Is it right for beautiful models or brilliant, athletic young men to sell their eggs or semen to the highest bidder? That is yet another question that economists really can’t answer any better than the average person.
But the recent media furor about a much-hyped Internet auction of human ova gives us an opportunity to think a little bit about the intersection of human life and money.
Many people have moral qualms about introducing money into situations of human fertility or medical procedures to extend life. Ask any 10 people if it’s either right or possible to put a dollar value on human life, and at least nine usually will say no.
The recently notorious models’ egg auction apparently was a media stunt, but many people criticized the very idea of auctioning eggs from young women to the highest bidder. Medical ethicists, suddenly in high demand on radio and TV talk shows, tsk-tsked their disapproval. Accepting a modest honorarium in compensation for the time and discomfort involved in donating eggs is acceptable, one argued. But auctioning off the same egg to the highest bidder introduced a motive of greed that was intrinsically wrong.
Another noted that some couples were already paying very large sums to surrogate mothers to carry a child to term, and that an auction was just an extension of this existing phenomenon. Payments of any level are acceptable in personal elective matters such as reproduction, he argued, but should certainly be taboo in matters of life and death such as organ donation.
Yet we do allow payments for some vital “donations.” What about my college classmate 30 years ago who supplemented his GI Bill funding with semi-monthly $20 semen donations for some research project and substantially more frequent than allowable blood donations to a for-profit blood bank?
Was he an altruistic benefactor of humanity or a conniving profiteer? There is a more liquid supply of blood than of transplantable human livers, kidneys or hearts. But for the patient who desperately needs a transfusion to cling to life, is blood really different than an organ?
I don’t know, and I doubt that any other economist does.
My point here is not to make fun of ethicists, but rather to show that the issues are complex and that society has conflicting, ambiguous values about money and health.
Economists can’t help much except to point out that incentives do matter. And money is a powerful incentive for many people.
As Stalinists who tried to urge on workers with “Hero of Socialist Labor” medals found out, few “moral incentives” are as effective as a handful of extra rubles.
On any given day, there are thousands of people anxiously waiting for transplantable organs. Football great Walter Payton, who died last week, was one of 13,000 people reportedly waiting for a liver transplant. We don’t have enough donors, and only a small fraction of them die in circumstances in which their organs are transplantable. And we generally don’t allow sales of human organs.
So many people wait, and some people die because there are not enough organs available.
The federal Department of Health and Human Services does regulate the rules by which organs are allocated between states, hospitals and individuals. Earlier this year they suggested changes for broader geographic sharing of available organs.
Regions that had put great resources into public awareness and donor solicitation campaigns and that had above-average levels of donations complained that they were being penalized for their success.
One wonders why our society is not willing or able to create some structure that would increase the motivation for becoming an organ donor without turning things into a bazaar.
I have had the organ donor box checked on my driver’s license for years. But I also told myself it would be a good thing to do for nearly a decade before I actually took the step. Why did I procrastinate?
I think that while I knew it would be a good thing to do, and had no qualms about being a donor, it simply was not a high priority. Twice I had other things on my mind while renewing my license and didn’t remember until afterwards that I did not check the donation box as I had intended.
Would an immediate $50 or $250 or the prospect of a few thousand dollars for my heirs have concentrated my mind? Would offering such sums attract people who would otherwise not give it a thought? I think it might.
Why doesn’t some state try the following? Pay people $50 or $100 per year as a retainer for being a donor. Pay their estate $2,500 if major organs are actually used after their death. People could sign up when renewing their licenses or could check a box on their income tax returns in states that have income taxes. The decision to be a donor could be revoked at any time.
Some other countries have adopted implied consent organ donation laws.
Unless citizens take an active step to register their refusal to donate, it’s assumed that their organs can be harvested for transplantation. Some people call for a similar system here in the United States as a way of lessening the long wait many ill people must undergo. I have qualms about such quasi-mandatory donation and would prefer to limit donation to people who positively affirm their willingness.
But we would get more donors if we offered some incentive to overcome people’s inertia. It is worth a try or at least some discussion.
© 1999 Edward Lotterman
Chanarambie Consulting, Inc.