The Broken Economics of Organ Transplants
All adults in England, are now considered to have agreed to be an organ donor when they die, unless there is a recorded decision to not donate. This ‘opt out’ system has prompted a broad rethink, all around the world, about the most sustainable scheme to supply the ever growing demand for organs.
Every 9 minutes, a doctor makes a life changing conclusion about a patient. They determine that the individual and their condition has progressed to the point that they will not survive without a transplant. Immediately, they are placed into a nationwide system that works to balance both societal utility and human ethics, to match organs to those who theoretically need and deserve them the most. The fundamental issue is the fact that there are more people waiting for transplant than there are organs available aligning with the basic economic problem of scarcity. This means that countries must decide how to best allocate these scarce resources, in this case, either through a market economic system or a donor list economic system.
The economic system is a solution to scarcity. In fact, money as a system is a solution to scarcity as the world does not have enough of what people want; there is limited supply. Thus, we have created a system to allocate things, the market economy. This matches up the items to those who are most willing and able to give up enough money to get the resource. Although this system provides an incentive for people to produce what is scarce since they get paid, at a fundamental level whenever something needs to be allocated, it is monetized. However, how much someone is willing to pay isn’t perfectly correlated to how much they need or want a thing. This is because in the real world some people have more money than other and so this system breaks down. One average person may really want a product and offer a full 1% of their income but a rich person with 11x the money might sort of want a product and offer one tenth of a percent of their income to get it and they will get the product. The overall social good is not maximized.
However, the issue with organ transplantations is that when the allocation of a scarce resource means the difference between life or death, market system inequality is perpetuated because people’s willingness to pay is infinite. Therefore, the organ will always go to who has more money.
In this case, allocation needs to happen in a different way such as America’s nationwide transplant list system. This works by determining a transplant survival score for each individual for which it will provide the most additional years to their life. As well as this, the system uses other factors such as geography, compatibility, necessity and more. Statistics from the figure above highlight the rapidly growing waiting list in the US. Despite over 54% of America’s population being registered as organ donors, individuals have to die in a very specific way in order for their organs to be eligible for donation. The specificity of mortality contributes to the scarcity of organs, so this system of allocation through nonmonetary system is designed to appeal to human ethics designed to work to match kidneys based on need, not ability to pay. On the other hand, this legislative system does not completely solve inequality such as the case for Steve Jobs. He received a liver transplant in 2009 in Memphis, Tennessee far from where he lived in California. Due to Tennessee being part of the stroke belt (an area recognized by public health authorities for having an unusually high incidence of stroke and other forms of disease) he was able to receive wait times 11 times shorter than those elsewhere. Furthermore, the ease of flying in a private jet to get to the transplant hospital in time made his chances of being at the top of the waiting list extremely high. Time and time again, the correlation between patients and income level seems to become stronger as more transplants are carried out. This system certainly perpetuates inequality, but the contrary would result in patient’s in other states being punished for the fact that their region is simply healthier.
Consequently, some are now justifying the practices in Iran. The waiting list has disappeared, the HDI has risen and the burden of stress on suffering families has diminished. Donors receive a fee of around 4500 dollars, equivalent to more than half a year’s salary, in addition to free health insurance for a year. This suggests that the problem can be solved providing an incentive and insurance. However, some argue that the negatives are too severe, as desperate individuals are incentivised to sell their organs whilst simultaneously making it even harder for poorer individuals to receive an organ transplant as they can be priced out.
In conclusion, an open organ market would greatly increase inequality with an advantage of more transplants per year. The bottom line is the option of saving more lives but in an unequal, unfair manner or saving fewer lives but assuring a greater sense of fairness. Looking at the evidence, most developed countries have decided to go with the second option as if not, they are potentially sending people to inevitable death. I believe that the allocation of organs should incentivise the selling of organs much like Iran, however they should be allocated through the government. Perhaps, even ensure that the donors meet a certain income threshold to minimise the donations through desperation. The current system in the UK and US seems too focused on reducing the disparity between income and the likelihood to get a transplant. The inevitable consequence is that the waiting list will continue to accumulate, for decades to come. After all, inequality is just a part of a monetary system, therefore despite economics being an incredibly powerful tool for allocation it is extremely hard to justify and formulate a plan with lives on the line.
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Dinil Wanni Arachchige
