream’? Nobody loses there right? Or what about the abusive husband (or wife) who coerces their spouse into donating an organ so that he/she can buy a new car/house/boat/suitcase full of cocaine? Is that cool?

    “Organ transplantation is built upon altruism and public trust. If anything shakes that trust, then everyone loses.” (I got that off of http://www.organtransplants.org/understanding/unos/)
    This isn’t about being some crazy dude who is all about organ donation (rather than organ retailing).

    This is about realizing that organs should go to those who need them the most and who have the least chance at rejecting the organ. Sure people will die this way – but people will die under your framework too…it just won’t be the people that you deal with on a day to day basis, but rather those people that you don’t ever see (unless you’re paying attention the people like those who clean your Ferrari, the public school teachers who will never teach your kids because they’re just not good enough for your kids, or the guys that cut your fancy lawn).

    Finally let’s talk about this “pay now, play later” idea of yours. You state that a ‘retailer’ will “receive upfront money from the clearinghouse while still alive in exchange for their commitment to bequeath their organs to the clearinghouse when they die.” So what happens if some poor sap signs the papers, gets his money and at some point later decides to kill himself? Perhaps some organs may be salvageable if he chooses certain methods of suicide – but what if he jumps off the 40th story of a building? Or what if he decides to use Potassium Chloride and ruins all his organs? Or what if he ruins his organs by drinking himself to death? Then what happens? Does the money just get written off at that point?

    Or what if the guy is smart enough to realize that such a contract isn’t really enforceable. What if he signs the papers, gets his money and then renegs on the agreement. What if he spent all the money? Does he go to jail? Are we going to start incarcerating people for their organs? If so, then why not just do that right off the bat and cut out the middleman?

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  2. Danneskjold says:

    “We are fast approaching the stage of the ultimate inversion: the stage where the government is free to do anything it pleases, while the citizens may act only by permission; which is the stage of the darkest periods of human history, the stage of rule by brute force.”
    -Ayn Rand

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  3. colmes says:

    @anonymous: Right, so about that.

    I think I see two basic points in your post. First, that it is not always clear that people are acting of their own volition when they sign away their basic rights. And second, that using money as a way of determining access to basic needs (organ transplants in this case) can lead to unjust outcome. (I’m not sure what you are getting at with your first paragraph.)

    I’m sympathetic to these points as a general matter. (Full disclosure: I’m a liberal who thinks that a government based solely on the NAP is a hot tub of crazy-sauce.) However, I don’t think they are of particular concern in this context.

    First, Mr. Longo is already sentenced to die. He proposes only to waive the right to further appeal his sentence. It is possible that such waivers might be regarded skeptically in countries such as China, where the rule of law is less clearly established than it is here. However, in the US waive constitutional rights and rights granted by statute or rule all the time, e.g., by pleading guilty to a crime and waiving their right to trial. So long as his waiver satisfies the standards of Godinez v. Moran and any applicable state law, I don’t see the issue.

    Second, I share a discomfort with allowing the wealthy preferred access to organs by making them available for purchase. And I think this is particularly true if purchase becomes the exclusive means of obtaining organs, and I’d want to be sure that such a system was designed so as not to entirely shut out the poor. But the existing system is just awful. And one could easily imagine a standard waiting list coupled with a second list which allows one to purchase an organ. A donor could choose which list they prefer their organs be on. And assuming that a substantial number of donors still choose to donate their organs for free, should increase donation rates overall and therefore decrease the backlog on the “standard” list.

    Further, even if most or all organs are ultimately available through the clearing house (i.e., assuming that everyone wants money for their organs), using a clearinghouse creates a real possibility of increasing rates of donation, perhaps such that the market price comes down to a range where it is more affordable. I’m not sure even this is a realistic assumption, given that no current organ donors in the US are motivated by pecuniary gain. (And keep in mind that the organ itself is far from the only thing that makes organ transplants expensive, so it’s not exactly like having only “free” organs available solves the problem of allowing the poor access to transplants.)

    It’s clear that the existing system is broken. Subject to my caveats above, Trey’s proposal strikes me as a reasonable way to increase overall donation rates.

