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Jewish World Review / Sept. 10, 1998 /19 Elul, 5758

Walter Williams

Donate or sell organs

EARLY THIS YEAR, the Clinton administration came out with new rules for organ transplant allocation: sickest patients go to the top of the waiting list.

That sounds like a caring and fair solution to the organ shortage problem, but is it really? Charles Carlstrom and Christy Rollow examine organ transplant questions in their article, "The Rationing of Transplantable Organs," appearing in the Fall 1997 Cato Journal.

During 1996, the number of people waiting for transplants versus the number of transplants supplied, respectively, were: kidneys 36,013 vs. 11,949; livers 7,467 vs. 4,058; pancreas 1,786 vs. 1,022; hearts 3,935 vs. 2,381 and lungs 2,546 vs. 844. These shortages persist despite public and private efforts to make potential organ donors and their families aware of donation options.

Transplantable organ shortages would disappear overnight if people were permitted to sell organs. You say, "Williams, people shouldn't make money selling organs!" I say, "Why not? Everybody else is making money on the deal."

Organ procurement organizations get $25,000 for just retrieving kidneys from cadavers. Transplant surgeons, hospitals and nurses profit mightily: liver transplant operations go for an average of $300,000, and that doesn't include the money earned from follow-up care. Kidney transplant operations are $100,000, plus $12,000 per year follow-up care.

If you think donation is such a great idea, how about also requiring that everybody having anything to do with organ transplantation donate their services and supplies? You say, "Williams, if we did that there'd be shortage of doctors and nurses to do transplants!" How come people can't apply that same reasoning to organs?

The fact of life is that there must be some way to decide which sick person gets an organ. One way to decide is to have a government mandate whereby the most critically ill gets first priority. That could result in waste because a not-so-critically-ill person has a greater chance of survival and a smaller chance of needing another transplant. Another way to decide is to allow the medical elite to put the rich and famous at the top of the list, as they did with Mickey Mantle, who received a liver transplant and died two months later.

Allowing the medical elite to decide who gets transplants has already created despicable arrogance. I was watching one show where a doctor refused to give a patient who smoked cigarettes a heart transplant. While it's popular right now to dump on cigarette smokers, tomorrow that same physician might refuse to give a transplant to an overweight person, a low-I.Q. person, a divorcee or whatever suits the whims of a particular hospital physician staff.

We shouldn't allow America's elite to decide who gets what in health and other areas of our lives. We wouldn't begin to tolerate somebody deciding that housing, food, cars and clothing be distributed on a first-come, first-served basis or on a who-needs-them-the-most basis? If we did, there'd be desperate shortages in housing, food, cars and clothing just as there are shortages in organs available for transplant.

There are other benefits from allowing people to sell their organs. For example, I smoke cigarettes and cigars. If I knew that my heart and lungs could become a part of my estate, I would take better care of them. But since my heirs can't monetarily gain, it makes sense for me to die with completely used up organs just like I'd try to die with a zero bank balance if Congress wouldn't allow me to bequeath money to my heirs.