Marginal Revolution: The Economist on Organ Transplants

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The Economist on Organ Transplants

The Economist has cogent things to say on setting up a market for organs including the fact that organ sales are legal in, of all places, Iran and the shortage in that country has been eliminated. Here's another interesting point:

America already lets people buy babies from surrogate mothers, and the risk of dying from renting out your womb is six times higher than from selling your kidney.

Hat tip to Harold Kyriazi.

Posted by Alex Tabarrok on November 19, 2006 at 07:21 AM in Economics, Medicine | Permalink

Comments

I've got a much better idea: increase spending on medical research and stop so many organs from failing in the first place. While being able to get a transplanted organ without a lengthy wait is good, not needing a transplant in the first place is vastly better.

Posted by: Peter at Nov 19, 2006 11:08:08 AM

If there is a market for this, I hope I could be the broker.

http://www.pipeline.com/~rougeforum/poor.html

Posted by: pumpkin at Nov 19, 2006 11:30:57 AM

Good idea Peter. And since an increase in research spending will lead to immediate results, no need to worry about everyone who needs a transplant today.

Posted by: David Andersen at Nov 19, 2006 12:34:48 PM

Good idea Peter. And since an increase in research spending will lead to immediate results, no need to worry about everyone who needs a transplant today.

Then by your reasoning, Einstein, we should stop all medical research and spend the money on immediate needs?
Did your parents have any kids that lived?

Posted by: Peter at Nov 19, 2006 2:18:49 PM

"I've got a much better idea: increase spending on medical research and stop so many organs from failing in the first place. While being able to get a transplanted organ without a lengthy wait is good, not needing a transplant in the first place is vastly better."

We shall fix the problem by assuming that it does not exist.

Posted by: Leviathan at Nov 19, 2006 2:23:57 PM

Peter confuses two entirely seperate questions. One is how much effort should be allocated to what sorts of research in order to optimize a stream of future technologies. The other is how to organize the use of presently available technologies to optimize the benefit they provide.

The proposal at hand addressed the second question. Peter ascribes to its advocates a position on the first that they have not taken.

Or perhaps, like some Marxist-Leninists believed that one shouldn't try to improve the lot of workers in capitalist societies, on the grounds that it would less their interest in promoting the glorious revolution, he believes that we shouldn't try to improve the lot of the sick today, on the grounds that it will lessen their interest in funding his glorious research program.

Posted by: David Wright at Nov 19, 2006 3:48:01 PM

"America already lets people buy babies from surrogate mothers, and the risk of dying from renting out your womb is six times higher than from selling your kidney."

That is a argument against allowing people to buy babies from surrogate mothers.

Posted by: Ragerz at Nov 19, 2006 5:25:38 PM

I cannot understand why so many people are opposed to increased medical research. Medical research may not offer instant gratification but has to the potential to save countless lives.

Posted by: Peter at Nov 19, 2006 5:32:49 PM

Peter, who is opposed to increased medical research? Not I. And I'm certainly not implying stop all research; don't be silly.

You, however, presented your idea as an alternative to organ transplant. Perhaps you didn't mean to, but I'm not the only one who read it that way. When you start with "I've got a much better idea..." that implies the other idea should be abandoned. Furthermore, while your idea may work in the long-run (there is no guarantee we can ever prevent organ failure to the point where it is trivial), it does nothing in the short-run.

Posted by: David Andersen at Nov 19, 2006 8:02:16 PM

This might come as a shock to Peter, but even in a world of scarce
resources there can be both medical research and organ transplants.
And you don't have to be Einstein to understand that.

Posted by: Bill Stepp at Nov 19, 2006 9:44:23 PM

Do you remember Star Trek IV twenty-some years ago during the chase scene at the hospital when Bones asked a woman with kidney failure: "Dialysis? Here, take this!" with an apparently effective result from the pill he gave her. I say, let StarFleet deal with the kidney shortage issue.