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  4. caulds989 says:

    “I’ll break it down for you: its just too similar to prostitution. “if he wants sex and she wants money – why can’t they just exchange goods”? Yeah true – but we’re all adults here, and we know what comes from dealings like that: exploitation. You get pimps, abusive Johns, child exploitation, etc.” – Anonymous, really thought provoking stuff. This all would be true, too, if this kind of stuff were to occur if prostitution were legal, but it wouldn’t. Pimps are merely brokers performing a service to customers. A prostitute would no longer have to roam the streets looking for clients because that would be her pimps job. And clients could now merely call up their favorite pimp so to ensure the quality of the prostitute. I am in no way condoning the buying and selling of sex, but from an economic standpoint, you have to look at prostitution and the selling of organs like any other good or service. The market is not moral or immoral, it is amoral. It is dependent upon the principals and values of those who work within it. If you want a further explanation of these principles, read defending the undefendable by walter e block. here is the pdf…http://mises.org/books/defending.pdf

    here is a small excerpt…

    “There are of course many negative aspects experienced by prostitutes which belie the “happy hooker” image. There are prostitutes who are drug addicts, prostitutes who are beaten by pimps, and prostitutes who are held in brothels against their will. But these sordid aspects have little to do with the intrinsic career of prostitution. There are nurses and doctors who are kid- napped and forced to perform for fugitives from justice; there are carpenters who are drug addicts; there are bookkeepers who are beaten by muggers. We would hardly conclude that any of these professions or vocations are suspect, demeaning, or exploitative.

    The life of the prostitute is as good or as bad as she wishes it to be. She enters it voluntarily, qua prostitute, and is free to leave at any time.
    Why then the harassment and prohibitions against prostitu- tion? The momentum does not come from the customer; he is a willing participant. If the customer decides that patronization of a prostitute is not to his advantage, he can stop. Nor does the move toward prohibition of prostitution come from the prosti- tutes themselves. They have volunteered for their tasks, and can almost always quit if they change their minds about the relative benefits.

    The impetus for the prohibition of prostitution is initiated by “third parties” not directly involved in the trades. Their rea- sons vary from group to group, from area to area, and from year to year. What they have in common is the fact that they are outside parties. They have neither stake nor standing in the matter, and should be ignored. To allow them to decide this matter is as absurd as allowing an outsider to decide about the trade between the milkman and the pieman.

    Why then are the two cases treated differently? Imagine a league called the “decent eaters,” organized to espouse the doc- trine that eating pie together with milk is evil. Even if it could be demonstrated that the league against pie-and-milk and the league against prostitution had identical intellectual merit— namely, none—the reaction to the two would still be different. The attempt to prohibit pie and milk would evoke only laughter but there would be a more tolerant attitude toward the attempt to prohibit prostitution. There is something in operation which staunchly resists an intellectual penetration of the prostitution question. Why has prostitution not been legalized? Though the arguments against this legalization are without merit, they have never been clearly assailed by the intellectual community as spe- cious.”

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  5. Sonic says:

    “Remember also that the smallest minority on earth is the individual. Those who deny individual rights, cannot claim to be defenders of minorities.”

    -Ayn Rand

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  6. Tom says:

    As far as the comparison to prostitution, I have no difficulty with the world’s oldest profession. If it’s a voluntary exchange of a service between adults for some form of value in exchange; usually money. I don’t care to take advantage of the service, but that’s my own personal voluntary decision. As long as the act does not result in an act of aggressive violence against my person or property or a member of my family, then it’s decidedly none of my business. As far as the death-row status of the inmate having been established because he murdered one or more individuals, the offer (by the inmate) to donate his organs, while at the same time foregoing any appeals process, means that the sentence of the state will be carried out (resulting in his death by some means presumably compatible with the process of donating his organs), the state will save (most probably) substantial amounts of public tax money since they won’t have to engage in fighting appeals (this can go on for many years) and paying lawyers (often on both sides of the issue) in the process. The only question that remains, for me, to be addressed then is whether or not this death-row inmate retains, in a legal sense following his conviction, ownership of his organs. Are they his to give/grant or are they the property of the state? Having been convicted of murder, he no longer owns his freedom. Since he was sentenced to die, it may be argued, with some force, that his future is certain death (assuming that all appeals fail to free him or to provide another opportunity before a different jury). However, even if the state does rightfully own his entire body (after conviction and sentencing), which I am not ready to concede at this point, it seems to me that the practical benefit arising from this inmate’s offer would outweigh any resistance on the part of the state to allowing the organ donations to go forward and save the lives of other individuals; individuals who have not murdered someone. The state’s refusal to allow this to happen could, and very likely would, result in the untimely deaths of some number of other individuals who might otherwise live.

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  7. Tom says:

    BTW, another good thought provoking article Trey.

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  8. Nadia Raisin says:

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  9. Thanks , I have just been searching for info about
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