Williams 14 Kristy L. Williams, University of Houston Law Center, Health Law & Policy Institute;
University of Texas Medical Branch, Institute of Medical Humanities.; Marisa Finley, Baylor Scott &
White Health Center for Health Care Policy; J. James Rohack, Baylor Scott & White Health March 31,
2014 American Journal of Law and Medicine, Forthcoming Just Say No to NOTA: Why the Prohibition of Compensation for Human Transplant Organs in NOTA Should Be Repealed and a Regulated Market for
Cadaver
Organs Instituted http://ssrn.com/abstract=2418514
Organ transplantation saves thousands of lives every year. However, many individuals die waiting for transplants due to an insufficiency of organs
.1
Currently, more than 122,000 individuals are waitlisted for organs in the U nited
S tates.2
Due to financial and other barriers to becoming waitlisted, the actual number of Americans requiring organs is likely higher
.3
This gap between available organs and the need for organs continues to widen
.4
The supply of organs is limited as only a small number of individuals die in circumstances medically eligible for organ donation, and less than sixty-eight percent of eligible individuals donate.5 As a result of those long waitlists and limited supply there is a substantial need to increase organ donations. This paper will focus on increasing consent rates for cadaveric organ donation in the Unites States by repealing current law prohibiting cadaveric donors and their estates from being financially compensated.6
The current organ donation system in the United States relies on the altruism of donors. The
National Organ Transplantation Act
(NOTA) prohibits the receipt of any form of valuable consideration in exchange for organs to be used for transplantation
.7 State statutes also prohibit the sale of certain organs and tissue for transplantation; however, state laws vary widely as to what body parts are covered.8 As paying for organs is prohibited, other methods have been employed in attempts to increase donations
.9
Despite the implementation of these strategies, a severe organ shortage remains
.
Beard 8 T.RANDOLPH BEARD, JOHN D. JACKSON , AND DAVID L. KASERMAN, profs of economics,
Auburn University Winter 2008 Regulation The Failure of US 'Organ Procurement Policy http://object.cato.org/sites/cato.org/files/serials/files/regulation/2007/12/v30n4-3.pdf
Aware of the increasingly dire consequences of continued reliance on the existing approach to cadaveric organ procurement and alarmed at the figures shown above, the transplant industry has examined and adopted a series of policy options ostensibly designed to improve the system’s performance. All of these, however, continue to maintain the basic zero-price property of the altruistic system. As a result, the likelihood that any of them, even in combination, will resolve the organ shortage is remote
.
At least seven such actions have been implemented
over the last two decades or so: ■ INCREASED EDUCATIONAL EXPENDITURES
In the absence of financial incentives, moral suasion becomes the principal avenue through which additional supply may be motivated.
Consequently, the organ procurement organizations (opos) created under the 1984 Act have launched substantial promotional campaigns.
The campaigns have been designed to both educate the general public about the desperate need for donated organs and educate physicians and critical care hospital staff regarding the identification of potential deceased donors. Over the years, a substantial sum has been spent on these types of educational activities. Recent empirical evidence, however, suggests that further spending on these programs is unlikely to increase supply by a significant amount. ■ ORGAN DONOR CARDS
A related activity has been the process of incorporating organ donor cards on states’ driver licenses.
The cards can be easily completed and witnessed at the

time the licenses are issued or renewed. They serve as a pre-mortem statement of the bearer’s wish to have his or her organs removed for transplantation purposes at the time of death. Their principal use, in practice, is to facilitate the opos’ efforts to convince surviving family members to consent to such removal by revealing the decedant’s wishes. The 1968 Uniform Anatomical Gift Act gave all states the authority to issue donor cards and incorporate them in drivers’ licenses. Moreover, a few states have recently begun to rely entirely on donor cards to infer consent without requiring the surviving family’s permission when such cards are present. Survey evidence indicates that less than 40 percent of U.S. citizens have signed their donor cards.
