Human Organs: Government Intervention on Domestic Trade

The national ban on the purchase of organs is one instance of the government’s encroaching intervention on trade. But data reflects that this acclaimed intervention is more of a costly imposition, leaving hundreds of thousands of Americans without access to organs. Rather than enact legislation to allow the purchase of human organs by consenting parties; the U.S. regulatory healthcare system has banned all organs from being sold. Instead, Americans rely exclusively on organ donation to fulfill the waitlist of people in need. Yet despite the initial attempt at the preclusion of market exploitation, the result of this government intervention on free market trade is a national deficit of human organs; alongside an annual waitlist of hopeful, dying recipients. Worse, a burden on taxpayers to pay the government funded dialysis for patients awaiting transplants.

The initial ban on organ sales occurred in 1984, when Congress passed the National Organ Transplant Act (NOTA) banning the payment for organs of any kind, (OPTN). The act (1) “established . . . a national registry for organ matching;” (2) decreed “the network to be operated by a private organization under federal contract;” and (3) made organ donation exclusive for any transplant, (OPTN). The National Institutes of Health (NIH) noted that “[t]he 1984 act recognised only altruism as a motivation for organ donation;” adding that “altruism alone has not increased the pool of organ donors, leading to a shift in thinking;” concluding that “[t]he ethical sea change now holds that it may be more unethical to fail to explore new ways of procuring organs and to make use of available organs than to proscribe their sale,” (NIH).

Human Dignity

The primary factor when considering the deregulation of the purchasing of human organs is the dignity of the recipient. Critics believe that allowing the sale organs on the free market would be a violation of human dignity; Zümrüt Alpinar-Şencan notes that “it must be noted that there is not only one, but many different approaches to human dignity in bioethical debates,” (PubMed). Organ transplantation is a relatively new practice, just over one century old. Organ transplantation is conducive with natural law, as God made men from dust and from one blood. In the Old Testament, it is written, “then the LORD God formed the man of dust from the ground and breathed into his nostrils the breath of life, and the man became a living creature,” (Genesis 2:7; ESV). Similarly, in the New Testament, the physician Luke wrote “[a]nd he made from one man every nation of mankind to live on all the face of the earth,” (Acts 17:26a; ESV).

Human life must bear the same reverence reserved for God, as His Holy Spirit lives within all of us. As Paul wrote in the New Testament, “Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, 20 for you were bought with a price. So glorify God in your body, (1 Corinthians 6:19-20; ESV). Paul’s words simultaneously support organ donation and rejects sacrificing the life of one patient for another.

Transplant Waiting List

The National Institutes of Health (NIH) noted in 2002, that United Network for Organ Sharing, the non-profit responsible for maintaining transplant lists; that “[c]urrently, 78 000 people are awaiting transplants and an estimated 15 000 people on transplant waiting lists die each year awaiting donor organs,” (NIH). Nearly two decades later, as of 2024, there are 104,833 “people need a lifesaving organ transplant;” while due to the lack of availability of resources, roughly 46,630 organ transplants are performed per year, (UNOS).

Notably, “[m]onetary compensation for organs in Iran has been lawful since 1988, and in the ensuing decade, Iran eliminated the entire backlog of kidney transplant patients, something no other nation has achieved,” (Miller, R., p. 55). Iran offers organ donors “from the government $1350 plus a year of fully paid health insurance and a payment of $4,000–$5,000 from the recipient (or a charity, if the recipient is poor),” (Miller, R., p. 55). Conversely, America’s organ donation system relies exclusively on altruism, leaving many citizens desperately waiting.

Increased Demand

Since the first successful organ transplant there has been an increasing demand for access to organs. Yet the solution has been limited to attaining organs by donation, as “since 1984, it has been against federal law to pay for human organs,” (Miller, R., p. 53). Roger Miller writes the cost is 8,000 deaths annually, as people “[wait] in vain for someone to donate an organ to them,” (Miller, R., p. 53). Roger Miller notes that dialysis patients would benefit from access to organs, allowing for “longer lives, because life expectancy on dialysis is lower than life expectancy with a donor organ,” (Miller, R., p. 57). Additionally, patients would no longer require to be attached to machines “for up to twenty-four hours a week,” (Miller, R., p. 57). Conclusively, “the savings to taxpayers exceed the extra private insurer costs,” thus the majority of Americans benefit from the deregulation of organ purchases. Legislators are increasingly pressured to expand eligibility The Uniform Anatomical Gift Act, “[o]riginally enacted in 1968,” is “an update of the 1987 uniform act addressing changes in federal law and regulation and related developments in the field of organ donation,” (LII; UniformLaws). The act was further revised in 2006, “expand[ing] the list of persons who can consent to organ donation on behalf of an individual,” (LII).

There remains an observable consistent public demand for expanding access to organs for patients in need. Worse, comatose individuals with low odds of survival—previously designated as organ donors—are removed from life support due to the high demand for organs. But while the costs for organ transplants can exceed one million dollars, “[f]or a person under the age of 65 with health insurance, private insurance pays for the transplant. For anyone 65 or older, the federal Medicare system pays for the transplant,” (Miller, R., p. 53). As a result, doctors, patients, and hospitals, economically benefit from organ transplantation—the issue is access to organs. There is no reason donors should not benefit from this; insurance or government grants could pay donors for the cost of prospective organs. As a result America would match Iran’s achievement of eliminating the entire waiting list for organ transplant; opening up domestic organ sales to the international market.

