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Human Organ Regulation November 26, 2006

Posted by federalist in Healthcare, Human Markets, Regulation.

The moral perils associated with a human organ market hardly justify the total prohibition by the United States on any pecuniary consideration for organ exchange.  Rather than reiterate the economic arguments, I would reference Richard Epstein’s great “Kidney Beancounters” essay published in the WSJ in May.

The lack of a human organ market has certainly both curtailed the supply of transplantable organs and also hindered the optimal allocation of those organs that are available.  And lest there be any doubt on this first count, David Harrington and Edward Sayre in an essay today note, “We have found clear empirical evidence that even modest compensation can dramatically affect donation decisions.”

Medical schools routinely pay for the cremation or burial (often with elaborate memorial ceremonies) of the people whose bodies were donated to them for medical research and student training. In contrast, it is against federal law to offer any compensation for transplant organ procurement, including paying for organ donors’ funeral expenses. This creates a bizarre asymmetry in the treatments of organ and whole body donations.



1. federalist - March 12, 2007

WSJ article notes that UNOS may finally be coming around to weighing “Net Benefit” in apportioning organs in the United States.

Today, a donated kidney generally goes to the person who has been waiting longest in the region in which it becomes available, with exceptions made for certain medical factors. A kidney from a 25-year-old donor could be transplanted into a 75-year-old, who is likely to die years before the kidney would have stopped working.
The new policy is being developed by the United Network for Organ Sharing, the nonprofit body that develops organ-distribution policy under a government contract.
Surgeons and others leading the process expect the final proposal will rely significantly — though not exclusively — on the concept of “net benefit,” which seeks to give kidneys first to those who will benefit most from them.
“Waiting time is arbitrary,” said Alan Leichtman, a University of Michigan kidney doctor helping to craft the policy. “It seems like a real shame that we’re not being better stewards of the organs.”

Statistics show that age is by far the biggest factor predicting how long someone will live after a transplant. A typical 25-year-old diabetic will gain an extra 8.7 years of life from a transplant, while a typical 55-year-old diabetic will gain only 3.6 extra years, according to the Scientific Registry of Transplant Recipients, a private group in Ann Arbor, Mich., that tracks data under a government contract. Other factors affecting survival include underlying illness and whether a person is overweight or has had a previous transplant. They, too, are included in the “net-benefit” calculation.
Transplants performed under the existing system generate about 44,000 extra years of life for the people who receive new kidneys each year, according to the registry. If all kidneys were distributed using a net-benefit calculation, that number would rise to more than 55,000 years, it says.

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