■ REQUIRED REQUEST Some
survey evidence published in the late 1980s and early 1990s found that in a number of cases families of potential deceased donors were not being asked to donate the organs. As a result, donation was apparently failing to occur in some of those instances simply because the request was not being presented. In response to this evidence, federal legislation
was passed in 1987 requiring all hospitals
receiving any federal funding (which, of course, is virtually all hospitals) to request organ donation
in all deaths that occur under circumstances that would allow the deceased’s organs to be used in transplantation. It appears that this legal obligation is now being met in most, if not all, cases. Yet, the organ shortage has persisted and the waiting list has continued to grow. ■ REQUIRED REFERRAL
While requiredrequest legislation can compel hospitals to approach the families of recently deceased potential organ donors with an appeal for donation, it cannot ensure that the request will be made in a sincere, compassionate manner likely to elicit an agreement. Following implementation of the required-request law, there were a number of anecdotes in which the compulsory organ donation requests were presented in an insincere or even offensive manner that was clearly intended to elicit a negative response. The letter of the law was being met but not the spirit. As a result, additional legislation
was passed that requires hospitals
to refer potential organ donors to the regional opo so that trained procurement personnel can approach the surviving family with the donation request. This policy response has resulted in no perceptible progress in resolving the shortage. ■ COLLABORATION
A fairly recent response to the organ shortage has been the so-called “
Organ Donation Breakthrough Collaborative,” which was championed by then-secretary of health and human services Tommy Thompson. The program was initiated shortly after Thompson took office in 2001 and is currently continuing.
The program’s basic motivation is provided by the observation of a considerable degree of variation in performance across the existing opos. Specifically, the number of deceased organ donors per thousand hospital deaths has been found to vary by a factor of almost five across the organizations. The presumption, then, is that the relatively successful opos employ superior procurement techniques and/or knowledge that, if shared with the relatively unsuccessful organizations, would significantly improve their performance. Thus, diffusion of
“best practice” techniques is seen as a promising method through which cadaveric donation rates may be greatly improved. A thorough and objective evaluation of the Thompson initiative has not, to our knowledge, been conducted. Figure 1, in conjunction with a recent econometric study of observed variations in opo efficiency, suggests that such an evaluation would yield both good news and bad news.
The good news is that the program appears to have had a positive (and potentially significant) impact on the number of donations. In particular, it appears that, after 2002, the growth rate of the waiting list has slowed somewhat. Whether this effect will permanently lower the growth rate of the waiting list or simply cause a temporary intercept shift remains to be seen. The bad news, however, is unequivocal— the initiative is not going to resolve the organ shortage. Even if, contrary to reasonable expectations, all opo relative inefficiencies were miraculously eliminated (i.e., if al organizations’ performance were brought up to the most efficient unit), the increase in donor collection rates would still be insufficient to eliminate the shortage.
■ KIDNEY EXCHANGES
Another approach that has received some attention recently involves the exchange of kidneys between families who have willing but incompatible living donors. Suppose, for example, a person in one family needs a kidney transplant and a sibling has offered to donate the needed organ. Further suppose that the two siblings are not compatible — perhaps their blood types differ. If this family can locate a second, similarly situated family, then it may be possible that the donor in the first family will match the recipient in the second, and vice versa. A relatively small number of such exchanges have recently occurred and a unos-based computerized system of matching such interfamily donors has been proposed to facilitate a larger number of these living donor transactions. Two observations regarding kidney exchanges are worth noting. First, such exchanges obviously constitute a crude type of market in living donor kidneys that is based upon barter rather than currency. Like all such barter markets, this exchange will be considerably less efficient than currency-based trade. Puzzlingly, some of the staunchest critics of using financial incentives for cadaveric donors have openly supported expanded use of living donor exchanges. Apparently, it is not market exchange per se that offends them but, rather, the use of money to facilitate efficient market exchange. This combination of positions merely highlights the critics’ lack of knowledge regarding the operation of market processes. It is quite apparent that living donor kidney exchanges are not going to resolve the organ shortage. Opportunities for such barter-based exchanges are simply too limited. ■
REIMBURSEMENT OF DONOR COSTS Finally, i n another effort to encourage an increase in the number of living (primarily kidney) donors, several states have passed legislation authorizing reimbursement of any direct
(explicit) costs incurred by
such d onors
(e.g., travel expenses, lost wages, and so on). Economically, this policy action raises the price paid to living kidney donors from a negative amount to zero. As such, it should be expected to increase the quantity of organs supplied from this source.
