Sunday, March 18, 2007

Organ Transplantation: How to Bankrupt the Medical System

Perhaps one of the most amazing things that we have accomplished in modern medicine is being able to remove an organ from a living or recently deceased human being and put it into another human being while allowing it to retain its essential level of function. Organ transplantation is a tribute to the genius of many hardworking men and women whose understanding of human anatomy, physiology, and function is so vast, that they have managed to save countless lives from the supposedly inevitable conclusion of poor lifestyle choices, infectious disease, or congenital defect. However, there is a dark side. I feel that I would be remiss if I didn't talk about the economic consequences of organ transplantation.

In the US, kidney transplantation costs about $100,000. Heart Transplantation can approach close to $1,000,000. These are astronomical costs. Also, many people with fatal conditions sit in highly expensive ICUs in sedated or non-functional states only to have no organs emerge in time and die after using huge amounts of resources. Waiting lists continue to grow, and donation is relatively flat.

I guess the first question that should be asked is, "How can we procure enough organs from donors in order to prevent these long ICU stays?" I think that the answer is simple. Let people pay for organs. Far from the astronomical prices that often come up on the black market, I'll bet that you could solve the entire organ shortage by letting people cover the funeral costs of an already deceased individual in exchange for their organs. In the face of the costs that I mentioned before, this would barely be a blip on the economic radar. It would also overturn this bizarre notion that because organ transplantation saves lives, we should ignore all economic laws of supply and demand when trying to procure organs. Anyone with a decent high school education who has seen a supply and demand curve can tell you that a shortage of a product on the market is probably the result of the price being set too low (in this case $0). At higher prices, there would be more donors.

Now, on the flip side of this, what would all of these donations cost? Because of the socialized and cost spreading nature of modern medicine, these costs would be directly (or indirectly) born by everyone. We'll start with kidneys. I recall reading that there are about 90,000 on the renal transplant waiting list. At ~$100,000 a pop, this would be a cost of about $9 billion in renal transplants alone, neglecting the cost of rejection, medication, lifelong immunosuppression, future hospitalizations, and the cost of training enough extra surgeons to cover 90,000 transplants. An ever aging population would insure that a steady supply of need would follow, and that the list would grow again in no time, causing a steady need for the expenditure. I realize that there would be savings in dialysis costs, but the longer life expectancy of the patients with the transplanted organs may offset those savings with increased need for medical care. Now, apply this to everything from cornea transplants to heart transplants, and the costs will easily soar. If we gave a conservative estimate of close to $50 billion for ALL additional organ transplants, while still ignoring the costs that come afterward, we will increase, almost perpetually, total costs by an amount that is equivalent to almost 2% of the ENTIRE FEDERAL BUDGET. It would be a MUCH HIGHER percentage of medical expenditure going to relatively few people at very high cost per person.

Now, I am not opposed to organ transplants. I believe that people should be able to pay for them like anything else. I believe that people should be able to get insurance to cover them like anything else, though I have no problem with different policies for those who want to be covered and those who don't want to pay the price of the expensive risk coverage. However, we shouldn't turn a blind eye to how the world of unreciprocated giving that so many see is the ideal is the reason for our shortages. We also shouldn't be afraid to point out that within the current system, the shortages are the only reason that we haven't gone bankrupt.


Anonymous Anonymous said...

Your most myopic post yet. You could have saved a lot of words and just said ORGANS FOR THE RICH. Your proposal would mean that instead of organs going to those in who are in the greatest need and most able to utilize the organs that we would give organs to the richest sick people.

Markets don't work for everything. It's a nice simplistic fantasy, much like communism (or collectivism if you like), but markets fail, are inefficient or incomplete, and lead to negative outcomes in many areas of culture.

We need more organs this is certain, but your proposal has as many, if not more, problems as it replaces.

Try again. You're clearly very smart, now let go of your market religion, or at least mix it with a bit of pragmatism.

6:01 PM  
Blogger MiamiMed said...

Are you going to pay for all of the transplants? I believe that I am being quite pragmatic. When there are shortages of something, it is usually too low on the supply and demand curve. This is basic high school economics. At the price of free, there are simply not enough. Your response to me starts with the ususal mindless liberal religious chant of "if it helps rich people, it must be bad." That is impractical.

You see, in the US, where we still have a measure of free market capitalism, 90% of millionaires are self-made (millionaire next door is a good reference). Unlike our socialist neighbors, where wealth is usually inherited in a social hierarchy, most wealthy americans actually EARN their wealth. It is no accident that countries with large centralized power bases that work "for the people" also deal with an aristocratic upper class giving handouts to the lower class. Wealth is largely redistributed by the government.

In the US, individuals with money, by and large, are more productive. In a capitalist economy, those that do the best job of giving society what it wants get the most money. If they then have more resources to use in the procurement of life saving treatments, so be it. They can use their money on whatever they want.

Your post is based on the dogma that we are all entitled to medical care. I don't believe this. Period. I am very chariable, but nothing I choose to give is the entitlement of the person who receives it. Period.

What I did here is attempt to explain the market forces at work in the current system, and how they interact with the economy at large. You are more than welcome to reply with something tangible that rebuts what I said. If not, perhaps you might reconsider your own point of view, unless you find the truth offensive.

12:57 PM  
Anonymous Anonymous said...

I love how ORGANS FOR THE RICH was put in capital letters. Maybe you could try replacing it with something like HERETIC. Or better yet, respond to a post about why rich people are more likely to drive ferraris, and respond with FERRARIS FOR THE RICH, as if this is some damning statement. Yes, rich people have more stuff. This is the definition of rich. It can be money, cars, or organs. They will always have more stuff. I think what the author is trying to point out is that the American health care system is somehow making organs "holy" when they are in fact simple commodities like anything else.

1:48 PM  
Blogger Cristy at Living Donor 101 said...

I guess the first question that should be asked is, "How can we procure enough organs from donors in order to prevent these long ICU stays?"

In my opinion, there's the flaw in your argument. The first question should be "how can we reduce the demand for donor organs?"

From an economic standpoint, if we encouraged people to maintain healthier lifestyles, health care costs would go down, and insurance premiums would be reduced.

However, private for-profit insurance companies don't think that way. They won't pay for gym memberships or weight loss programs (hell, some won't even pay for birth control pills that have medical benefits but they will pay for Viagra!). They won't pay for breast cancer gene screening because they'd rather take the chance a woman won't get cancer, or if she does, the treatment they'll pay for will be less than the screening and perhaps subseqent preventative masectomy.

Here's the other problem - your 'solution' assumes there are no or minimal risks to living donors, and that simply isn't true. There is NO comprehensive, long-term data about LDs health and well-being. Even the UofMinnesota study recently published contains severe limitations, least of which was the strict criteria used to select the LDs in the study. This criteria has been expanded to, ironically, increase the number of donor organs available. As a result, these LDs are at risk for many long-term complications and issues including bleeding, blood clots, hernias, reduced adrenal gland function, hypertension, chronic fatigue, testicular swelling, and severely reduced kidney function.

Some donors have found themselves on the other side of the equation, as would-be recipients themselves.

Educate yourself about the REAL risks, benefits and costs of living donors -

9:12 PM  
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