Rutgers University Policy Advisor for Governor DeSantis Analysis Suppose you are a policy advisor for Governor DeSantis. He has just informed you that his

Rutgers University Policy Advisor for Governor DeSantis Analysis Suppose you are a policy advisor for Governor DeSantis. He has just informed you that his constituents would like him to comment on the state of organ donation and address the inability of the current system to meet demand. His office is in charge of finding solutions to the difficult issue of organ trade.

He will be addressing the issue in the upcoming commission meeting and needs an economic analysis of the situation completed before then for review. Refer to the articles Black Market Bodies and Meat Market (posted below) to help you begin to your analysis. Use the articles and other references you may find to evaluate the limitations that exist with the current ‘solution’ to meeting organ demand in the US.

The governor asks that you draw upon your critical thinking and problem-solving skills in order to break down the complex problem that exists in the market for organs and help him examine, propose, and support potential solutions. You are encouraged to propose an original solution or contribution even if it deviates from mainstream solutions.

In your analysis you must include the following 6 Sections:

Current State of the Kidney Market in the U.S.: What is the current state of kidney donation in the US according to the first article? Describe this market using supply and demand; reference your graph in your description. Include “graph 1” of this market at the end of the paper (not included in page count).
Deregulation of the Kidney Market: Consider what would happen if the US did allow payment for kidney donation [if there is payment involved, can we still call it “donation?”]. Describe the deregulated market (no government intervention, free market system) using supply and demand; reference your graph in your description. Include “graph 2” of the deregulated market at the end of the paper (not included in page count).
Equity and Efficiency in the Kidney Market: Who gains and who loses in the current state of the kidney market. Who gains and who loses in a deregulated market? Discuss the economic efficiency of the market in its current state and after deregulation; reference your graphs 1 and 2 in your discussion.
Donation Systems Around the World: Explore the policies that are currently implemented across the globe (i.e. those discussed in the articles – routine removal, presumed consent, organ donor points, “no give, no take”, etc.). Evaluate the limitations of these policies. Also consider how these policies fare in terms of the efficiency vs. equity debate. (You do not need to critique them all, just select 2 or 3 that you find interesting/appealing.)
New Policy Proposal: Come up with a policy proposal of your own that might help deal with the vast shortage of kidneys in the US. Use a supply/demand diagram to show how the policy will decrease the current shortage of kidneys and analyze the impact to society; reference your graph in your description. Include “graph 3” of the market with your new policy changes at the end of the paper (not included in page count).
Recommendations: If you had to pick from one of the policies you described (current state of the market, deregulation, other policies, or your own proposal), which would you recommend for the US? Why? You must defend the policy you choose. If you recommend no changes to the current policy you must defend this recommendation.

