The Market for Kidneys, Livers and Lungs

[Clark]

http://online.wsj.com/article/SB10001424052970204554204577023623689583052.html

The Market for Kidneys, Livers and Lungs
It already exists, but unwise laws push it dangerously underground.
By SALLY SATEL

Last month, Levy Itzhak Rosenbaum, a 60-year-old Israeli who made his home in Brooklyn, pleaded guilty in federal court to illegally brokering kidney sales. Between 2006 and 2009, he arranged transplants for three New Jersey patients with renal failure. The donors, poor Israelis, were flown to the U.S. The surgeries took place at American hospitals where doctors had no knowledge that each patient had paid Rosenbaum about $160,000.

Rosenbaum is the first person convicted for violating the 1984 National Organ Transplant Act (NOTA). But with 90,000 people in need of kidneys and 12 dying daily while waiting, it's surprising there aren't more Rosenbaums doing business in the U.S.

Overseas, his counterparts are thriving. Roughly 10% of all organ transplants in the world are obtained on the black market, according to the World Health Organization. A new investigation by Bloomberg Markets puts a brutal face on that underground world. It describes a transcontinental network of criminal rings in former Soviet republics such as Azerbaijan, Belarus and Moldova, along with South America, Israel, Egypt, the Philippines and South Africa.

Sometimes patients come from one country, donors from another, and the transplant occurs in a third. Impoverished and illiterate donors are often misinformed about surgery that awaits them, cheated out of promised payment, and deprived of medical follow-up. Even more chilling, according to the Bloomberg report, the brokers' strongmen threaten prospective donors with violence if they change their minds about selling.

But whether in New Jersey or Belarus, the drama is the same: a patient frantically trying to save his own life and a poor donor trying to salvage his own.

This morbid fraternity is the result of a near-universal ban on organ trading. Organs should be a "gift," goes the government-approved narrative, an act of selfless generosity. A beautiful sentiment, yes; but for those without a willing loved one to donate or years to wait on an ever-growing list, altruism can be a lethal prescription.

The only solution is more organs. In the U.S., we need a regulated system in which compensation is provided by a third party (government, a charity or insurance) to well-informed, healthy donors. Rewards such as contributions to retirement funds, tax breaks, loan repayments, tuition vouchers for children and so on would not attract people who might otherwise rush to donate on the promise of a large sum of instant cash in their pockets.

With private buying kept unlawful, available organs would be distributed not to the highest bidder but to the next needy person according to a transparent algorithm. For organs that come only from deceased donors, such as hearts, or those that are less often given by loved ones, like livers and lungs, a pilot trial of government-paid or charity-financed funerals makes sense. (Britain's Nuffield Council on Bioethics suggested a model like this last month.)

The idea almost came to pass here. In 1994, Pennsylvania's governor, Robert P. Casey, who had received a heart-and-liver transplant a year earlier, signed a burial-benefit law. But the state didn't implement it for fear of violating NOTA.

Were donor compensation legal, it might have been a good option for Donna Barbera of California. Last week, she wrote me asking how she could sell her kidney. She sent her phone number and blood type. "I do not find anything immoral about helping someone get a kidney and in return they help me out of a financial bind," she said by email, noting that she faces foreclosure on her house. "I have a donor card on my license, so my intentions have always been to help. I just thought maybe someone could help me too."

Revising NOTA would allow healthy people like Donna to save a life in exchange for bettering their own. As countries provide for their own needy patients, they will keep future clients from patronizing people like Levy Rosenbaum—and they'll keep brokers from preying on the vulnerable.

The U.S. attorney who prosecuted the Rosenbaum case did not bring charges against the patients who purchased the organs or the surgeons who performed the transplants. I choose to read this wise action as an acknowledgment that society should not punish a person for trying to save his own life. And here's hoping that Congress will soon demand innovation to our transplant system so that sick people are not driven to such desperate cures.