Because the explicit, out-of-pocket expenses associated with live kidney donation are unlikely to be large relative to the longer-term implicit costs of potential health risks, however, such reimbursement should not be expected to bring forth a flood of new donors.
Moreover, recent empirical evidence suggests that an increase in the number of living donors may have a negative impact on the number of deceased donors because of some degree of supply-side substitutability. Again, this policy is not a solution to the organ shortage.
We must conclude that none of the
above-listed policies should be expected to resolve the transplant organ shortage.
We say this not because we oppose any of these policies; indeed, each appears sensible in its own right and some have

unquestionably succeeded in raising the number of organ donors by some (perhaps nontrivial) amount
. Rather,
our concern is that every time another one of these marginalist policies is devised, it delays the only real reform that is capable of fully resolving the organ shortage
.
Beard 8 T.RANDOLPH BEARD, JOHN D. JACKSON , AND DAVID L. KASERMAN, profs of economics,
Auburn University Winter 2008 Regulation The Failure of US 'Organ Procurement Policy http://object.cato.org/sites/cato.org/files/serials/files/regulation/2007/12/v30n4-3.pdf
WAITING LISTS YET TO COME The consequences of our failure to adapt our
cadaveric organ procurement policy
to the changed technological realities of the transplant industry have been unconscionable. Figure 2, above, suggests that more than
80,000 lives have now been sacrificed on the altar of our so-called “altruistic” system. In addition, the unnecessary pain and suffering of those who have been forced to wait while undergoing dialysis, unemployment, and declining health must also be reckoned along with the growing despair of family members who must witness all of this. Nonetheless, the pain, suffering, and death imposed on the innocents thus far pales in comparison to what lies ahead if more fundamental change is not forthcoming
. In order to illustrate the severe consequences of a continuation of the altruistic system, we use the data presented in
Figures 1 and 2 above to generate forecasts of future waiting lists and deaths. The forecasts represent our best guess of what the future holds if fundamental change continues to be postponed. The results should serve as a wake-up call for those who argue that we should continue tinkering with the existing procurement system while further postponing the implementation of financial incentives. The costs of such a “wait and see” approach are rapidly becoming intolerable. CHANGING VARIABLE To produce reasonable forecasts of future waiting lists and deaths, we must first confront an apparent anomaly in the reported data that could cast doubt on the accuracy of some of the more recent figures. Specifically, the reported number of deaths of patients on the waiting list (plus those too sick to receive a transplant) follows a consistently upward trend that is very close to a constant proportion of the size of the waiting list over most of the sample period.
Beginning in 2002, however, the number of deaths levels off and even starts to decline, despite continued growth of the waiting list. It is not clear why there is an abrupt change in the observed trend in this variable. Our investigation of this issue yielded several plausible explanations but no definitive answer. For example, it may be the case that recent advances in medical care, such as the left ventricular assist device, have extended some patients’ lives and, thereby, reduced the number of deaths on the list. Alternatively, it may be the case that because of rising criticism of the current system, unos has taken steps to remove some of the relatively higher-risk patients from the list before they die. For example, the meld/peld program, which was introduced in February 2002, removed a number of liver patients
(who have a comparatively high death rate) from the waiting list. Additionally, the increasing use of so-called “extended criteria” donor organs may have a similar effect, getting the most critically ill patients off the list prior to their deaths. Clearly, the implications of these alternative explanations for reliance on the data are not the same. For example, if patients are, in fact, simply living longer and the data accurately reflect that reality, then our analysis should incorporate the observations. But if the more recent figures are, instead, a manifestation of strategic actions taken by the reporting agency, then they should be excluded. Because we have been unable to identify a single, convincing explanation for the observed phenomenon, we elected to perform our analysis both ways — including and excluding the post-2002 observations on the number of deaths. ESTIMATES Given the two alternative sample periods, the methodology we employ to generate our forecasts is as follows: First, because the number of deaths appears to be causally driven by the number of patients on the waiting list, we begin by estimating a simple linear regression model of the former as a function of the latter. The results of that estimation are reported in Table 1 for the two sample periods described above. Next, we estimate a second linear model with the number of patients on the waiting list regressed against time, again using the two alternative sample periods. Those results are reported in Table 2. From the results, we are able to produce forecasts of the expected size of future waiting lists
for each of our sample periods.
