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By Root 678 0

End Stage Renal Disease (ESRD) component of the Social Security Act. In 2006, Medicare spent almost $23 billion on ESRD, and the total cost per person, per year, was $61,164.25 The real punch: Only one-third of dialysis patients survive after five years. More specifically, a thirty-five-year-old spending nine years on dialysis will accumulate a total cost of $600,000 while a sixty-four-year-old over four years will cost $300,000. Now compare these extravagant treatment costs with the $75,000 onetime cost of the “surgeries and hospital stays of the donor and recipient, plus the first year of follow-up care (including medicine).”26 It is more cost-effective to cure than to treat, and we already have the cure. It is called a transplant.

And check out this number crunch. Virginia Postrel of The Atlantic magazine suggests transplant centers pay $25,000 or $50,000 to each living kidney donor.27 As a result, taxpayers would save billions: “Eliminating the waiting list would save taxpayers $8 billion, or $4 billion if each living donor received a lump-sum payment of $50,000.”28 To make an even starker point, Nobel Laureate economist Gary Becker and economist Julio Elías estimated that a mere payment of $15,000 per donor would eliminate the kidney shortage in the United States. These economists suggest the federal government make the payments so as to avoid any inequality in allocation.29 That, of course, would be unconstitutional.

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The bottom line is transplants are cheaper than dialysis, and since dialysis treatment is paid by Medicare’s ESRD program, it is in our interest to cut costs. Even more convincing, these monetary calculations completely ignore the benefits enjoyed by the recipient in the form of health, happiness, and quality of life. It seems like a no-brainer, but our government cannot seem to pull it off.

Success Stories Around the Globe

There is only one country in the world that has eliminated its shortage of transplant organs. Interestingly enough, it is Iran. Iran began its system of organ donation incentives in 1988 and eliminated its shortage by 1999.30 If Iranian patients are not assigned a kidney from a deceased donor or cannot find a family donor, they apply to a non-profit called Dialysis and Transplant Patients Association (Datpa). Datpa finds donors in its pool of applicants, and an independent third party evaluates them. The government pays the donors $1,200 and provides one year of limited health coverage while those that worked through Datpa receive an additional payment (from Datpa) between $2,300 and $4,500.31 Although the Iranian donor system is not fully a free market system, it does demonstrate that an organ shortage can be fixed by offering financial incentives. The United States government could learn a thing or two.

Singapore and Israel, on the other hand, use non-monetary methods of incentivizing their people to donate. Alex Tabarrok calls the program, “no give, no take.”32 If an individual “opts out” of Israel’s presumed consent system, he or she is assigned a lower priority on the transplant list should one day he or she need an organ.33 In other words, if you do not give, you do not receive. While this presumed consent program may seem potentially harmful to an individual’s autonomy, anyone can “opt out” at any time. Other countries that have adopted presumed consent have had great success in decreasing their waiting lists. Spain, for example, adopted presumed consent in 1989, and within a decade had doubled its donor number.34 Austria quadrupled its donation numbers when it adopted presumed consent.35

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Whatever Happened to Personal Autonomy?

Our government has done it again. The rules of the kidney game are wholly dictated by a governmental monopoly. As a result, you cannot determine what is best for you and your body. However, by attempting to quell organ trafficking, all the government is doing is running the black market further and further underground, making it more and more dangerous for everyone involved.

While opponents of organ trade argue that it is an exploitation