Socialist and communist governments have nationalized all sorts of things: oil and gas fields, phone companies, steel mills, coal mines, airlines and farms. Now the American Medical Association, which generally does not favor collective ownership of the means of production, has proposed to go even further. It suggests nationalizing corpses.

Today, you have to agree in advance to donate your organs in case of your untimely demise. In a system of "presumed consent," by contrast, you would automatically surrender them, unless you gave specific instructions to the contrary.

"Presumed consent" is a nice euphemism for something that falls well short of real consent. It's bad enough that the government expects to live off the sweat of your brow while you are among the living, or that it insists on collecting estate taxes when you have the misfortune to die. But now it's going to extract a literal pound of flesh before allowing you the peace of the grave?

But it is not only moral and political differences that motivate his strenuous objections to the AMA's plan. There is also the matter of efficacy:

No one denies that a problem exists. Nearly 90,000 people are on waiting lists to get transplants that can mean the difference between health and sickness, and even life and death. Every year, an estimated 7,000 or more patients who need organ transplants die without getting them. Clearly, something needs to be done.

The AMA says some other countries have boosted their organ donation rates through presumed consent laws. But David Kaserman, an Auburn University economist and co-author of the book "The U.S. Organ Procurement System: A Prescription for Reform," says that while countries with such laws do get more organ donations, "all the studies agree that it is not enough to solve the problem."

Chapman also points out another important stumbling block to implementing "presumed consent" in the United States- cultural expectations:

Americans and Europeans often have drastically different sensibilities. People in this country are not likely to react positively to the ghoulish notion that the government has presumptive title to their remains.

In many places, Americans don't even like the idea of being required to make a choice about organ donation. When Virginia adopted a "mandated choice" policy, forcing people to decide whether to become organ donors, 24 percent simply refused to indicate a preference. In Texas, mandated choice was enacted -- and then repealed after a backlash that reduced the supply of organs. Some people apparently get touchy when you're trying to talk them out of their vital parts.

So what does Chapman recommend? Not surprisingly, a market-based solution:

If you want to induce people to provide something that other people want, there are basically three possible approaches. The first is to encourage them to do so out of the pure joy of helping others. That hasn't worked. The second is to take it from them, an approach that "presumed consent" uses. That probably won't be enough, either, and it has the added downside of infringing on personal autonomy. The third is to appeal to their own self-interest -- by paying them. People could sign contracts agreeing to donate any organs suitable for transplant when they die, with the money going to their heirs.

And just how much money are we talking about? According to Chapman, not enough to make very many people worth more dead than alive:

Right now, we're paying people zero to hand over their organs, and many of them are not tempted by the offer. At a modestly higher price -- Kaserman figures less than $1,000 per organ -- the number of volunteers would quickly rise to meet the demand. ... Some skeptics think organ donation is too noble a cause to leave to the market. But really, it's too important not to.

He had me up to this point. However a noble cause it may be, the potential for abuse would be so substantial and the incentives so potentially perverse, that this would need to be a very strictly regulated market, so strict in fact, that it might not really resemble anything like what we think of as a market. And as much as a market-lover as I am, I can't help but thinking this is a good thing. After all, while Americans, as Chapman asserts, rightly reject the notion of having their organs confiscated without their express permission, they would be absolutely appalled to see them for sale on E-bay or E(ye)-bay or Kidney-bay, permission or no.

My feeling is that there is no market-based solution to this problem, that there can never really be anything resembling a free-market for internal organs, no matter how sorely they are needed. Nor, I believe, can their even be a socially-acceptable quasi-market administered by organizations like the AMA, let alone a government agency. Those who would see this problem solved are going to have to rely on providing moral, rather than economic incentives. They will have to better make their appeals to the better angels of our nature, to the organ where those angels rest, our hearts, the one organ over which no state can ever rightfully lay claim.
UPDATE: Flagrant Harbour provides a chilling example of how NOT to solve the organ shortage.
health | transplant | kidney | organ donation | organ donor

See also: | Presumed consent: supply-side economics of the moribund kind | Let's put organs on the free market |

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