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Die Waiting

February 15, 1999

Former National Football League star Walter Payton has been stricken by a
rare liver disease and needs a transplant in order to live. Unfortunately,
the demand for available organs far outstrips the supply, and several
thousand Americans this year will die waiting for those life-saving organs.

When Congress passed the National Organ Transplant Act of 1984, authored
by then Sen. Al Gore of Tennessee, it was supposed to solve the chronic—and deadly—shortages. Like many other acts of Congress, this one has
failed to solve the problem, and has actually made things worse.

Gore's law makes it illegal for individuals to sell organs, whether they
come from live donors or from people who have just died. Donor organs are
to be made available by altruism, although that standard applies only to
potential donors and their families. Legal altruism does not apply to
doctors, procurement agencies and hospitals, and, predictably, they defend
their turf.

The desperate search for some needing transplants has become big news. For
example, NBC recently publicized a system in China in which individuals
from the United States and elsewhere pay $30,000 or more for an organ
transplant. The coverage, as expected, was decidedly negative.

What the journalists and others fail to point out, however, is that the
current system makes the Chinese option, as ghoulish as it may seem, more
attractive to people whose only other alternative is a slow, painful death.

Economists unanimously agree that whenever authorities force
lower-than-market prices upon a good or service, shortages and long lines
develop. People at the back of the line often seek illegal or questionable
alternatives. In the case of transplantable organs, that "official" price
is zero, and the lines are miles long.

Defenders of the system say that the zero price enables poor people to
afford transplants, and that donated organs are of highest quality.

Those explanations are not only wrong, but are really a smokescreen that
hides the fact that the current system mainly benefits existing players in
the structure.

Economists point out that the zero cost of organs does not mean that
transplant recipients get a price break. Indeed, both procurementorganizations and doctors and hospitals are now able to capture all the
value of that organ in the prices they charge for their services.

A market for organs would not increase the price of a transplant, and
evidence exists that suggests a legal market would reduce the final price
of the whole procedure. Some estimates suggest that organs would cost less
than $1,000 on a free market.

One reason that prohibition of organ markets is unanimously supported by
the medical profession is that the ban preserves the incomes of those
already in this business. For example, the shortage of available organs
limits the number of doctors and hospitals which can do transplants,
severely curtailing competition.

Supporters of the "altruistic" system claim ending prohibition would
resemble a bad used car lot. The poor, they say, would be "forced" into
selling their organs for peanuts to unscrupulous vendors preying upon human
misery and price the poor out of transplants. (Likewise, bakers "prey"
upon those who are hungry.)

These arguments are ridiculous and dishonest. As noted earlier, economists
say markets for cadaveric organs would result in low prices for the organs
as more needed body parts come available. People waiting in line could now
receive transplants.

Moreover, organs are not bought by themselves; they are useful only as
part of the transplant surgery, which is performed by a trained surgeon. In
other words, the organ is valuable insofar as it permits the transplant
surgery to take place.

In the present system, procurement agencies, while technically being
"reimbursed" for "procurement costs," are rewarded handsomely per organ. In
1997, for example, acquisition costs for hearts and lungs averaged $16,314,
$32,845 for kidneys, and $10,312 for livers. These costs are then factored
into the total price for transplant surgery.

Increased availability of donor organs would attract more doctors into
transplants. As the supply of transplant physicians increased, the price
per transplant would fall, lowering the incomes of doctors who are already
established in this field. Thus, what might be good for those needing
transplants might not be in the best financial interest of some physicians.

Walter Payton won't die waiting for a liver transplant. Those who benefit
from the current system know the death of a superstar waiting in line would
expose the regime's brutality.

Like the late baseball star Mickey Mantle,who allegedly was jumped ahead of many others waiting in line to quickly
receive a liver, the principals of the procurement system will almost
certainly find the needed organ for Mr. Payton.

He will be lucky.
Thousands of other desperately ill people who live outside the media
spotlight will succumb to this system's bogus altruism.

* * * * *
Andy Barnett is professor of economics at Auburn University where William Anderson is a Phd candidate and a Mises fellow.

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