Roosevelt Institute | Cornell University

Is a Legal Market for Organ Transplants in Our Future?

By Layla HoodPublished April 6, 2014

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A recent push by renowned academics has again sparked the debate surrounding the commercialization of organ donations.
By Layla Hood, 04/06/2014                  


While 79 Americans receive organ transplants each day, 18 will die waiting for a donation with another person added to the waitlist every 10 minutes.  In January of 2014, there were over 120,990 people in the US waiting for an organ transplant.  If the same number of kidney transplants performed in 2013 and no new organ recipients are added to the waitlist, only 14% of those in need of a kidney would receive one in 2014.  Organs like the heart and the lungs must come from brain dead donors that are still on life support, but are expected to pass away. However, other organs, like kidneys and livers, can be donated safely by healthy individuals.  The National Kidney Foundation reported that of the donations made in 2013, 9,314 donations were from deceased donors, while only 4,715 came from living donors.  The drastic shortage of organ donations in America has recently sparked talks of incentivizing organ donation.

                  Nobel Prize-winner and University of Chicago economics professor Gary Becker along with Universidad del CEMA's professor of economics, Julio Elias, recently published an essay in The New York Times suggesting that the creation of a market for organs would quickly solve the organ shortage plaguing the U.S.  Given the great demand for organs, the creation of a legal market would increase supply and lead to a reduction in waitlist size, waiting time, and deaths associated with the current shortage.  In fact, the medical costs associated with wait times, such as the dialysis that kidney patients require, often far surpass the cost of the organ transplantation itself.  Therefore, an increase in supply could reduce medical costs.  Currently, Iran is the only country to have legalized living donations for kidneys.  Living donors not only receive free medical insurance but are also compensated for their organ. In the U.S., living donors are only spared the medical costs associated with transplantation.  In the first year of commercialized organ donations, living donors in Iran doubled.  Iran now no longer has a waitlist for kidneys.

                  Although organ donations are heavily regulated by the government, a black market for organs does exist.  Organs sold on the black market have been estimated to be worth, on average, $150,000 per organ.  However, the methods by which the organs are harvested and transplanted pose tremendous legal and medical risks.  Due to the illegality of the donation process, donors can be ripped off or even killed in order to harvest more of their organs.  The creation of a legal market for organ donations would not only lead to a reduction in these prices, but it would encourage safer donation practices, presumably eliminating the black market. 

There is concern that those living in poverty would sell their organs not out of their own free will, but in order to collect the monetary compensation.  The results in Iran refutes this notion by revealing that the commercialization of organs would both control the market price and lead to rapid reduction in the demand for organs, which would decrease the need for these individuals to donate.  Additionally, it is possible that these low income individuals are already desperate enough to sell their organs on the black market, subjecting themselves to much more dangerous conditions and outcomes.  While the ethical issues surrounding organ donations are heavily contested, it is clear that the creation of an organ market in the U.S. could not only increase the supply of organs, but could also lead to the destruction of the dangerous black market that exists for organs.