Every day 13 Americans die while waiting for a kidney transplant. This is a problem we can solve by waving a little money around. The reason we don’t is that people such as Michael Sandel think it is unethical to involve something as icky as money in something as important as a life. My own ethics and morals work the other way around. We should be doing what works to save those lives, the involvement or not of dead presidents printed on green pieces of paper be damned.
Which brings us to the current administration and president. They have just taken a baby step toward making things better. This ethically driven “Ewwww!” about involving money in transplants has meant that people cannot be paid for donating an organ. Right now, they can’t even be paid the wages they lose while recovering from having done so. This is the rule that is being changed. In the future you will be able to have your lost earnings made up, as well as the medical expenses that can already be covered.
This is important, for there is no possible source of the organs we desire other than live human beings. Sure, dead people don’t need them any more, but we, roughly enough, already use all of those that can be used. Most deaths leave the cadaver unusable for transplants. That’s just the way it is as we expire.
Various systems are tried to increase the rate of donation, but most don’t seem to work. For example, assuming that organs may be used (“opt out” in the jargon) rather than having to ask permission (“opt in”) doesn’t change the number of transplants successfully carried out. Sure, we all wish it would, but it doesn’t. That’s Al Roth pointing it out to us, the same Al Roth whose Nobel Prize is in part for working out the economics of organ transplantation and the matching of donation chains.
Dead bodies just can’t supply us here, but live donations are possible. Sure, hearts are a problem as life after donation is pretty tough, but we can usually donate one kidney without harm. We can also donate part of a liver, it’ll grow back, or donate a lobe of a lung.
I disagree with Dylan Matthews at Vox about near everything but admire him for having donated a kidney. He donated not to a family member but just to someone who needed one. I agree with Virginia Postrel on near everything and admire her equally to Matthews for her own kidney donation.
But here’s our problem. Altruism isn’t enough; the lines of people willing to donate don’t match those needs. We’ve not enough dead bodies of the right type. Therefore people die needing organ transplants. They die painful, long, and slow deaths. In the case of kidney disease, dialysis works, but only for a time.
We should, thus, add cash to the organ transplant equation, to save lives.
There’s only one place in the world that doesn’t have people dying waiting for a kidney: Iran. There’s also only one place that actually pays people for the live donation of a kidney: Iran. Sure, the mullahs are supposed to be the object of the Daily Hate these days, and I don’t support their wider system of government or economics either. But some decades back they made a very pragmatic decision.
Under sanctions (these were the ones about the revolution itself, back in the 1980s) the Iranians noticed that they couldn’t actually afford the dialysis all their kidney patients needed. Plus, they kept dying after a few years anyway. They also noticed that a transplant is cheaper than dialysis. Yep, the operation, plus the anti-rejection drugs, is the cheaper option. So, the Iranian system has the government (note it’s the government paying, you can’t just turn up at the hospital and donate to pay off a drug debt immediately) paying live donors of a kidney. The amount is, broadly, equal to a year’s median income. Think in U.S. terms about $30,000 to $40,000 in relative value.
Iran doesn’t have a line of people dying on dialysis as they wait for a kidney transplant that isn’t ever going to happen. Iran throws money at the problem and solves it. This is what we should do.
The Trump administration has made the system better by allowing that compensation for costs and lost wages. But we should go further and have a proper paid market for transplant organs. Yes, it will need to be a regulated one. Yes, we’ll have to put Michael Sandel back into his box by pointing out that pure altruism just doesn’t solve the problem.
There is a certain amusement here that we’ve a problem that can actually be solved just by splashing a little cash. It’s something that will save money in the medium term, even. And yet the richest nation the world has ever seen isn’t willing, as yet, to solve it in the only manner that we know works: spending some money on it.
After that amusement, there’s the deeper point we all really need to grasp: Some problems, such as the curing of sick people, are just too important for us not to have markets and cold hard cash used to solve them.
Tim Worstall (@worstall) is a contributor to the Washington Examiner’s Beltway Confidential blog. He is a senior fellow at the Adam Smith Institute. You can read all his pieces at The Continental Telegraph.
