The Meat Market Alex Tabarrok

 

Summary

Tabarrok  raises the issue of shortage of human organs for transplants in the United States, and proposes a solution i.e. payment to the living donors. He gives the example of  Singapore, Iran and Israel  to support his idea of organ purchase from the donors. Tabarrok states that a large number of people suffer from kidney disease in the world. In the United Stats, While 83,000 people were  waiting on the official kidney-transplant list, only 16,500 people received a kidney transplant in 2008. And nearly 5,000 died waiting for the transplant.

To deal with the shortages, surgeons adopt several methods. Perhaps the most extreme method is the routine removal. It is an act of removing pieces of tissue from dead patients for transplant without any prior consent. Similarly medical doctors in some states of America while conducting autopsies may harvest corneas without notifying the family of the deceased one. This practice looks controversial though it is legal.

According to the law, human organs are taken only after the doctors declare death of the donors. While transplanting, the doctors must make sure about the point where the donor dies, but not his organs. However, it’s not easy to tell the exact time of death. Nobody can identify the exact line between life and death. This is the paradox of deceased donation. So we can not exactly say whether the organs are harvested from a dead donor or living one. In the past brain dead donors were a good source of harvesting organs for transplantation. But these days, decreasing crime rate and increasing automobile safety have led to fewer potential brain-dead donors than in the past. Now the doctors are giving focus on donation after cardiac death though this practice is controversial. Due to the scarcity of the of organs, the doctors are forced to transplant the organs which were thought to be unsuitable in the past. Kidneys of overage or unhealthy people are being donated. Thus, the quality of transplants is questionable since it may cause harms rather than benefits to the health of the receivers. But the doctors have no alternative either.

Several countries are following the concept of  presumed consent. According to this concept, since the doctors can use the organs of the deceased without the prior consent of the dead ones or their family members,  everyone is taken as a potential organ donor unless they have denied this system  by signing a non-organ-donor card. Presumed consent is popular in Europe, and India is planning to introduce this program. However, it has not  flourished in America, but  this can be experimented at the state level for its development.

 Due to the shortage of organs for transplants, the black market is growing. It covers about ten percent of transports worldwide. It may have negative impact on the health of the donors as they are less likely to get proper postoperative care. So it is a good idea to legalize the sale of organs for the overall benefit of all.

Iran has solved the shortage of transplant organs. It has developed a legal payment system for organ donation. In this system, organs are not bought and sold at the bazaar. They have established a non profit organization called Dialysis and Transplant Patients Association (Datpa) that helps provide kidneys to the needy patients. Patients who cannot manage a kidney from a deceased donor or from a related living donor apply to Datpa. Datpa has a list of medically evaluated potential donors. The donors are paid $1,200 by the Iranian government, and the kidney recipients pay between $2,300 and $4,500. The poor recipients are supported by Charitable organizations. Thus, in Iran no patients are deprived of kidney transplants.

 Iranian system and black market make it clear that the shortage of organs can be solved by paying the living donors. It is effective as well as cheaper. Iran introduced the system in 1988 and eliminated the shortage of kidneys by 1999.  Nobel Laureate economist Gary Becker and Julio Elias state that a payment of $15,000 to living donors is likely to minimize the shortage of kidneys in America. And the federal  government can pay the donors. This is cheaper than the dialysis.

The world governments are gradually becoming successful to harvest kidneys from the living donors. As human  body can function properly with one kidney, there is no harm in donating the other kidney. But at the same time, it’s an ugly practice on behalf of the concerned agencies. They have failed to solve it reasonably. Is it justifiable to extract kidneys from the living ones while a number of kidneys that  could have saved lives are being buried and burned every day? The government can introduce the policies and programs to encourage the people to donate their organs after their death.

Singapore and Israel, have introduced nonmonetary incentives systems for potential organ donors.  Singapore does not force its citizens to sign the  presumed consent system, but people who opt out are given a low priority on the transplant waiting list in case they need an organ. This concept of no give, no take surely encourages people to follow the presumed consent system. Even the people who find the idea of paying for organs disgusting accept the ethical foundation of no give, no take. Moreover, it helps reduce the shortage because it encourages people to  sign the organ donor card. Israel has developed a point system to systematize the organ transplants in an effective and fair manner.

The shortage of organs is in increasing order worldwide, however, it can be solved if we follow the successful stories of different nations, and innovate some new methods. Presumed consent, financial compensation for living and deceased donors, and point systems would surely increase the availability of transplant organs.