[Clark]

http://www.theatlantic.com/life/archive/2011/11/why-legalizing-organ-sales-would-help-to-save-lives-end-violence/248114/

Why Legalizing Organ Sales Would Help to Save Lives, End Violence
There are only about 20,000 kidneys every year for the approximately 80,000 patients on the waiting list. In 2008, nearly 5,000 died waiting.
By Anthony Gregory

Last month, New Yorker Levy Izhak Rosenbaum pled guilty in federal court to the crime of facilitating illegal kidney transplants. It has been deemed the first proven case of black market organ trafficking in the United States. His lawyers argue that his lawbreaking was benevolent: "The transplants were successful and the donors and recipients are now leading full and healthy lives."

Indeed, why are organ sales illegal? Donors of blood, semen, and eggs, and volunteers for medical trials, are often compensated. Why not apply the same principle to organs?

The very idea of legalization might sound gruesome to most people, but it shouldn't, especially since research shows it would save lives. In the United States, where the 1984 National Organ Transplantation Act prohibits compensation for organ donating, there are only about 20,000 kidneys every year for the approximately 80,000 patients on the waiting list. In 2008, nearly 5,000 died waiting.

A global perspective shows how big the problem is. "Millions of people suffer from kidney disease, but in 2007 there were just 64,606 kidney-transplant operations in the entire world," according to George Mason University professor and Independent Institute research director Alexander Tabarrok, writing in the Wall Street Journal.

Almost every other country has prohibitions like America's. In Iran, however, selling one's kidney for profit is legal. There are no patients anguishing on the waiting list. The Iranians have solved their kidney shortage by legalizing sales.

Many will protest that an organ market will lead to exploitation and unfair advantages for the rich and powerful. But these are the characteristics of the current illicit organ trade. Moreover, as with drug prohibition today and alcohol prohibition in the 1920s, pushing a market underground is the way to make it rife with violence and criminality.

In Japan, for the right price, you can buy livers and kidneys harvested from executed Chinese prisoners. Three years ago in India, police broke up an organ ring that had taken as many as 500 kidneys from poor laborers. The World Health Organization estimates that the black market accounts for 20 percent of kidney transplants worldwide. Everywhere from Latin America to the former Soviet Republics, from the Philippines to South Africa, a huge network has emerged typified by threats, coercion, intimidation, extortion, and shoddy surgeries.

Although not every black market transaction is exploitative -- demonstrating that organ sales, in and of themselves, are not the problem -- the most unsavory parts of the trade can be attributed to the fact that it is illegal. Witnessing the horror stories, many are calling on governments to crack down even more severely. Unfortunately, prohibition drives up black-market profits, turns the market over to organized crime, and isolates those harmed in the trade from the normal routes of recourse.

Several years ago, transplant surgeon Nadley Hakim at St. Mary's Hospital in London pointed out that "this trade is going on anyway, why not have a controlled trade where if someone wants to donate a kidney for a particular price, that would be acceptable? If it is done safely, the donor will not suffer."

Bringing the market into the open is the best way to ensure the trade's appropriate activity. Since the stakes would be very high, market forces and social pressure would ensure that people are not intimidated or defrauded. In the United States, attitudes are not so casual as to allow gross degeneracy. Enabling a process by which consenting people engage in open transactions would mitigate the exploitation of innocent citizens and underhanded dealing by those seeking to skirt the law.

The most fundamental case for legalizing organ sales -- an appeal to civil liberty -- has proven highly controversial. Liberals like to say, "my body, my choice," and conservatives claim to favor free markets, but true self-ownership would include the right to sell one's body parts, and genuine free enterprise would imply a market in human organs. In any event, studies show that this has become a matter of life and death.

Perhaps the key to progress is more widespread exposure to the facts. In 2008, six experts took on this issue is an Oxford-style debate hosted by National Public Radio. By the end, those in the audience who favored allowing the market climbed from 44 to 60 percent.

Yet, the organ trade continues to operate in the shadows and questionable activities occur in the medical establishment under the color of law. Even today, doctors sometimes legally harvest organ tissue from dead patients without consent. Meanwhile, thousands are perishing and even more are suffering while we wait for the system to change.

The truly decent route would be to allow people to withhold or give their organs freely, especially upon death, even if in exchange for money. Thousands of lives would be saved. Once again, humanitarianism is best served by the respect for civil liberty, and yet we are deprived both, with horribly unfortunate consequences, just to maintain the pretense of state-enforced propriety.