Keep in mind, Governor DeSantis is not one for 1,000 page policy briefs. He prefers his analysis to be professional, clear, complete, correct, and most importantly concise. His constituents also require credible sources so be sure to document all references, including but not limited to those listed below. THE WALL STREET JOURNAL. | LIFE & STYLE
THE SATURDAY ESSAY | JANUARY 8, 2010
The Meat Market In a race to prevent thousands of needless deaths
a year, countries from Singapore to Israel are launching innovative new programs
to boost organ donation. Alex Tabarrok on paying donors for kidneys, favoritism
on waiting lists and the shifting line between life and death.
By ALEX TABARROK
Harvesting human organs for sale! The idea suggests the lurid world of horror movies and 19thcentury grave robbers. Yet right now, Singapore is preparing to pay donors as much as 50,000
Singapore dollars (almost US$36,000) for their organs. Iran has eliminated waiting lists for
kidneys entirely by paying its citizens to donate. Israel is implementing a “no give, no take”
system that puts people who opt out of the donor system at the bottom of the transplant waiting
list should they ever need an organ.
Millions of people suffer from kidney disease, but in 2007 there were just 64,606 kidneytransplant operations in the entire world. In the U.S. alone, 83,000 people wait on the official
kidney-transplant list. But just 16,500 people received a kidney transplant in 2008, while almost
5,000 died waiting for one.
To combat yet another shortfall,
some American doctors are routinely
removing pieces of tissue from
deceased patients for transplant
without their, or their families’, prior
consent. And the practice is perfectly
legal. In a number of U.S. states,
medical examiners conducting
autopsies may and do harvest
corneas with little or no family
notification. (By the time of autopsy,
it is too late to harvest organs such as
kidneys.) Few people know about
routine removal statutes and perhaps
because of this, these laws have effectively increased cornea transplants.
Routine removal is perhaps the most extreme response to the devastating shortage of organs
world-wide. That shortage is leading some countries to try unusual new methods to increase
donation. Innovation has occurred in the U.S. as well, but progress has been slow and not
without cost or controversy.
Photo illustration by Mick Coulas, photos: Alamy (heart), Photo Researchers (lung, kidney)
* 3,363; Americans who died waiting for a kidney transplant, January to October 2009
Organs can be taken from deceased donors only after they have been declared dead, but where is
the line between life and death? Philosophers have been debating the dividing line between
baldness and nonbaldness for over 2,000 years, so there is little hope that the dividing line
between life and death will ever be agreed upon. Indeed, the great paradox of deceased donation
is that we must draw the line between life and death precisely where we cannot be sure of the
answer, because the line must lie where the donor is dead but the donor’s organs are not.
In 1968 the Journal of the American Medical Association published its criteria for brain death.
But reduced crime and better automobile safety have led to fewer potential brain-dead donors
than in the past. Now, greater attention is being given to donation after cardiac death: no heart
beat for two to five minutes (protocols differ) after the heart stops beating spontaneously. Both
standards are controversial—the surgeon who performed the first heart transplant from a braindead donor in 1968 was threatened with prosecution, as have been some surgeons using donation
after cardiac death. Despite the controversy, donation after cardiac death more than tripled
between 2002 and 2006, when it accounted for about 8% of all deceased donors nationwide. In
some regions, that figure is up to 20%.
The shortage of organs has increased the use of so-called expanded-criteria organs, or organs that
used to be considered unsuitable for transplant. Kidneys donated from people over the age of 60
or from people who had various medical problems are more likely to fail than organs from
younger, healthier donors, but they are now being used under the pressure. At the University of
Maryland’s School of Medicine five patients recently received transplants of kidneys that had
either cancerous or benign tumors removed from them. Why would anyone risk cancer? Head
surgeon Dr. Michael Phelan explained, “the ongoing shortage of organs from deceased donors,
and the high risk of dying while waiting for a transplant, prompted five donors and recipients to
push ahead with surgery.” Expanded-criteria organs are a useful response to the shortage, but
their use also means that the shortage is even worse than it appears because as the waiting list
lengthens, the quality of transplants is falling.
Routine removal has been used for corneas but is unlikely to ever become standard for kidneys,
livers or lungs. Nevertheless more countries are moving toward presumed consent. Under that
standard, everyone is considered to be a potential organ donor unless they have affirmatively
opted out, say, by signing a non-organ-donor card. Presumed consent is common in Europe and
appears to raise donation rates modestly, especially when combined, as it is in Spain, with
readily available transplant coordinators, trained organ-procurement specialists, round-the-clock
laboratory facilities and other investments in transplant infrastructure.
The British Medical Association has called for a presumed consent system in the U.K., and
Wales plans to move to such a system this year. India is also beginning a presumed consent
program that will start this year with corneas and later expand to other organs. Presumed consent
has less support in the U.S. but experiments at the state level would make for a useful test.
Rabbis selling organs in New Jersey? Organ sales from poor Indian, Thai and Philippine donors?
Transplant tourism? It’s all part of the growing black market in transplants. Already, the black