We run the forecasts out 10 years
from the end of our longer sample period, to 2015. Given the forecasted waiting list values, we are then able to use the regression results in Table 1 to generate our forecasts of the number of deaths over the same period. The two alternative sets of forecasts are shown graphically in Figures 3 and 4. Depending upon the sample period chosen, the results show the waiting list reaching 145,691 to 152,400 patients by 2015. Of the patients listed at that time, between 10,547 and 13,642 are expected to die that year. Even more tragically, over the entire period of both actual and predicted values, a cumulative total of
196,310 patients are conservatively expected to die by 2015 as a consequence of the ongoing shortage.
Figure 5 illustrates the results. In that figure, we incorporate several historical reference points in order to put the numbers in

perspective. No one directly involved in the transplant industry is likely to be surprised by our results. Thirty years of experience consistently point to a continuation of the current, long-standing trends. There is nothing on the horizon that should lead anyone to expect a sudden reversal. But our purpose is not to surprise the parties who are already knowledgeable about this increasingly severe problem.
Rather, our intent is to awaken the sleeping policymakers whose continuing inaction will inevitably lead to these results. They can no longer continue to postpone meaningful reform of the U.S. organ transplant system in the futile hope that, somehow, things will improve.
They will not.
Sigrid Fry-Revere. Director of bioethics studies, CATO Institute 2014
The Kidney Sellers: A Journey of Discovery in Iran p 6
At the time, what Congress did seemed reasonable, but over the following three decades, no matter how efficient the U.S. cadaver organ procurement sys- tem became, it could not satisfy the demand.
Medical innovations keep people alive longer, and the ever-growing diabetes and hypertension epidemics contin- ually increased the number of people who could benefit from a kidney transplant.
Today the number of kidneys provided from cadavers could never be enough, even if every organ from every potential qualified donor could be harvested. This is true because not every death results in useable organs. Organs can be diseased or injured, or the body can be dead too long before it reaches the hospital. Patients who die in the hospital after a car accident or similar trauma are the best potential organ donors because the appropriate medical equip- ment is at hand to switch gears from saving the patient to preserving organs for transplantation. Nevertheless, given what we know now, no matter how the process for retrieving organs from the dead improves, there will never be enough kidneys to meet the ever-growing demand.
Richard Adhikari has written about high-tech for leading industry publications since the 1990s
03/26/14 Bioprinting, Part 1: The Promise and the Pitfalls http://www.technewsworld.com/story/80198.html
[According to Jordan Miller, assistant professor of bioengineering at Rice University]. "Parts of the body which require human cells to perform biomechanical functions, such as the liver or kidney, are still several decades away from reaching human patients," Miller said. "We are still in the feasibility stage -- not sure how to keep cells alive at high cell density and adequate size needed to match human organs." A 3D structure will require nearly 1 billion functioning cells to approximate the function of a liver or kidney, and "there are dozens of cell types in these organs," Miller pointed out.
"We are typically only looking at one or two cell types being put into a 3D printed structure."
