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