The Market is the Heart of the Organ Matter

“We need to start doing what other countries do,” says James Bredin, Toronto firefighter and father of two heart transplant patients (“New approach urged on organ donation,” Toronto Sun, 08/13/10). “[O]rgans become property of the state and they don’t need permission to take them.”

Writing from within the US health care system — an admittedly broken state capitalist system slouching toward something much like Canada’s failed state socialist model — I find Bredin’s sentiments disconcerting.

Why urge further travel down the road to ruin, from state socialism toward outright fascism? “Organs as state property” is something right out of Auschwitz, where Jewish prisoners were literally drained of their blood to provide plasma for the Wehrmacht, or the Chinese laogai system in which prisoners are executed for the express purpose of selling their organs to patients from the wealthier nations of the Pacific Rim.

Acknowledgment of property rights in one’s body is the obvious — in fact the only — solution to the problem of transplant organ shortages.

For decades, government has artificially reduced the available supply of donor organs by dictating that such organs may not be bought or sold. The results of such policies can be rationally expressed in two words: Body count.

How many patients have died awaiting the availability of an organ which never arrived? How many organs would have arrived had the owners of those organs been permitted to sell them, pre-mortem in the case of kidneys, liver and pancreas sections, etc., or post-mortem in the case of hearts and lungs?

In any transplant operation, the patient or the patient’s proxy pays through the nose. The hospital is paid. The surgeons are paid. The nurses are paid. The anesthetists are paid. The bookkeepers, bean-counters and bureaucrats all take home a paycheck. And the medical “ethicists” who inveigh against applying market principles to transplant organ supply? They do so on salary.

The only person not paid — the only person forbidden by law to be paid — is the one indispensable supplier, the owner of the organ. And we wonder why there’s an organ shortage?

Those who demand, on the basis of nebulous “ethical concerns,” that patients die rather than receive transplant organs love to regale us with horror tales of a dismal future: The alcoholic street-dweller induced to part with a kidney for the price of a bottle of rotgut. The working poor forced to make their mortgage payments with liver lobes and patches of skin for grafts. And so on and so forth.

The reality is that a market in organs would likely look nothing at all like these fairy tales.

In countries where health care is still at least nominally a private sector matter, medical insurance companies might offer their policy holders discounted premiums in exchange for binding post-mortem donation agreements. Over time, the pricing would stabilize and arrangements would be made for the discounts and the agreements to transfer from one company to the next — or for the discount to be subject to “clawback” — should the client change insurers.

Similarly, life insurance companies might offer substantial benefit bumps in return for post-mortem organ donations and act as middlemen between the deceased’s estate and the transplant industry.

For organs from living donors, it might be cash on the barrelhead, but price would similarly stabilize as hospitals and insurers discovered what rates kept the waiting lists empty or nearly so.

And in more thoroughly state socialist systems? There’s no saving such systems — and no good reason to save them if we could — but common sense says that patients should be presented with the option: Sign the donor form or forgo the system’s services.

What there’s no case for is claiming a “state property right” in people’s organs. That idea falls into the same moral class as chattel slavery, the drafting of “comfort girls” by occupying armies, and military conscription. The shades of Mengele and Mao and Tojo hover immovably over it.

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