A market for body parts?

The saddest aspect of Walter Payton’s death at 45 has hardly been
discussed. If there were a market in human organs rather than a federal law
prohibiting their exchange for money, it is at least possible that he would
be alive today.

To be sure, that’s not an absolute certainty. As I understand the news
accounts (and without access to detailed medical records) very shortly after
he was diagnosed with the rare liver condition primary sclerosing
cholangitis and announced that he needed a liver transplant, he was
diagnosed with liver cancer, which soon spread beyond the liver, making a
transplant untenable. But it does seem that there was a short window of
opportunity when a liver transplant could have saved his life.

If there had been a market in human organs rather than a donation system
whose keepers complain constantly of shortages as they rejigger the
allocation schemes, Walter Payton probably would have gotten a liver.
Perhaps none would have become available even in a market system, but his
chances would have been much better. Unless his will contains surprises, he
could have afforded one. And if he couldn’t have afforded one, an appeal to
Chicago Bears fans and football fans in general would have produced enough
donations to pay for one within days, if not minutes.

Would that have been unfair to people who aren’t rich or famous or widely
beloved? You could make a case. But the other side of the picture is that
the present system assures that the number of human organs available for
transplanting is far smaller than the number of patients — rich, poor,
famous, unknown, and everywhere in between — who could benefit from them.

A market in human organs would produce an occasional situation where a
rich person would jump to the head of the line or get what could be viewed
as special treatment. Social nannies would cluck. But it would also produce
an overall situation in which far more organs would be available than are
available now. That would improve the odds for those who aren’t rich. It
would mean a lot fewer people would die while waiting for a transplantable
organ to become available.

It could also make things somewhat less trying for people with grave or
terminal illnesses. A person dying of lung disease, for example, but who
still had a healthy heart or liver or kidney could make arrangements in
advance to sell those organs. The proceeds could be part of his or her
estate, or perhaps applied to final medical bills. Knowing that one’s
relatives and heirs wouldn’t be burdened by bills or might even have a
little nestegg after one was gone wouldn’t relieve all of the pains of
terminal illness and death, of course, but it might help a bit.

There would be potential pitfalls in such a system, of course. You
wouldn’t want doctors or relatives hastening a death so somebody could cash
in on the body parts. But while that might happen from time to time, it
shouldn’t be that tough to develop protocols and enforceable contracts that
would make such occurrences rare.

None of this can happen, however, because when he was in the Senate Al
Gore pushed through a law that outlawed the buying or selling of organs.
That hasn’t eliminated transplants, of course, nor was it intended to. It
simply means that those who want transplants must rely on a system of
begging for organ donations rather than undertaking a transaction sullied by
filthy lucre.

There’s considerable hypocrisy in the situation. Nobody expects the
surgeon performing a transplant operation to donate his time and knowledge.
Nobody expects the hospital where the operation is performed to go without
compensation. Nobody expects the manufacturer of the specialized containers
in which organs are transported to donate them. Nobody expects the charter
aircraft in which transplant organs are sometimes transported to donate the
transportation services. Although there might be exceptions from time to
time, in almost all transplant operations all those people expect to be and
are paid, and rightly so. To coerce their services would be to make them
slaves.

So money changes hands all around — except none goes to the person who
provides the commodity without which none of it could happen — the person
who, if anyone is, is the rightful owner of the one essential ingredient of
this modern miracle of medical technology. How fair and just is that?

I know, I know. Some people simply shudder in horror at the idea of a
money-based market in body parts, reducing the human body to a mere
commodity. But people whose aversion to such transactions is so strong would
not be obligated to participate in them.

The question is whether they should be allowed to enforce their aversion
on others who don’t share it.

I could call the notion that inserting money, filthy money into what
should be an altruistic decision to donate an organ with no concern for
possible recompense makes it all somehow disgusting, and maybe sinful a
religious belief. But I think it is more accurately characterized as a
pre-religious superstition rooted in an immature and confused sense of
spirituality.

You know why Al Gore pushed that law. Whether he could or would put it in
words or not, he has the typical liberal attitude (especially common among
those who never had to scratch for a living) that commercial transactions
involving money are — well, kind of icky. So he embraces and trades on the
essentially emotional notion that inserting money into something as
important as saving lives makes it all dirty and somewhat suspect.

The belief can’t be defended rationally, of course. Money has no magical
powers; it’s simply a medium of exchange developed to make mutually
beneficial trades and transactions more convenient for all concerned, so
people could get beyond haggling over how many bags of seeds a cow was
worth. And even though some lovers and haters of gold tend to develop a
mystical relationship with it, it’s simply a metal that turns out to be
handy for these purposes.

St. Paul didn’t say money was the root of all evil. He said that love of
money is. He also noted that inordinate love of or attachment to almost
anything could constitute an occasion of sin. Evil resides and takes place
in the human heart and soul — whether it’s prodded along by a devil, demon
or evil spirit is a secondary issue in all major religions.

Material things don’t cause evil. One’s relationships with material
things, the choices one makes about how to use material things can. Using a
material object like a club to beat an innocent person to death is evil, but
that doesn’t make the club evil. Developing an obsessive love for the things
one owns can lead a person to evil, but that doesn’t make the things evil.

An immature sense of spirituality — or an unrealistic view that wants to
ignore the fact that preventing or reducing evil depends on the difficult
and sometimes impossible process of converting human hearts and spirits away
from the inclination to do evil — can lead to efforts to control evil by
controlling material things. Thus, some want to ban guns or certain drugs or
flammable pajamas to reduce the amount of evil in the world.

Some moderns wouldn’t be caught dead using the word “evil” of course, so
they talk about public safety or health. But the impulse to fix things by
banning material objects is thoroughly religious — or pre-religious — in
the sense that it is based on beliefs that can’t be proven rationally and
are not subject to rational argument. Then some people use the language of
religion to cloak the real purpose of expanding the scope of political
institutions, inserting them into the thoroughly inappropriate realm of
spiritual healing, where they almost always do more harm than good.

The desire to remove filthy lucre from decisions about whether or not to
make one’s organs available to others is part and parcel of this trend
toward demonizing material objects. Money is icky. Bringing money into the
decision makes it somehow dirty and suspect, so we’ll simply make it
illegal.

As we’ve seen, that breeds hypocrisy, making only one party — well, two,
the only two whose lives are at stake — forbidden to have anything to do
with money. It also produces — as any limitation or ban on legitimate
transactions does — what politicians and economists choose to call
shortages. That means fewer people get the opportunity to have transplants
and more people die before it’s utterly necessary.

That’s not what I would call sweetness.