Economic analysis supports the idea, but critics say the practice would exploit low-income people.


The ability to purchase organs from live donors could largely eliminate transplant waiting times and only modestly increase total transplantation costs, according to a newly published economic analysis.

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The analysis suggests that healthy young donors in an economy like that in the United States—which place them at low-risk for post-surgical death—would sell a kidney or a portion of a liver at prices that would drastically increase the number of those organs available for transplantation and increase transplantation costs by only 12%.


In a study published in the Journal of Economic Perspectives (2007;21:3-24), economists Julio Elias, PhD, of the State University of New York at Buffalo (SUNY Buffalo) and Gary Becker, PhD, of the University of Chicago argue that the use of monetary incentives could increase the supply of organs for transplant sufficiently to eliminate the very long waiting times. They say this approach could eliminate the suffering and deaths of many of those individuals waiting for a kidney without increasing the total costs of transplant surgery by a large percentage.


Putting kidneys and other organs on the market may seem like a proposal straight from the cold heart of a free-market economist, but Dr. Elias does not see it that way. He notes that 18 Americans die every day—more than 6,500 a year—awaiting transplants, according to the United Network for Organ Sharing.


“When an economist sees a persistent gap between supply and demand, as in the demand for and supply of organs for transplant, the next step is usually to look for the obstacles to market equilibrium,” said Dr. Elias, an assistant professor of economics. “In the case of the market for transplantable organs, the obstacles are obvious. Very few countries allow the use of monetary incentives to acquire organs from either living donors or cadavers.” Those few countries include Iran, starting in 1988. India had allowed payment for organs in the 1980s and early 1990s, but today it is not legal, Dr. Elias observes.


Although previous authors have discussed using monetary incentives to increase cadaveric organ donations, Drs. Elias and Becker stress the potential for obtaining more kidneys from living persons. This approach, they argue, would in several respects be less subject to abuse and corruption than harvesting cadaveric organs.


The researchers say donating an organ for transplantation may affect a person’s quality of life, risk of mortality and the ability “to perform market and non-market activities for some period of time after the surgery.” Building on the value of statistical life, a measure that summarizes tradeoffs between monetary wealth and fatal safety risks, and other parts of economic analysis, the authors compute how much additional income or market consumption a person will require to be indifferent as to the question of selling an organ or not.


Their analysis suggests that in the United States, a payment of $15,200 per kidney, as a case in point, to a healthy live donor would significantly increase the pool of transplantable kidneys and eliminate the large numbers of people on waiting lists. In the United States, nearly 74,000 people were on a kidney transplant wait list by the end of 2007, up from about 17,000 in 1990, Dr. Elias notes.

Payment for organs—whether from the living or cadavers—has been widely criticized on several grounds, among them the immorality of commodifying body parts, the likelihood that the poor would be the most likely people to step forward to sell an organ, and the possibility of reckless or impulsive donations. The authors argue, however, that paying for organs that save lives is no less moral than paying surrogate mothers for the use of their wombs or paying market wages to attract an army, which they note commodifies a recruit’s entire body.


The economists say the organs of low-income persons who are sick are likely to be rejected, so live donors would likely come from among the healthy poor and middle classes. They argue that poor individuals should not be deprived of revenue that could be highly useful to them, especially when their organs might save the lives of persons who are in desperate need.


Drs. Elias and Becker say reckless or impulsive donations can be mitigated by requiring that donors be given written and verbal information about the risks posed by the surgery as well as afterwards. They also should be given a “cooling off” period that is long enough for potential donors to seriously consider their decisions, according to the authors.


Based on reactions to their paper, Dr. Elias says his impression is that older physicians disfavor the idea of allowing payments for organs, but younger physicians seem to be more amenable to the concept. “We have this problem of too many people waiting [for organs] and a lot of people dying while on the waiting list. And the problem is increasing. I think at some point this idea will be accepted.”