NOTE SOURCE WITH QUALS EDITED INTO BEGINNING OF CARD
Artificial are too expensive
Gopar 14 Jennifer Julisa Gopar ans Dr. Rance LeFebvre 28 July 2014 COSMOS Cluster 7: Biomedical
Sciences The Moral and Ethical Debate Regarding Artificial Organ Growth http://cosmos.ucdavis.edu/archives/2014/Cluster7/Gopar_Jennifer_EthicsofGrowingOrgans.pdf
With these possible outcomes taken consideration, it is now becoming clear that money will play an important role in artificial organ growth. If we begin producing artificial organs, will these be

available to everyone? Or will these be only available to the wealthy? The whole purpose of artificial organ growth is to give hope to those waiting for an organ transplant. How would this fulfill that purpose if only the wealthy will be able to afford it? The Scientist elaborated on this possible problem, stating, “[Jeffrey] Platt thinks that organ engineering is too costly to meet the needs of everyone waiting for a transplant. ‘You’d have to turn over
to accomplish that,’ he says. On the other hand, ‘I could get a pig for a couple of hundred dollars.’ But
[Paolo] Macchiarini argues that organ engineering is in its infancy, and every advance improves efficiency and lowers cost. ‘What we did in 2008 in 6 months, we can now do in a few weeks,’ he says. ‘We do care about getting this to every patient.’ [Joseph] Vacanti adds that mass-producing artificial scaffolds will make organ engineering even more cost-effective. ‘When you scale them up, the bulk materials and manufacturing tech are extremely cheap,’ he says. ‘I think it’s going to be cheaper than growing lots of pigs.’” So it is still unclear whether the cost of these artificial organs will allow them to be within the reach of patients in need of an organ transplant.
Dr. David Kaserman is currently Torchmark Professor of Economics at Auburn University.
Issues in Law & Medicine Summer, 2007 23 Issues L. & Med. 45 ARTICLE: Fifty Years of Organ Transplants: The
Successes and The Failures lexis
Financial Incentives Proposals to resolve the organ shortage through the use of financial incentives
(or, similarly, through the formation of cadaveric organ procurement markets) have surfaced repeatedly over the years. n56 Importantly, every economist that has written on this subject has reached the same conclusion - i.e., that the shortage is caused by the zero price policy and that the straightforward cure, therefore, is the elimination of that policy. Other, non-economist commentators have reached that same conclusion as well.
The Economist Feb 16th 2011 Blood, not money http://www.economist.com/blogs/blighty/2011/02/volunteering_and_profiteering
Blood donors are also unpaid, in Britain and elsewhere. A debate over whether or not they should be compensated for their efforts has raged for at least four decades. In a classic 1970 study called "The
Gift Relationship: From Human Blood to Social Policy" Richard Titmuss compared the voluntary
British system favourably with the American one in which payments were then widely made. Titmuss reckoned such a market was inefficient and wasteful, that it created shortages and surpluses, and led eventually to a contaminated product. Although he was wrong, and such arguments have since been widely discredited, Americans mostly no longer receive payment for giving blood. Too many people in poor health lied about their medical histories in order to make a few bucks, endangering those who were to receive the blood. As the World Health Organisation notes, people who give blood voluntarily and for altruistic reasons have a lower prevalence of HIV, hepatitis viruses and other blood-borne infections than do those who seek monetary reward. Presumably that is because being rich is a great protection against disease.

J. Randall Boyer, J.D. candidate, April 2012, J. Reuben Clark Law School, Brigham Young University.
2012 Brigham Young University Law Review 2012 B.Y.U.L. Rev. 313 COMMENT: Gifts of the Heart ... and Other
Tissues: Legalizing the Sale of Human Organs and Tissues lexis
It should also be noted that allowing the sale of organs would not preclude someone from donating without compensation. n156 Currently, the sale of blood and ova is allowed under law, but many of the donations of these tissues take place without compensation. n157 In fact, giving the donor the right to sell could actually increase the value of an uncompensated donation by providing donors with more power to ensure the recipient receives the surplus value of the organ through contractually stipulated prices to prevent any inflation by middlemen.