market may account for 5% to 10% of transplants world-wide. If organ sales are voluntary, it’s
hard to fault either the buyer or the seller. But as long as the market remains underground the
donors may not receive adequate postoperative care, and that puts a black mark on all proposals
to legalize financial compensation.
Only one country, Iran, has eliminated the shortage of transplant organs—and only Iran has a
working and legal payment system for organ donation. In this system, organs are not bought and
sold at the bazaar. Patients who cannot be assigned a kidney from a deceased donor and who
cannot find a related living donor may apply to the nonprofit, volunteer-run Dialysis and
Transplant Patients Association (Datpa). Datpa identifies potential donors from a pool of
applicants. Those donors are medically evaluated by transplant physicians, who have no
connection to Datpa, in just the same way as are uncompensated donors. The government pays
donors $1,200 and provides one year of limited health-insurance coverage. In addition, working
through Datpa, kidney recipients pay donors between $2,300 and $4,500. Charitable
organizations provide remuneration to donors for recipients who cannot afford to pay, thus
demonstrating that Iran has something to teach the world about charity as well as about markets.
The Iranian system and the black market demonstrate one important fact: The organ shortage can
be solved by paying living donors. The Iranian system began in 1988 and eliminated the shortage
of kidneys by 1999. Writing in the Journal of Economic Perspectives in 2007, Nobel Laureate
economist Gary Becker and Julio Elias estimated that a payment of $15,000 for living donors
would alleviate the shortage of kidneys in the U.S. Payment could be made by the federal
government to avoid any hint of inequality in kidney allocation. Moreover, this proposal would
save the government money since even with a significant payment, transplant is cheaper than the
dialysis that is now paid for by Medicare’s End Stage Renal Disease program.
In March 2009 Singapore legalized a government plan for paying organ donors. Although it’s not
clear yet when this will be implemented, the amounts being discussed for payment, around
$50,000, suggest the possibility of a significant donor incentive. So far, the U.S. has lagged other
countries in addressing the shortage, but last year, Sen. Arlen Specter circulated a draft bill that
would allow U.S. government entities to test compensation programs for organ donation. These
programs would only offer noncash compensation such as funeral expenses for deceased donors
and health and life insurance or tax credits for living donors.
Bloomberg News
Source: Organ Procurement and
Transplantation Network
World-wide we will soon harvest more
kidneys from living donors than from
deceased donors. In one sense, this is a
great success—the body can function
perfectly well with one kidney so with
proper care, kidney donation is a low-risk
procedure. In another sense, it’s an ugly
failure. Why must we harvest kidneys
from the living, when kidneys that could save lives are routinely being buried and burned? A
payment of funeral expenses for the gift of life or a discount on driver’s license fees for those
who sign their organ donor card could increase the supply of organs from deceased donors,
saving lives and also alleviating some of the necessity for living donors.
Two countries, Singapore and Israel, have pioneered nonmonetary incentives systems for
potential organ donors. In Singapore anyone may opt out of its presumed consent system.
However, those who opt out are assigned a lower priority on the transplant waiting list should
they one day need an organ, a system I have called “no give, no take.”
Many people find the idea of paying for organs repugnant but they do accept the ethical
foundation of no give, no take—that those who are willing to give should be the first to receive.
In addition to satisfying ethical constraints, no give, no take increases the incentive to sign one’s
organ donor card thereby reducing the shortage. In the U.S., Lifesharers.org, a nonprofit network
of potential organ donors (for which I am an adviser), is working to implement a similar system.
In Israel a more flexible version of no give, no take will be phased into place beginning this year.
In the Israeli system, people who sign their organ donor cards are given points pushing them up
the transplant list should they one day need a transplant. Points will also be given to transplant
candidates whose first-degree relatives have signed their organ donor cards or whose first-degree
relatives were organ donors. In the case of kidneys, for example, two points (on a 0- to 18-point
scale) will be given if the candidate had three or more years previous to being listed signed their
organ card. One point will be given if a first-degree relative has signed and 3.5 points if a firstdegree relative has previously donated an organ.
The world-wide shortage of organs is going to get worse before it gets better, but we do have
options. Presumed consent, financial compensation for living and deceased donors and point
systems would all increase the supply of transplant organs. Too many people have died already
but pressure is mounting for innovation that will save lives.
—Alex Tabarrok is a professor of economics at George Mason University and director of
research for the Independent Institute.
Correction & Amplification
Surgeons from the University of Maryland’s School of Medicine have performed five transplants
using kidneys that had either cancerous or benign tumors removed from them. Also, Singapore is
preparing to pay donors as much as 50,000 Singapore dollars (almost US$36,000) for their
organs. A previous version of this article incorrectly said that five patients received transplants of
kidneys that had cancerous masses, and failed to note that the 50,000 figure was in Singapore,
not U.S., dollars.
Copyright 2009 Dow Jones & Company, Inc. All Rights Reserved

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