Putting a price on living organ donations

A Chicago economist says the organ shortage is not a medical problem but a public policy issue, and doctors won't make the final decision.

By Andis Robeznieks, amednews staff. June 16, 2003.

The subject of paying living organ donors appears to be one of the slipperiest of "slippery slope" issues, but a Nobel Prize-winning economist not only endorses the practice, he's come up with some prices.

Saying that "economists are always answering unanswerable questions," University of Chicago professor Gary Becker, PhD, calculates that private insurers or the government should pay living donors $15,000 for a kidney and $32,000 for a piece of liver.

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At little expense, he said, this could end black-market deals while reducing waiting times and deaths.

Dr. Becker, who was recognized "for having extended the domain of microeconomic analysis to a wide range of human behavior and interaction" when he won the 1992 Nobel Prize, factored in lost earnings, donor health risks multiplied by the "value of a life," and the going rate for such transactions in India and Iran, where cadaver transplants are illegal. For the calculation, Dr. Becker placed the value of life at $3 million, and the risk of a living donor dying during organ removal as one in 1,000 for a kidney and one in 300 for liver.

Dr. Becker thinks the United States will eventually pay living donors, but that paying families for cadaver organs will come first. He said radical change is inevitable once people realize the current system doesn't work.

"It's not a medical problem, it's an economic and ethical problem," he said. "We can get more organs, but are we willing to take the necessary steps to do it?"

Each day, 17 people in the United States die waiting for an organ.

Dr. Becker gave a presentation last month in Chicago. Francis L. Delmonico, MD, a professor of surgery at Harvard Medical School, Boston, offered the rebuttal.

Dr. Delmonico noted a recent study indicating people in India who sell organs continue to live in poverty and experience declining health.

"The poor remain poor, but with one less kidney," Dr. Delmonico said, adding that paying for organs would change a physician from a healer to an "enabler in a business transaction."

But with 17 people in the United States dying each day while waiting for an organ, Dr. Becker said, doctors will have limited say. "It's ultimately a public policy issue which transplant surgeons will have input on, but they're not going to be the ones making the major decisions."