Sarah Murnaghan, the 10-year-old Pennsylvania girl with cystic fibrosis in need of a lung transplant, is getting the new lungs she needs in a procedure today.
But the organ shortage that kept her waiting could be eliminated through better public policy.
The Murnaghan case was ultimately a controversy over the rules for allocating organs. Without enough lungs to go around, the government must make rules about who gets the limited supply about available ones. Children like Murnaghan are required to wait for other child lungs, on the grounds that child-to-child transplants are more likely to be successful.
There were no child available, so Murnaghan’s family appealed to public officials, including Health and Human Services Secretary Kathleen Sebelius, to bend the rules and let her receive an adult lung transplant. Sebelius declined to intervene, but Fox News reports that the lungs Murnaghan is getting came from an adult.
The reason Murnaghan had to wait at all is that public policies do not maximise the availability of transplant organs:
- A 1984 law prohibits providing financial compensation to organ donors, living or dead. Price controls reduce supply, and price ceilings of $0 especially reduce supply.
- Organs can only be taken for donation from the dead bodies of people who agreed, in advance, to be donors.
There are huge costs to these supply restrictions. Over 100,000 Americans are waiting for organs that are unavailable. Over 6,000 Americans die every year while waiting for organs.
People who need kidneys (by far the most commonly transplanted organ) now typically have to wait five years for a transplant, up from less than a year in 1980, according to Arthur Matas of the University of Pennsylvania. While waiting, they must continually undergo dialysis treatment, which reduces quality of life and is expensive (and often paid for by taxpayers).
Allowing payment would increase the supply of organs available, just as it does now for blood plasma, which can legally be bought and sold.
Other countries, such as Singapore, have a system of “presumed consent” where all people are organ donors unless they affirmatively choose to opt out. This also increases the supply of donor organs.
People are morally squeamish about the idea of paying for organs. They fear that a legal market in organs would exploit the poor and only benefit people wealthy enough to pay market prices. A well-designed market should overcome these concerns.
One such option is a proposal from Matas. Under his plan for kidneys, organs would not be traded person-to-person; insurance companies or the government would set prices and buy them like any other medical supply. Combined with a system of universal coverage, this would ensure that transplanted organs would not be a luxury for the rich.
It is highly likely that live organ sellers would tend to be poor. But the prognosis for donors giving in the legal market is good: A mortality rate of just 0.03% for kidney donations. That is still a risk, but people make all sorts of life choices that entail added risk for added money, including entering dangerous occupations; legal organ sales would simply make one more such option available.
Our system also places too much weight on people’s desire for bodily integrity after death and not enough on the fact that people are dying because organs are unavailable. Following Singapore’s lead on presumed consent would make more organs available while still preserving the option for people who care a great deal about not donating to opt out.
We’re all hoping that Murnaghan’s surgery today is successful. But we should also demand policy changes so that other people like her are not unnecessarily kept waiting for the organs they need.
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