Full study available in pdf

Conflicting opinions on the
ethics of organ donation have existed as long as organ transplantation
has been medically feasible. Eligibility requirements, reason for
transplant, and international organ tourism continuously resurface as
difficult medical policy and ethics issues. One issue about which there
is little dispute is demand for organs far exceeding the supply of
donors. Demand for kidneys exceeds the current supply of deceased donor
organs and altruistic donors. Approximately 73,000 people sit on the
waiting list for a kidney — 18 of them will die by tomorrow and 6,000
more patients join the list every year. By 2010, over 100,000 Americans
will wait for a kidney donation. A kidney transplant in the United
States generally requires a five-year wait.

The development
of a transparent, regulated market for live organ donation is currently
prohibited by the National Organ Transplant Act of 1984 (NOTA), which
imposes criminal penalties of up to $50,000 and five years in prison
for any person who “knowingly acquire[s], receive[s], or otherwise
transfer[s] any human organ for valuable consideration for use in human
transplantation.”

The establishment of a transparent, public
market to permit the sale of organs from live donors will transform
organ procurement from a lengthy, stressful, medically damaging waiting
game into a safer, more efficient, routine, life-saving process. Such a
market would have both economic and moral merit; it would deliver more
and better organs at less cost than alternative options, and will
result in more lives saved.

A model of direct payment for
organs is available in the experience of Iran, which has allowed
compensation since the late 1980s. Singapore plans to introduce direct
compensation in 2009. What can be learned from a study of this process
and its potential role in the modern American medical landscape? The
deliberate choice to rely on altruism has been unsuccessful and fails
to reflect the advances that have been made in transplant techniques.
Technology and success rates have improved; why has policy remained
largely unchanged? The tide, however, is beginning to turn. Individual
states are experimenting with indirect payment systems to increase the
number of live donors.

Moral outrage ought to be directed
not at the tension between markets and altruism, but at the needless
loss of life as transplant waiting lists continue to grow. In that
spirit, this paper offers two policy proposals to support the
development of payment systems — both direct and indirect — for
procurement of organs. The most expedient route to a transparent
regulated market requires a repeal of section 301 of the National Organ
Transplant Act of 1984.

Related Files: Jennifer Monti - The Case for Compensating Live Organ Donors.pdf