Michael Gill, Ph.D., Assistant Professor, Department of Philosophy, College of Charleston AND Robert
Sade, M.D.,Professor in the Department of Surgery and Director of the Institute of Human Values in Health Care,
Medical University of South Carolina. Kennedy Institute of Ethics Journal 12.1 (2002) 17-45
Paying for Kidneys: The Case against Prohibition http://muse.jhu.edu/journals/kennedy_institute_ of_ethics_journal/v012/12.1gill.html
3. In the early 1970s, Titmuss (1971) and Singer (1973) argued that the existence of financial incentives for blood products would decrease the amount of blood products overall, and some people might believe that the same argument can be extended to financial incentives for kidneys, leading to the conclusion that payment for kidneys will decrease the overall number of kidneys available for transplant. Singer and Titmuss's criticisms of payment for blood products are consequentialist—they argue that such payment is wrong because it would reduce the amount of blood for people who needed it. We believe, first of all, that their consequentialist arguments against payment for blood products have turned out to be inconclusive at best—that the available evidence does not support the conclusion that payment for blood products has reduced blood supply in the United States. And we believe, secondly, that because live kidney donations are usually between family members, there is a significant difference between blood and kidneys that makes it illegitimate to transfer Titmuss and Singer's conclusions to the kidney debate. We do, however, remain open to the possibility that future evidence may vitiate our belief that payment for kidneys will increase supplies. For discussion of Titmuss and
Singer in relation to kidney sales, see Campbell (1992, pp. 41-42); Cherry (2000, pp. 340-41); and Harvey
(1999, p. 119).
Gary S. Becker, Nobel Prize-winning professor of economics at the University of Chicago and a senior fellow at the Hoover Institution; and Julio J. Elias, economics professor at the Universidad del CEMA in
Argentina. Updated Jan. 18, 2014 Wall Street Journal Cash for Kidneys: The Case for a Market for
Organs http://online.wsj.com/news/articles/SB10001424052702304149404579322560004817176?mod=WSJ_hpp_MIDDL
ENexttoWhatsNewsFifth

Finding a way to increase the supply of organs would reduce wait times and deaths, and it would greatly ease the suffering that many sick individuals now endure while they hope for a transplant.
The most effective change
, we believe, would be to provide compensation to people who give their organs—that is, we recommend establishing a market for organs.
Organ transplants are one of the extraordinary developments of modern science. They began in 1954 with a kidney transplant performed at Brigham & Women's hospital in Boston. But the practice only took off in the 1970s with the development of immunosuppressive drugs that could prevent the rejection of transplanted organs. Since then, the number of kidney and other organ transplants has grown rapidly, but not nearly as rapidly as the growth in the number of people with defective organs who need transplants. The result has been longer and longer delays to receive organs. Many of those waiting for kidneys are on dialysis, and life expectancy while on dialysis isn't long. For example, people age 45 to 49 live, on average, eight additional years if they remain on dialysis, but they live an additional 23 years if they get a kidney transplant. That is why in 2012, almost 4,500 persons died while waiting for kidney transplants. Although some of those waiting would have died anyway, the great majority died because they were unable to replace their defective kidneys quickly enough. Enlarge Image The toll on those waiting for kidneys and on their families is enormous, from both greatly reduced life expectancy and the many hardships of being on dialysis. Most of those on dialysis cannot work, and the annual cost of dialysis averages about $80,000. The total cost over the average 4.5-year waiting period before receiving a kidney transplant is $350,000, which is much larger than the $150,000 cost of the transplant itself. Individuals can live a normal life with only one kidney, so about 34% of all kidneys used in transplants come from live donors. The majority of transplant kidneys come from parents, children, siblings and other relatives of those who need transplants. The rest come from individuals who want to help those in need of transplants. In recent years, kidney exchanges—in which pairs of living would-be donors and recipients who prove incompatible look for another pair or pairs of donors and recipients who would be compatible for transplants, cutting their wait time— have become more widespread. Although these exchanges have grown rapidly in the U.S. since 2005, they still account for only 9% of live donations and just 3% of all kidney donations, including after-death donations. The relatively minor role of exchanges in total donations isn't an accident, because exchanges are really a form of barter, and barter is always an inefficient way to arrange transactions.
Exhortations and other efforts to encourage more organ donations have failed to significantly close the large gap between supply and demand. For example, some countries use an implied consent approach, in which organs from cadavers are assumed to be available for transplant unless, before death, individuals indicate that they don't want their organs to be used. (The U.S. continues to use informed consent, requiring people to make an active declaration of their wish to donate.) In our own highly preliminary study of a few countries—
Argentina, Austria, Brazil, Chile and Denmark—that have made the shift to implied consent from informed consent or vice versa, we found that the switch didn't lead to consistent changes in the number of transplant surgeries. Other studies have found more positive effects from switching to implied consent, but none of the effects would be large enough to eliminate the sizable shortfall in the supply of organs in the U.S. That shortfall isn't just an American problem. It exists in most other countries as well, even when they use different methods to procure organs and have different cultures and traditions.
