12/15/09 - kidney transplants

In today's excerpt - an economist writes on the demand for kidney transplants:

"The first successful kidney transplant was performed in 1954. To the layperson,  it looked rather like a miracle: someone who would surely have died of kidney failure could now live on by having a replacement organ plunked inside him. Where did this new kidney come from? The most convenient source was a fresh cadaver, the victim of an automobile accident perhaps or some other type of death that left behind healthy organs. The fact that one person's death saved the life of another only heightened the sense of the miraculous.

"But over time, transplantation became a victim of its own success. The normal supply of cadavers couldn't keep up with the demand for organs. In the United States, the rate of traffic fatalities was declining, which was great news for drivers but bad news for patients awaiting a lifesaving kidney. ... In Europe, some countries passed laws of 'presumed consent'; rather than requesting that a person donate his organs in the event of an accident, the state assumed the right to harvest his organs unless he or his family specifically opted out. But even so, there were never enough kidneys to go around.

"Fortunately, cadavers aren't the only source of organs. We are born with two kidneys but need only one to live. ... Stories abounded of one spouse giving a kidney to the other, a brother coming through for his sister, a grown woman for her aging parent, even kidneys donated between long-ago playground friends. But what if you were dying and didn't have a friend or relative willing to give you a kidney? One country, Iran, was so worried about the kidney shortage that it enacted a program many other nations would consider barbaric. It sounded like the kind of idea some economist might have dreamed up ... the Iranian government would pay people to give up a kidney, roughly $1200, with an additional sum paid by the kidney recipient.

"In the United States, meanwhile, during a 1983 congressional hearing, an enterprising doctor named Barry Jacobs described his own pay-for-organs plan. His company, International Kidney Exchange, Ltd., would bring Third World citizens to the United States, remove one of their kidneys, give them some money, and send them back home. Jacobs was savaged for even raising the idea. His most vigorous critic was a young Tennessee congressman named Al Gore, who wondered if these kidney harvestees 'might be willing to give you a cut-rate price just for the chance to see the Statue of Liberty or the Capitol or something.'

"Congress promptly passed the National Organ Transplant Act, which made it illegal 'for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation.' ...

"And what about U.S. organ-donation policy? ... There are currently 80,000 people in the United States on a waiting list for a new kidney, but only some 16,000 transplants will be performed this year. This gap grows larger every year. More than 50,000 people on the list have died over the past twenty years, with at least 13,000 more falling off the list as they became too ill to have the operation. ... This has led some people ... to call for a well-regulated market in human organs ... but this proposal has so far been greeted with widespread repugnance. ...

"Recall, meanwhile, that Iran established a similar market nearly thirty years ago. Although this market has its flaws, anyone in Iran needing a kidney transplant does not have to go on a waiting list. The demand for transplantable kidneys is being fully met."


Steven D. Levitt & Stephen J. Dubner


Superfreakonomics: Global Cooling, Patriotic Prostitutes and Why Suicide Bombers Should by Life Insurance


HarpersCollins Publishers


Copyright 2009 by Steven D. Levitt


111-112, 124-125
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