I agree with David that we need to deal with the current organ shortage problem with the technologies available to us. A market in organs is one of those technologies. Sometime prior to Operation Iraqi Freedom the New York Times Magazine had an article about for-sale kidney transplants, contrasting the fate of an Israeli who had a quickie transplant in Istanbul which failed, probably due to lack of follow-up care after surgery, with a successful for-sale kidney transplant in Iraq of all places. I could only imagine how successful for-pay transplants would be at major U.S. or European medical centers.

Given a hypothetical question whether we should cease all funding for biomedical research and direct it towards enabling warp-drive, expecting that the benefits of exploring new worlds in space will far exceed the benefits of research here on earth, including therapy for kidney failure, I am undecided (just kidding).

But we should concentrate on research and interventions we can do, aided by free markets in organ donation.

FWIW, the shortage in for-sale donatable kidneys is a market opportunity for countries adjacent to the U.S. Imagine if Newfoundland legalized for-sale organ transplants. Canadian physicians and hospitals meet essentially the same quality standards as U.S. physicians and hospitals. Newfoundland hospitals would do a brisk transplant business, and with the appropriate tracking tools the outcomes could be compared to those of kidney recipients in the U.S. who received cadaver or non-paying donor kidneys.

Virginia Postrel call your office!

Posted by: Tony Suruda at Nov 19, 2006 9:50:30 PM

This might come as a shock to Peter, but even in a world of scarce
resources there can be both medical research and organ transplants.
And you don't have to be Einstein to understand that.

So why not reallocate the relative spending a bit? Right now it appears as if research gets neglected.
Oh, and what about preventative medicine? No one seems to care about that either.

Posted by: Peter at Nov 19, 2006 11:57:11 PM

I also wasn't aware that backing open markets in organs = not caring about preventative medicine.

So Peter, should I call up the guy who appropriates all the money to research and organ transplants and tell him to change his allocation formula or do you want to take that to-do?

Seriously Peter, do you think all this spending is managed by a committee?

Posted by: David Andersen at Nov 20, 2006 12:08:56 AM

Peter, you are not making a point either for or against for sale organ transplants. You are raising side issues that are irrelevant.

Posted by: Leviathan at Nov 20, 2006 12:21:26 AM

Peter, you're making the most obvious straw-man argument I've ever heard. If this is the best argument the anti-organ-market people have, then choosing to allow an organ market is a no-brainer.

Let me present to you another way. You've got two options:

1. Keep the current Organ donor program and increase research spending. No matter the funding, the research spending will not meet the most immediate needs and may or may not meet the needs in the distant future. (If you know some doctors to give money to that will cure Kidney diseases in six months, let us know.)

2. Legalize organ markets and fund research, immediately curing those with Kidney diseases and keeping the possibilities of major new cures alive.

This decision, in every sense, is a no-brainer. The only reasons we haven't taken option 2 are people's unwillingness to see a possible "market" for a body part and the lack of will of politicians to show the life and death consequences of not having a market.

I mean, if you knew someone that needed a Kidney transplant, which option would you support?

Posted by: Matthew at Nov 20, 2006 12:48:02 AM

>> increase spending on medical research

People are free to spend whatever they want on this? Or are you implying that people should be forcible taxed for this effort even if they're not interested in this effort?

Posted by: Chris Meisenzahl at Nov 20, 2006 1:06:25 AM

What exactly is the right balance between spending on current and future demand (i.e. immediate needs and research)? On what basis - i.e. What are the relative values of those expenditures (accounting for risk and payoff)? What is the current spending on each? Who is going to make the necessary corrections? How many problems besides transplantable organ failure must be accounted for in this? How do we know that those guiding the spending will get just the right balance by choosing just the right solutions to the most important problems? Why haven't they already?

BTW - it's "preventive", not "preventative". You want prevention, not preventation.

Posted by: Eric H at Nov 20, 2006 10:13:31 AM

Let me present to you another way. You've got two options:

2. Legalize organ markets and fund research, immediately curing those with Kidney diseases and keeping the possibilities of major new cures alive.

