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Death Toll Still Rising

August 1, 2002

Terrorists killed nearly three thousand people on September 11, 2001, but that figure is swamped by the number of people who die each year while waiting for an organ transplant. More than three thousand died in the year 2001 waiting for a kidney transplant. Thousands also died waiting for livers, hearts, and other vital organs, and the number of people dying each year is increasing at a gory pace.

These official figures actually understate the true number of deaths, because many people who need a transplant are denied access entirely, and as the shortage of organs grows, the standards for entering the waiting line are becoming even more stringent. Worse still, people waiting for a transplant are taken off the list if they become too weak for the transplant operation. Many of these people die shortly thereafter but are not counted in the official body count. As the shortage becomes more acute, waiting times increase, suffering increases, and the number of unofficial deaths skyrockets.

Economists David Kaserman and A.H.Barnett describe and diagnose this largely unnoticed tragedy in their new book The U.S. Organ Procurement System: A Prescription for Reform. Of course, it was entrepreneurs who discovered this lifesaving procedure and made it a safe and effective treatment for what otherwise would be life-threatening ailments, but you certainly cannot blame this problem on the free market. Kaserman and Barnett conclusively show that the "chronic shortage of transplantable organs can be laid squarely at the feet of that public policy" that prevents a marketplace for human organs to exist.  

The current system is one in which the government manages the supply of organs by a system of regional nonprofit monopolies which are suppose to seek out permission to obtain the vital organs of accident and stroke victims. The organs are then given to the transplant centers for the patients at the top of the waiting lists. The government pays most of the cost of the transplant and subsequent treatment. This is a "market" in which the government controls production, distribution, and consumption, and where the market is explicitly banned.

The National Organ Transplant Act of 1984, sponsored by Senator Al Gore and signed into law by President Ronald Reagan, set up this bureaucratic killing machine that imposes a five-year sentence and a fine of $50,000 for anyone willing to invade its turf by offering "valuable consideration" to a family that would donate the organs of a deceased family member to save someone else’s life.   

Naturally, a government-managed monopoly does a lousy job of obtaining a sufficient supply of organs. They often fail to ask permission to obtain usable organs or are ineffective when they do ask. As a result, they only collect about a fourth of the available organs. After years of double-digit growth, the supply of cadaveric organs abruptly leveled off after the passage 1984 Transplant Act.

Kaserman and Barnett show conclusively that market forces would completely eliminate this shortage of organs and end all the needless death and suffering caused by current government policy. It would save taxpayers billions of dollars, and, according to their calculations and estimates, organs would cost less than $200 each, depending on the forces of supply and demand. I believe that market forces would generate the necessary incentives to provide an ample supply because the true opportunity cost of your internal organs is near zero, unless you either are Pharonic or place a high value on feeding worms.

Kaserman and Barnett investigate all other possible approaches to organ procurement and find them both ineffective and ethically inferior. Those who run the current system find the idea of a market for human organs repugnant, but frankly, their arguments are self-serving. Surveys find that the general public overwhelmingly disagrees with their convenient moralizing and supports the use of incentives to increase the supply of organs.

Allow me to read through the author’s neoclassical economics and well-couched scientific analysis and tell you that the bureaucrats and surgeons find the market system repugnant because they make monopoly profits off the current "altruistic" system. Individually, they may or may not realize that their ethical view is responsible for so much unnecessary death and suffering, but collectively, they understand that it is what protects the pocketbook of the bureaucracy and the medical transplant establishment.

Organ procurement is an issue that deserves the attention of the general public. Our authors here have done an excellent job of explaining the current system, the extent of the shortage, the suffering it brings, the cause of the shortage, and its cure. It would make an excellent case study for courses in economics, public policy, and philosophy.

One hidden advantage of the book is the lesson it provides for the debate over the legalization of drugs. The current organ procurement and allocation policy is, after all, a prohibition of the market and free-market forces. The important difference is that in the case of the government's prohibition of drugs, a black market replaced the market, while in the case of organs, bureaucracy and government intervention displaced a nascent market.

Most advocates of drug "legalization" argue that drug prohibition should be replaced with bureaucracy and intervention, not free-market forces. Disheartened by the prospects for policy reform, and inspired with the concept of "harm reduction," they advocate a system where government regulates the supply of drugs and determines who is allowed access to drugs, what drugs are permitted, and how much you are allowed to consume.

Some drugs might be subject to high taxes while the government would provide other drugs for free. Government would regulate drug treatment centers, and addicts would be subsidized and required to participate in treatment and rehabilitation. Government would register, monitor, and study drug addicts. The market would be limited to government contracts for nonprofit organizations and heavily regulated for-profit firms, but government would ultimately control all of the major decisions and functions in this "legalized" market.   

The disastrous results of government control of organ supply should give these advocates great cause for concern. The real free market is the only policy of providing economic rationality to human organ procurement, and it is the only policy that can address the issues of dangerous and addictive drugs.

When particular issues are raised in either case, policymakers should always move in the direction of freer market forces and less government intervention. Contrary to popular belief, government is particularly inept at handling the new and complex problems of society. Only the free market can handle the daunting the tasks of society, a point well illustrated by Professors Kaserman and Barnett.


Mark Thornton is a senior fellow of the Mises Institute. Send him MAIL. See his Mises.org Articles Archive and his scholarly pieces in the QJAE, the RAE, and the JLS.


Note: The views expressed on Mises.org are not necessarily those of the Mises Institute.

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