Paying donors for their organs would finally eliminate the supply-demand gap
. In particular, sufficient payment to kidney donors would increase the supply of kidneys by a large percentage, without greatly increasing the total cost of a kidney transplant. We have estimated how much individuals would need to be paid for kidneys to be willing to sell them for transplants.
These estimates take account of the slight risk to donors from transplant surgery, the number of weeks of work lost during the surgery and recovery periods, and the small risk of reduction in the quality of life.
Our conclusion is that a very large number of both live and cadaveric kidney donations would be available by paying about $15,000 for each kidney.
That estimate isn't exact, and the true cost could be as high as $25,000 or as low as $5,000—but even the high estimate wouldn't increase the total cost of kidney transplants by a large percentage. Few countries have ever allowed the open purchase and sale of organs, but
Iran permits the sale of kidneys by living donors.
Scattered and incomplete evidence from Iran indicates that the price of kidneys there is about $4,000 and that waiting times to get kidneys have been largely eliminated
.
Since Iran's per capita income is one-quarter of that of the U.S., this evidence supports our $15,000 estimate. Other countries are also starting to think along these lines: Singapore and Australia have recently introduced limited payments to live donors that compensate mainly for time lost from work.
Since the number of kidneys available at a reasonable price would be far more than needed to close the gap between the demand and supply of kidneys, there would no longer be any significant waiting time to get a kidney transplant. The number of people on dialysis would decline dramatically, and deaths due to long waits for a transplant would essentially disappear.
Today, finding a compatible kidney isn't easy. There are four basic blood types, and tissue matching is complex and involves the combination of six proteins. Blood and tissue type determine the chance that a kidney will help a recipient in the long run. But the sale of organs would result in a large supply of most kidney types, and with large numbers of kidneys available, transplant surgeries could be arranged to suit the health of recipients (and donors) because surgeons would be confident that compatible kidneys would be available. The system that we're proposing would include payment to individuals who agree that their organs can be used after they die. This is important because transplants for heart and lungs and most liver transplants only use organs from the deceased. Under a new system, individuals would sell their organs "forward" (that is, for future use), with payment going to their heirs after their organs are harvested. Relatives sometimes

refuse to have organs used even when a deceased family member has explicitly requested it, and they would be more inclined to honor such wishes if they received substantial compensation for their assent. The idea of paying organ donors has met with strong opposition from some (but not all) transplant surgeons and other doctors, as well as various academics, political leaders and others. Critics have claimed that paying for organs would be ineffective, that payment would be immoral because it involves the sale of body parts and that the main donors would be the desperate poor, who could come to regret their decision. In short, critics believe that monetary payments for organs would be repugnant. But the claim that payments would be ineffective in eliminating the shortage of organs isn't consistent with what we know about the supply of other parts of the body for medical use.
For example, the U.S. allows market-determined payments to surrogate mothers—and surrogacy takes time, involves great discomfort and is somewhat risky. Yet in the U.S., the average payment to a surrogate mother is only about $20,000. Another illuminating example is the all-volunteer U.S. military. Critics once asserted that it wouldn't be possible to get enough capable volunteers by offering them only reasonable pay, especially in wartime. But the all-volunteer force has worked well in the U.S., even during wars, and the cost of these recruits hasn't been excessive. Whether paying donors is immoral because it involves the sale of organs is a much more subjective matter, but we question this assertion, given the very serious problems with the present system. Any claim about the supposed immorality of organ sales should be weighed against the morality of preventing thousands of deaths each year and improving the quality of life of those waiting for organs. How can paying for organs to increase their supply be more immoral than the injustice of the present system?
