delanceyplace.com 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
$1,200, 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, William Morrow,
Copyright 2009 by Steven D. Levitt & Stephen
J. Dubner, pp. 124-125.