Solving The Organ Donation Shortage

by Steve Chapman

Health and Human Services Secretary Tommy Thompson can see that entirely too many bull riders are leaving hospitals under their own power. So he's launched a new version of an old campaign, looking for ways to promote more organ donations.

Thompson, interviewed on a recent visit to Chicago during National Organ and Tissue Donor Awareness Week, says there were 22,000 transplants in the United States last year -- but there are 76,000 patients on the waiting list for organs. The need for organs is increasing twice as fast as the supply. Fifteen people die every day simply because the organs they need are being diverted to cemeteries, where they serve as high-grade lawn fertilizer.

The new secretary wants companies and employee groups to provide more information about organ donation. He's come up with a model organ and tissue donor card. He wants to create a national "Gift of Life" medal to be awarded to the families of organ donors. His initiative, he says, is the start of "the most comprehensive effort yet in our nation regarding donation and transplantation."

But there is no chance that this campaign will fill the growing need for transplant organs. Everyone understands the value of organ donations, and most people are sympathetic to the idea of helping out. Unfortunately, the impulse of selfless charity, despite constant stimulation, has failed to solve the problem. What is needed is a more powerful incentive often used to further worthy purposes: money.

Lloyd Cohen, a law professor at George Mason University, has long advocated a plan to allow the buying and selling of vital body parts. He envisions letting people contract in advance to donate any usable organs when they die -- in exchange for a fee to be paid to their heirs. It would work like life insurance, only without monthly premiums.

The idea conflicts with a common sentiment that people shouldn't turn their bodies into commodities for exchange. But we allow the sale of blood, semen and hair without getting squeamish. And Cohen doesn't propose to recruit homeless vagrants to trade a kidney or a cornea for a quart of malt liquor, which would raise more serious moral issues.

All he suggests is to let people who make a useful sacrifice after their death get paid for it. As the 18th-century economist Adam Smith wrote, "It is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner, but from their regard to their own interest." Why should we depend on altruism to furnish something any of us may someday need even more urgently than our next meal?

Cohen's plan would also force medical professionals to do something many of them prefer to avoid: Confront surviving relatives with the deceased's instructions on organ donation. Today, if doctors let organs go to waste, they may suffer nothing worse than pangs of conscience. This approach would make them liable if they fail to harvest organs that have been designated for sale.

Having been entrusted with the body of the deceased, says Cohen, the hospital "will be required to take as much care with it as with his wallet and watch. That is, to preserve it and deliver it to the proper party." If a motorcyclist's widow is deprived of a handsome bequest because no one bothered to harvest his organs, she would be entitled to compensation from the person who screwed up. This change would infuse medical professionals with a new zeal to carry out the wishes of those who die.

The other obvious objection to the sale of body parts is that only the rich would be able to afford them. But Cohen estimates the going rate at only a few thousand dollars per organ -- a piddling sum next to the cost of surgery, drugs and treatment for each recipient. Insurance companies and governments would much rather pay for a kidney than finance long-term dialysis.

Keeping commerce out of organ donations means ignoring what's truly important. "If I were in need, I'd love an organ to come from a kind, loving, generous person who donates out of the kindness of his heart," says Cohen. "But barring that, I'll take it from a mean, selfish SOB whom I pay for it."

Secretary Thompson and Company, however, are willing to do anything to encourage organ donations except pay for them. But their approach hasn't worked, and it isn't likely to. Unless we make bull-riding a mandatory part of every PE class.