Rad Geek People's Daily

Good. I hope so. If so, then thank goodness. I can only hope that this opens the door for more radical changes. The organ transplant control monopoly poses as a humane medical system but in fact it is a cruel, strangling vine that has wrapped itself around life-saving medicine and produced a system of utterly needless delay, protracted misery, and daily needless death. May it burn to the ground and never rise again. There are some political issues, the Bruce Banner issues in our political life, that I am just always angry about — not just concerned or committed, but actually really angry about, constantly, and genuinely angry with the people and systems that uphold them. This is one of them. Here’s why:

If successful, the proposal would leave little unaffected in the sprawling, multibillion-dollar network that sends kidneys, livers and other organs from deceased donors to severely ill recipients. That system has long been criticized as inadequate: Nearly 104,000 people are on waiting lists for organs, most of them kidneys; 22 people die each day awaiting transplants, with poor and minority patients generally faring worse than affluent and White people.

— Lenny Bernstein, Troubled U.S. organ transplant system targeted for overhaul
Washington Post, 22 March 2023.

I can only hope that this opening will be allowed to pass, and that after it passes the opening up of competitive bids will allow for some space for innovation, accountability and improvement within the system. Any improvement over the appalling public-private status quo will save lives. But ultimately the problem is not with United Network for Organ Sharing’s monopolistic position. The problem is with the Health Resources and Services Administration itself, which made the monopoly possible, and with the National Organ Transplant Act that controls this inhuman, stifling system of controls against the availability of willing organ donations.

Under UNOS, which holds a $6.5 million annual contract with HRSA, the network has been plagued by problems: Too many organs are discarded, damaged in transit or simply not collected, faulty technology sometimes jeopardizes transplants, and poor performers face little accountability.

. . . One major obstacle to the plan is that UNOS’s grip on the network is virtually written into the 1984 National Organ Transplant Act. It established the network to be run by a nonprofit that would function as a quasi-governmental agency under a single contract — with UNOS in mind. And although UNOS is a contractor with the federal government, it considers the technology that undergirds the nation’s transplant system its own.

. . . Johnson said she will ask Congress to amend that law and raise the cap on what it can spend on contractors. But she also asserted that she has the legal authority to move forward if Congress does not act. Bid solicitations could go out as soon as this fall, she said.

— Lenny Bernstein, Troubled U.S. organ transplant system targeted for overhaul
Washington Post, 22 March 2023.

In reality, easing up on the existing system of controls will help people in need of transplants, and that will save lives, and that is good if it happens. But whatever the politics may be, there is no policy solution to this problem — no available solution to the constant crisis of organ availability — except for a radical, order-of-magnitude increase in the number of organs available for transplant.

And there is a simple, consensual, and effective way to find far more willing donors — a way that is already practiced in a real-world market in a large country without any noticeably catastrophic results — which is simply to make it legal to pay them openly (or to pay their families, in the case of posthumous donations).

There’s no reason you couldn’t do this; there’s no good reason you shouldn’t do it. Mainstream political debate about the issue still amounts to little more than blank stares of incomprehension, or by unmoored bioconservative meandering about the importance to human dignity of disregarding actual human beings’ deliberate choices about their bodies, or by purely speculative fantasies and fear-mongering about possible socioeconomic dynamics or structural outcomes.^[1] It is appalling, and it is utterly needless. There is another, better way, and it is maddening that this is so rarely even brought up for consideration, that even most of those who bring it up with the most humane and intelligent and urgent of reasons to consider the change still feel that they must bring it up only when hedged around with all kinds of timid qualifications and halfway-house measures limiting the extent of open buying and selling, in the hopes that this might do at least a little bit of what open and unrestricted market exchange would do far more simply and fully. The current system kills people — slowly tortures people to death — every single day. It is not just wrong, but insane and obscene. Let us consider another, better way.

1. ^[1]Never mind the actual, observed socioeconomic dynamics and structural outcomes of a system that chronically under-supplies the need for transplant organs, that inevitably resorts to strict rationing and endless queues, that utterly predictably leaves people slowly dying on dialysis every day, and that utterly predictably happens to be far more likely to do that to poor, minority and socially marginalized patients than it is to the affluent and privileged.↩