The Cost of Prohibition

The United Network for Organ Sharing (UNOS) costs taxpayers $67 Million annually, with requests to Congress for a $13 Million increase by 2025, (UNOS). The UNOS stated that “[b]oth UNOS and the Modernization Initiative have the same goal: to strengthen the organ donation and transplant system to help save more lives,” (UNOS). But money alone will not save lives. Opening the sale of organs to the free market would allow for abolition of the United Network for Organ Sharing. Thus, millions of tax dollars could be better allocated to save lives, in accordance with the mission of UNOs.

Government prevention of the consensual purchasing of organs has also led to a conglomeration of regional standards, readily restructured to adhere to the norms of modern culture. The Dead Donor Rule “originally stated that organ donors must not be killed by and for organ donation,” and that “vital organs should not be procured before death,” (Link). Anne L. Dalle Ave contends that “the original rendition of the DDR banning killing by and for organ donation is the fundamental norm that should be maintained in transplantation ethics.” (Link) Critical disputes have remained persistent against organ donation. Robert Sade argued over a decade earlier that “[a]bandoning the DDR will eliminate all of the public’s and health care professionals’ confusion and misunderstanding about definitions of death and deciding when someone is dead,” (PMC). Yet doctors must place more value on all human life, and be deposed of the authority to choose specifically which life is more valuable. God is capable of producing Supernatural miracles against all worldly odds. Denying someone the right to life, due to a clinical diagnosis of “braindead” is against man’s inherent natural law.

Conclusion

In sum, revising the National Organ Transplant Act (NOTA) to include the purchase of organs by consent will open up organ sales to the free market, saving hundreds of thousands of lives. Civil government is limited, highlighting the importance of jurisdiction. The power to do something is distinct from the authority to act; thus because the government bears an ability to intervene in domestic trade, does not mean that it should. Government is not the only sphere of authority equipped to manage the organ market. The purchase of organs will further reduce the strain on organ donors, and ease the conflict of specificity surrounding the numerous controversial designations of death. The introduction of organs into the free market reduces the burden dialysis places on taxpayer, and has the potential to make organ donation waitlists obsolete.

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Bibliography

Bernat JL. (Accessed on November 24^th, 2024). Challenges to Brain Death in Revising the Uniform Determination of Death Act: The UDDA Revision Series. Neurology. 2023 Jul 4;101(1):30-37. DOI: 10.1212/WNL.0000000000207334. PMID: 37400259; PMCID: PMC10351312

Carden, L. (2024). Let’s Play God: Commodifying the Human Body. Georgia Journal of International and Comparative Law, 52(1), 157-190.

LII. (Accessed on November 24^th,2024). Uniform Anatomical Gift Act. Wex. US Law. LII / Legal Information Institute. https://www.law.cornell.edu/wex/uniform_anatomical_gift_act.

Link. (Accessed on November 24^th, 2024). The Ethical Obligation Of The Dead Donor Rule. Medicine, Health Care and Philosophy. https://link.springer.com/article/10.1007/s11019-019-09904-8

Miller, R., et al. (2017). The Economics of Public Issues, 20th Edition. [VitalSource Bookshelf 10.3.1]. Retrieved from vbk://9780134532035

NIH. (Accessed on November 24^th, 2024). United States Starts to Consider Paying Organ Donors. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC1172054/

OPTN. (Accessed on November 24^th, 2024). History and NOTA. https://optn.transplant.hrsa.gov/about/history-nota/

PMC. (Accessed on November 24^th,2024). Brain Death, Cardiac Death, And The Dead Donor Rule. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC3372912/.

PubMed. (Accessed on November 24^th, 2024). Does Organ Selling Violate Human Dignity? Monash Bioeth. Rev. 34, 189–205 (2017). https://doi.org/10.1007/s40592-017-0070-x

UniformLaws. (Accessed on November 24^th, 2024). Anatomical Gift Act. Uniform Law Commission. https://www.uniformlaws.org/committees/community-home?CommunityKey=015e18ad-4806-4dff-b011-8e1ebc0d1d0f&5f3d6ce4-bbc3-44da-ac7d-7c92de9acbfa=eyJsaWJyYXJ5ZW50cnkiOiIzODAxNWQ1YS1iY2VmLTQ5NDQtOWU0OS01NTVmZmJkMjFjMzcifQ%3D%3D.

UNOS. (Accessed on November 24^th,2024). UNOS Applauds U.S. Senate Appropriations Committee for Increasing Funding for he OPTN Modernization Initiative. UNOS. https://unos.org/media-resources/releases/unos-applauds-u-s-senate-appropriations-committee-for-increasing-funding-for-the-optn-modernization-initiative/.

UNOS. (Accessed on November 24^th,2024). UNOS Data and Transplant Statistics. Organ Donation Data. https://unos.org/data/.