#2 is obviously the better choice. Except we're not really making either choice, because research seems to be stagnating. Even if substantial amounts are being spent on research it's having little effect, as organ failure rates keep climbing.

Posted by: Peter at Nov 20, 2006 10:25:04 AM

Y'all are ganging up on Peter, but he has a decent point...so in light of that great libertarian classic: "Defending the Indefensible"...I'd like to suggest ya listening more carefully to what he is saying and think more about what it means for you and your family...

1) While medical research investments are not all allocated by some giant committee (as Peter's critic implies he might expect), Kevin Murphy and friend suggest the benefits of most medical research are terribly hard to capture. And so we get way, way, way to little of it....

http://www.milkeninstitute.org/publications/review/2000_3/mir5_22_medresearch.pdf ...they

2) It's therefor not silly to suggest that billions that should go to research might well go to transplants instead...

Of course we can persue transplants and other "preventive" measures at the same time... but Peter's sense that we are focusing too much on transplants is not so easily dismissed. As to pharmaceuticals, Peltzman suggests we have been loosing around 60% of new drugs from "over-regulation" http://fdareview.org/harm.shtml What other high tech industry requires about half a billion dollars and a decade to get government approval for any new product?

Posted by: Dave Meleney at Nov 20, 2006 2:59:10 PM

"Even if substantial amounts are being spent on research it's having little effect, as organ failure rates keep climbing."

All the more reason to hasten the move to an open market on organ donation, eh?

Posted by: David Andersen at Nov 20, 2006 11:23:01 PM

I think Peter may be the devil's advocate.

Posted by: Matthew at Nov 21, 2006 2:31:37 AM

Y'all are ganging up on Peter, but he has a decent point... Of course we can persue transplants and other "preventive" measures at the same time... but Peter's sense that we are focusing too much on transplants is not so easily dismissed.

Well thank you for coming to my defense! It was pretty lonely here, with everyone acting as if I were proposing a group trip to Canada to club the baby seals or something.

I mean, increasing the supply of organs for transplants is a good idea, but even if there were no shortages transplants would still be a far-less-than-ideal solution: major surgery, expensive, and with an ever-present risk of rejection.
I don't know why the rate of organ failure seems to have increased so much or in fact why organs are failing in the first place. I do know, however, that looking into the causes of organ failure and trying to prevent as many cases as possible is a win-win proposition.

Posted by: Peter at Nov 21, 2006 1:22:37 PM

Prof. AT,

Iran is also making impressive headway in stem cell research.

Presumed consent seems like a good idea.

As for living donation of kidneys, if a market was allowed, transplants would take place more liberally. Currently doctors consider it to be a last resort. We would see more poor people donating and (perhaps) more rich people receiving. Should the proceeds from the sale be taxable? Where do we draw the line in terms of age? Should a starving college student be allowed to donate and cash in at 19?

What incentive does the medical provider have in continuing to provide health care to the donor after donation? Would there be a contractual relationship? Do you think Medicare should cover care for donors whose only other kidney fails?

Posted by: Chairman Mao at Nov 21, 2006 9:41:46 PM

I think that, organ transplantation is important but what do you donor in the future?

Posted by: sükran at Jan 23, 2007 3:28:31 AM

I think that, organ transplantation is important but what do you donor in the future?

Posted by: sükran at Jan 23, 2007 3:28:33 AM

@peter etc.
no doubt in the importance of med research.
but what about healthy living - and about how many people f***ing up their bodies by just not caring about them? and the general consumption environment helping this?
i do have an organ donor card, but actually, coming to think about it, i'd like my organs, which i care for well, to help a person that is in need of it/them not of their own fault, but because of unlucky circumstances or conditions. but sure not someone who has smoked/drunken/drugged/consumed his kidneys/liver/heart to death.
i totally agree the actual organ donation concept based on altruism only is inadequate. tabarrok's idea of enhanced altruism (eligibility for donated organs by being organ donor) seems a good step towards that.

Posted by: durdu at Feb 7, 2007 5:53:08 AM

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