Organ Market

[Music]

eleven-year-old matthew

was diagnosed with a rare kidney

disorder at the age

of five weeks he waited more than a

decade

before he was able to get a life-saving

kidney transplant

that is 10 painful long years of

dialysis

in a childhood without tag sports

and all of the things that children love

matthew was one of the lucky ones who

was able to have an altruistic donor

but that is not the norm sadly

more than 2 000 dialysis patients will

die today

these are mothers fathers sons and

daughters

all of whom would have lived full

healthy lives

if they had been able to get a

transplant

my name is rohan pandey and today

i want to talk to you about how we can

create

a simple and efficient solution to the

organ transplant problem

before we can dive into a solution we

must first understand the current system

of organ transplantation for the

purposes of this talk

i will consider one organ in one country

kidneys in the united states a nation

whose system mirrors many around the

world

in 1984 the united states congress

passed the national organ transplant act

which among other things outlawed

compensation for organs

meaning the you cannot buy or pay for an

organ

the result of this is that the

altruistic supply of organs

runs out quite quickly

if it were me needing an organ in the

united states

i’d be very concerned because i might

die

before i get the life-saving transplant

that i need

it seems that there are some factors or

costs

that are deterring people from donating

their organs

likely the time involved when you

undergo surgery

for a donation you cannot go to work or

engage in strenuous activity

for two to three weeks to incentivize

people to donate

and to make donation more accessible for

everyone

many countries have allowed compensation

for time

and salary lost while that is an

excellent

first step the empirical data shows us

that despite these changes waiting times

for organs

can be just as long as such

it seems that there is some other factor

deterring people

from donating their organs likely the

risk involved

the risk of death for a donor during a

kidney transplant

is about 0.0003 percent

which is incredibly low that’s good news

for a lot of us who are concerned about

donating

you are 32 times more likely to die in a

car accident

nonetheless there is a risk involved

and we can compensate for it when you

compensate for the cost of time

risk and loss of an organ you can then

create

a simple solution to the organ

transplant issue

nobel prize winner gary becker and

professor julio elias

of the universidad del sema an

instructor of mine

while i studied this subject explained

in their seminal paper

that once you can put a price tag on an

organ

you can then create a legal market

structure

to buy and sell organs

i believe that if we were to create such

a market structure

we could eliminate the worldwide

shortage of organs

and save hundreds of thousands of lives

before i go any further let me be very

clear about the definition of the market

that i’m using

a market is a non-physical system that

facilitates the exchange of a good

in this case organs for a cash incentive

i know that markets have a reputation

for being exploitative

or favoring one side over another but in

reality

markets generally benefit all parties

involved

think of it like a supermarket the

owners of the supermarket

import goods and sell them to consumers

for a profit

and the buyers are happy because they

not only get to eat but they don’t have

to grow the food themselves

in the case of organs the donors are

happy

because they don’t they get to make

money and they get to save another

person’s life

the recipients are happy because they

get to live

a long and healthy life

when you when you introduce a market

system

you increase the altruistic supply of

organs

because people now have a monetary

incentive to give

in the current system the recipient pays

for the cost of the surgery

which covers the cost of time for the

for the physicians

the instrumentation used facilities

medications

in a market system they would also have

to cover the cost

of the organ which in the case of a

kidney

is estimated to be about 15 000 us

dollars

making the total cost of a transplant

surgery about a hundred and seventy five

thousand dollars

the extra cost in a market system would

go

to the donor as an incentive to give

their organs

creating an incentive for donors is

quite important

because when we increase the altruistic

supply of organs

we also decrease waiting times which is

incredibly beneficial in many ways

first of all because dialysis is not a

sustainable solution

the unemployment rate for dialysis

patients

is about 80 percent and it costs around

80 000

a year for three to five years on

average

this total cost is much greater than the

total cost of a transplant

even with the market system the money

saved here

would benefit everyone because more

often than not

it is the government that is footing the

cost of transplants

or of dialysis through medicare or

medicaid

in 2016 for example the us government

spent more than 35 billion dollars on

dialysis treatment

this money could have gone towards

education

health care reform prison reform and

mental health programs

with the ongoing coven 19 pandemic the

situation in organ transplantation

is more dire than ever when the pandemic

hit

many countries curtailed their

transplant programs this recess

in organ transplantations has resulted

in waiting times for organs getting much

longer

as people are added to the end of the

list without many people

being removed from the front

additionally

many physicians are finding that covid19

causes long-term heart lung

liver and kidney deficits in patients

the people who survive this pandemic

will likely be added to the already

lengthy transplant lists

in the future meaning that this is an

issue

that we need to act on now

at this point i’m sure some of you have

realized that despite the economic and

social benefits of this idea

there is really only one reason why it

hasn’t been implemented yet

moral repugnance and look i get it

selling your organs doesn’t sound great

on paper

however professor elias found that

people were 20

more receptive of the market system when

they received

educational material on the subject

that’s incredibly significant because

people are generally very hesitant to

accept any form of repugnant transaction

what that also tells us is that if we

present

people with a simple safe

and non-exploitative system they will be

willing to consider it

and a lot of their fears are probably

caused by the worldwide black market

every year thousands of people

are abducted and coerced and have their

organs taken from them

young men and women in one case in india

a four-year-old girl whose parents found

that she was missing a kidney after an

unrelated surgery

the worldwide black market is estimated

to generate between 840 million

and 1.7 billion dollars in revenue

that is a lot of illegal transplants

the good news is is that a legal market

structure

would likely eliminate our reliance on a

black market

a study from the who found that black

market organs

are likely much more expensive than

legal market organs would be

additionally a black market thrives

on the concept of scarcity or the lack

of something

a legal market structure removes the

scarcity of organs by increasing the

altruistic supply

making a black market obsolete and our

cities

streets and societies safer

still i’m sure some of you are skeptical

of how we could implement this idea

in the real world well there is one

country in the world

with the system even remotely similar to

this

iran in iran donors and recipients

can meet and the donors receive

compensation

for their organs but the system is not

standardized

and it’s not regulated study after study

has found

that despite iran’s poor corruption

index

the country’s transplant system is safe

and deters trafficking and exploitation

another study found that in the country

access to organs across economic groups

is equal what that tells us

is that if we were to create a more

regulated and a more standardized

version

of the iranian model we can create a

fair

and open transplant system for everyone

i will admit even if we create the

safest system possible

with the best laws and the best

lawmakers the best enforcement

there will still be people trying to

exploit the system

the question we need to ask ourselves is

whether or not that is worth

the immense human social and economic

cost we face

and to me the benefits of the market

system

greatly outweigh the risks i believe

that we can create

a transplant system for everyone and

that it begins

with education that is why i’m here

giving this talk today

the more people who understand the

benefits of this idea today

the more likely it is that the lawmakers

physicians and politicians of tomorrow

will work to implement it in the future

together we can create a system around

fairness

and access to life

to finish today i want you to imagine

that you yourself need an organ

maybe it’s a kidney a liver a lung

maybe even a heart without this organ

you won’t live for long the days you

have left

will be painful you have two

options you could add your name to the

transplant list

wait for half a decade or more in pain

pay hundreds of thousands of dollars in

treatments

that may or may not bring you much

benefit and in the end

you might still die waiting

on the other hand you could pay a

fraction of the money

that you were paying for treatment

receive the organs in a few weeks

and live a long healthy pain-free life

the choice is ours thank you very much