Free-market system not way to distribute rare donor organs

March 11, 1998|By Ellen Goodman

BOSTON -- At least it isn't China. In that benighted country, prisoners are subject to both the worst of the old totalitarian ways and the crudest of capitalism.

On the one hand, you can still get executed in China for your political beliefs. On the other hand, you can then have your organs sold in the marketplace to the highest bidders.

In China, prison authorities actually prep pre-executed bodies to save the parts, and doctors stand by to reap the remains. It's even reported that prisoners with prime organs and ready customers get bumped to the front of the execution line.

But in Missouri, they aren't talking about postmortem sales figures. They are, however, considering a proposal to make death-row prisoners an offer they can't refuse.

Under a bill just filed in the state Legislature, an inmate sentenced to death would be offered the option of giving up his kidney or bone marrow. For the price of a body part, he could have capital punishment commuted to life without parole.

This prompts Boston University ethicist George Annas to come up with a cross-cultural quip: "In China, they kill you to get your organs; here, we kill you unless you give your organs." Well, not yet, but you get the idea.

The use of prisoners as spare body-part factories, or organ farms if you prefer, is the latest attempt to deal with what economists call dryly a problem of supply and demand.

A grim wait

In the United States, 57,690 people are on organ waiting lists. In 1996, one person died every three hours for want of a transplant. That's no small problem. This gap between the number of donors and the number of patients has enticed all sorts of organ entrepreneurship.

In the mid-1980s, a Virginia businessman first came up with the idea of importing poor Third World people and paying them for a kidney. This led then-Sen. Al Gore to push through a law that banned the sale of human organs and tissue.

While this law hasn't entirely blocked the market, it has blackened it. A couple of weeks ago, two Chinese people were arrested in an FBI sting in New York for trying to sell the corneas, kidneys, livers and lungs of executed prisoners.

Nevertheless, new schemes are being proposed. These include setting up a "futures market" -- paying people now who agree to have their organs used after death -- and giving money to those who agree to part with their relatives' postmortem parts.

We have been quite properly queasy about the free-market approach to the human body. Some things aren't and shouldn't be for sale -- among them an "extra" cornea or "spare" kidney.

We do let people sell blood, hair and sperm. We've paid surrogate mothers and egg "donors." But we've become increasingly uneasy, especially since a bidding war erupted in human eggs, upping the price to $5,000 for a month's supply.

We should be even more uneasy about getting lifesaving surgery mixed up with the death penalty. Even in China, there's a difference between execution for punishment and dismemberment for profit. When you can make a dollar from a liver or lung, it becomes a grisly incentive for capital punishment. Last year, the Chinese executed some 4,000 prisoners.

Missouri has just 87 prisoners on death row, and this bill offers commutation through transplantation. But do we really want justice determined by the medical marketplace?

First, the court rules an eye for an eye. Then it allows a man who killed one person to redeem himself by giving his bone marrow to another?

While we're talking about equity, under this bill, a murderer with a nice clean kidney could live. A murderer who wasn't as healthy would get the lethal injection. And if a killer could get his sentence reduced, why couldn't a burglar bargain his bone marrow for five years?

All this brings us to the bottom line, to the word donor. The system we now have depends on a value rarely heard in the marketplace: altruism.

Confronting death

It's been a long, slow, hard sell to convince people to donate their own organs and those of the people they loved. We have old and complex attitudes toward death and the human body.

Every scheme that offers dollars for "donations," every entrepreneur who brings trade-offs into the system, every incentive plan that is tinged with coercion, is likely to undermine the whole system.

This is one area in which the much-lauded free market doesn't hTC work and doesn't belong. Kidneys aren't commodities, and livers aren't objects. We need more donors -- not deal-makers.

Ellen Goodman is a syndicated columnist.

Pub Date: 3/11/98

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