The Global Organ Shortage: Economic Causes, Human Consequences, Policy Responses (Stanford Economics and Finance) - Hardcover

Beard, T. Randolph; Kaserman, David L.; Osterkamp, Rigmar

Hardcover

ISBN 10: 0804784094 ISBN 13: 9780804784092

Verlag: Stanford University Press, 2013

Inhaltsangabe

Although organ transplants provide the best, and often the only, effective therapy for many otherwise fatal conditions, the great benefits of transplantation go largely unrealized because of failures in the organ acquisition process. In the United States, for instance, more than 10,000 people die every year either awaiting transplantation, or as a result of deteriorating health exacerbated by the shortage of organs.

Issues pertaining to organ donation and transplantation represent, perhaps, the most complex and morally controversial medical dilemmas aside from abortion and euthanasia. However, these quandaries are not unsolvable. This book proposes compensating organ donors within a publicly controlled monopsony. This proposal is quite similar to current practice in Spain, where compensation for cadaveric donation now occurs "in secret," as this text reveals.

To build their recommendations, the authors provide a medical history of transplantation, a history of the development of national laws and waiting lists, a careful examination of the social costs and benefits of transplantation, a discussion of the causes of organ shortages, an evaluation of "partial" reforms tried or proposed, an extensive ethical evaluation of the current system and its competitors.

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Über die Autorinnen und Autoren

T. Randolph "Randy" Beard is Professor of Economics at Auburn University. Rigmar Osterkamp is Fellow at the School for Political Studies at University of Munich. The late David L. Kaserman was Torchmark Professor of Economics at Auburn University.

T. Randolph "Randy" Beard is Professor of Economics at Auburn University.Rigmar Osterkamp is Fellow at the School for Political Studies at University of Munich.The late David L. Kaserman was Torchmark Professor of Economics at Auburn University.

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The Global Organ Shortage

Economic Causes, Human Consequences, Policy ResponsesBy T. Randolph Beard David L. Kaserman Rigmar Osterkamp

Stanford University Press

Copyright © 2013 Board of Trustees of the Leland Stanford Junior University
All right reserved.
ISBN: 978-0-8047-8409-2

Contents

List of Illustrations..............................................................................................ixForeword Friedrich Breyer.........................................................................................xiPreface............................................................................................................xiiiAcknowledgments....................................................................................................xv1. Introduction....................................................................................................12. The Evolution of Organ Transplantation and Procurement Policy...................................................83. Consequences of the Current Policy..............................................................................304. Social Costs and Benefits of Transplants........................................................................725. Economic and Political Causes of the Shortage of Organs.........................................................926. Reforms Short of Open Donor Compensation........................................................................1137. An Assessment of the Moral Basis of Alternative Organ Donation Rules............................................1438. Compensation for Organ Donation and a Proposal for a Public Monopsony for Organ Acquisition.....................1709. Conclusion......................................................................................................207Notes..............................................................................................................213References.........................................................................................................217Index..............................................................................................................231

Chapter One

Introduction

Do not go gentle into that good night.... Rage, rage against the dying of the light. Dylan Thomas

The organ transplantation policies adopted by the vast majority of the world's nations have failed. Although transplantation provides the best, and often the only, effective therapy for many otherwise fatal conditions, the great benefits transplantation could provide go largely unrealized because of failures in the organ acquisition process. In the United States, for example, more than 10,000 persons die every year either awaiting transplantation or as a result of deteriorating health exacerbated by the shortage of organs. More than 350,000 kidney patients receive dialysis treatment at an average annual cost of over $75,000. Similar statistics can be observed in many other wealthy countries. In poor countries, the problems are often masked by inadequate public health resources: countries in which dialysis is generally unavailable do not exhibit waiting lists because their end-stage renal disease patients die quickly. Patients needing transplants of organs other than kidneys receive less attention due to their smaller numbers, but in such cases no therapeutic alternative to transplantation, such as dialysis, exists. These patients usually die quickly, and thus receive less attention than those on dialysis.

Organ transplantation, especially in the cases of kidneys and livers, has shown itself to be by far the best medical response to a variety of life-threatening conditions. Further, numerous studies have established the large financial savings many transplants provide, even in less-than-ideal patient populations. Patients receiving successful transplants often enjoy substantial improvements in the qualities of their lives, including being able to work, care for family members, and so on. As a result, it is nearly universally agreed that a large expansion in transplantation activity, at least for kidneys and livers, is unambiguously desirable from virtually any point of view. Further, it is nearly universally agreed that, on purely medical grounds, there exist sufficient, or more than sufficient, numbers of suitable organs, currently unutilized, which could in principle be used to support a large increase in transplant operations. Such an expansion would save many tens of thousands of lives annually and would reduce the burden on public health insurance funds by many billions of dollars or euros. Lives saved, pain eliminated, costs reduced—what could be more worthwhile? And yet, despite these essentially undisputed facts, the deaths, suffering, and costs continue, year after year, all over the world. How can this be?

The problems of organ transplantation and the shortages of organs represent perhaps the most complex and morally controversial medical issue aside from abortion and euthanasia. In the "organ problem," one comes face to face with such topics as the meaning of personhood, the proper treatment of the bodies of deceased persons, the ethics of rationing a life-saving yet extremely finite resource, the meaning and definition of death, the problems attendant on the mechanical maintenance of human life beyond its "natural" limits, black markets, and so on. Add to these very difficult questions the often conflicting religious and cultural traditions, and toss in many billions of dollars of public expenditure and powerful special interest groups, and one has a perfect recipe for conflict, controversy, and public policy gridlock.

Yet, it is the contention of this book that the problems of organ transplantation, and the shortages of organs for that purpose, are in no sense unsolvable. Although one may hope, and perhaps reasonably expect, that scientific advances such as cloning will one day allow transplant patients to receive tailor-made organs grown from their own cells, it is both unnecessary and irresponsible to fail to act now just because ultimately the problem may be resolved by technical means. Rather, we have the means now to resolve the shortage over a reasonable period if we choose to do so. The primary problems are not technological but are instead political and moral. Establishing this thesis is a primary purpose of this book.

As economists, we must confess to the typical economist's bias toward cynical, financially based explanations for human behavior. However, any prospect for true reform, which we feel must include meaningful donor compensation, is dependent on taking the opposing arguments seriously and vanquishing them on their own terms. Hence, we cannot avoid entering the moral arena and battling the moral objections using the tools of ethics and philosophy. This book, therefore, is not solely composed of economic analyses and financial calculations.

Our conclusions are relatively simple: any practical solution to the organ shortages under current technological means must involve paying meaningful compensation to donors for their willingness to donate. All available evidence, fairly evaluated, suggests that compensation will be effective in greatly increasing the availability of organs for transplant. Compensation may be paid both to the families of deceased donors and to living donors (in the case of kidneys). We propose the establishment of public monopsony buyers for organs and argue that such a system may be adequately managed to produce greatly improved patient outcomes while saving money and avoiding...

Details zur Ausgabe

• Verlag: Stanford University Press
• Erscheinungsdatum: 2013
• Sprache: Englisch
• ISBN 10: 0804784094
• ISBN 13: 9780804784092
• Einband: Gebundene Ausgabe
• Anzahl der Seiten: 264
• Kontakt zum Hersteller: Mare Nostrum Group B.V.; gpsr@mare-nostrum.co.uk; ; Doelen 72; Breda; 4831 GR; Niederlande