U.S. Organ Procurement System

The organ procurement system in the United States has failed patients awaiting transplants, as evidenced by years-long waiting lists, with many patients declining in health or dying before a suitable organ donor is found. The cadaveric organ shortage can be remedied by allowing for organ purchases and sales, to encourage families of the deceased to donate the organs. This monograph is part of AEI's Evaluative Studies Series. The series aims to enhance understanding of government programs and to prompt continual review of their performance. David L. Kaserman is the Torchmark Professor and chairman of the Department of Economics at Auburn University. A. H. Barnett is a professor in, as well as the chairman of, the Department of Economics, International Studies, and Public Administration at the American University of Sharjah in the United Arab Emirates. A summary of the book follows. The first successful human organ transplant in the United States was performed on December 23, 1954, when a kidney was transplanted from a living donor who was an identical twin of the recipient. Since then, the ability to use organ transplants to save the lives and improve the health of thousands of patients suffering from kidney, heart, liver, and other organ failures has improved dramatically. New immunosuppressive drugs and advanced surgical techniques have allowed the successful use of cadaveric donor organs and, thereby, expanded the set of organs for which transplantation is a viable treatment. As a result, the number of organ transplants performed in this country has now grown to approximately 22,000 each year. Despite the tremendous successes that have been achieved, transplantation technology has failed to realize its full promise because of a chronic shortage of cadaveric organs that are made available for that use. The sad fact is that every year for the past three decades the number of cadaveric organs supplied has fallen well short of the number demanded. As a consequence, many patients are denied timely access to this life-saving treatment modality. Those who are deemed medically suitable candidates for transplantation are placed on organ waiting lists, where they often remain for one or more years before an acceptable organ becomes available. While they wait, these patients' health declines, making successful treatment increasingly problematic. Indeed, many of them die before a suitable donor organ is found. As of June 25, 2001, more than 77,000 patients were waiting for an organ transplant. Approximately 7,000 patients died in the preceding year as still more were added to the lists. And as the shortage continues, the length of the lists grows, waiting times increase, and the death toll rises. Importantly, the cadaveric organ shortage is not attributable to an inadequate number of potential organ donors. Of the 2 million or so deaths that occur in the United States each year, estimates indicate that somewhere between 13,000 and 29,000 occur under circumstances that would allow the organs of the deceased to be transplanted. Of these, only 5,843 (or 28 percent of the midrange of the estimates of the number of potential donors) yielded organ donations in 1999. Given the number of potential donors, then, organ collections could easily double or perhaps even triple without exhausting the existing potential supply. Thus, the organ shortage is the product of an ill-conceived public policy that fails to achieve higher collection rates from the available pool of donors. That policy, often referred to as the "altruistic system" of organ procurement, operates (as this name implies) entirely on the basis of unpaid donors. In the typical situation, the families of recently deceased accident or stroke victims who have been declared brain dead are asked for permission to remove the organs of the deceased for use in transplantations. Under the National Organ Transplant Act of 1984, any payment or other form of compensation to encourage the family...