Under the type of system we propose, safeguards could be created against impulsive behavior or exploitation. For example, to reduce the likelihood of rash donations, a period of three months or longer could be required before someone would be allowed to donate their kidneys or other organs. This would give donors a chance to re-evaluate their decisions, and they could change their minds at any time before the surgery. They could also receive guidance from counselors on the wisdom of these decisions. Though the poor would be more likely to sell their kidneys and other organs, they also suffer more than others from the current scarcity. Today, the rich often don't wait as long as others for organs since some of them go to countries such as India, where they can arrange for transplants in the underground medical sector, and others (such as the late Steve Jobs ) manage to jump the queue by having residence in several states or other means.
The sale of organs would make them more available to the poor, and Medicaid could help pay for the added cost of transplant surgery. The altruistic giving of organs might decline with an open market, since the incentive to give organs to a relative, friend or anyone else would be weaker when organs are readily available to buy. On the other hand, the altruistic giving of money to those in need of organs could increase to help them pay for the cost of organ transplants.
Paying for organs would lead to more transplants—and thereby, perhaps, to a large increase in the overall medical costs of transplantation. But it would save the cost of dialysis for people waiting for kidney transplants and other costs to individuals waiting for other organs. More important, it would prevent thousands of deaths and improve the quality of life among those who now must wait years before getting the organs they need.
Michelle Minton • March 27, 2014 Human Achievement of the Day from HumanProgress.org:
Organ Replacement Technology https://cei.org/blog/human-achievement-day-humanprogressorg-organ-replacement-technology
Medical breakthroughs are giving hope to hundreds of thousands of people waiting for organ transplants. There are 120,000 people waiting for organ transplants in the United States alone. By this time tomorrow, twenty to thirty Americans will die because they cannot get a new kidney—not to mention other organs. Compare this man-made shortage to Iran where organ donors may be compensated with cash. In contrast to the United States, there is a donor waiting list in Iran. As long as the industrialized world rejects the Iranian model, we must turn to innovation to resolve the organ shortage crisis.
Christy M. Watkins, University of Tulsa Journal of International and Comparative Law Spring,
2005 5 JICL 1 ARTICLE: A Deadly Dilemma: The Failure of Nations' Organ Procurement Systems and Potential
Reform Alternatives n1 lexis
2. The Market Process

A minimum of five groups would be seriously affected by an organ market: (1) current and potential transplant candidates; (2) actual and potential organ donors and their families; (3) hospitals, physicians, and other transplant caregivers; (4) The United Network for Organ
Sharing, the Organ Procurement and Transplantation Network, and other organ procurement [*27] organizations; and (5) taxpayers and those who finance patient care. n214 First, the organ supplier (potential donor or his or her surviving relatives) would be offered a market-determined price, which would fluctuate depending on supply and demand.
n215
Price flexibility would eliminate surpluses or shortages automatically.
n216 Organ procurement firms would then remove the organs at death and sell them to transplant centers that have put in an organ order. n217 In turn, the centers would include the price paid to the firm in the operation bill, with the resale price being the price paid to the donor plus the firm's collection and distribution cost. n218 From here, the center could allocate the organs in "precisely the same fashion they are allocated today" under the guidelines of the UNOS. n219 The firms acquiring the organs for sale would presumably operate competitively on a for-profit basis, resulting in powerful market incentives to create and use the best strategies in finding potential donors and encouraging them to donate. n220 Procurement agencies currently operate on a nonprofit basis, and while they may work diligently, it is doubtful they could match the performance of the competitive for-profit firms. n221

Hughes 9 J. Andrew Hughes, J.D. candidate, Vanderbilt University Law School, May 2009.
Vanderbilt Journal of Transnational Law January, 2009 42 Vand. J. Transnat'l L. 351
Note: You Get What You Pay For?: Rethinking U.S. Organ Procurement Policy in Light of Foreign Models
U.S. organ procurement policy has consequences beyond a domestic organ shortage. A thriving global
black market in human organs has resulted from U.S. policy banning organ sales
. n78 While nearly all developed nations have banned the sale and purchase of human organs, many countries do not strictly enforce these laws. n79
The illegality of the organ trade is insufficient to discourage many of those faced with the possibility of dying on an organ waiting list, and "transplant tourism" has become its own industry.
n80 In Bombay in
2001, nearly US$ 10 million were exchanged for kidney transplants. n81 Patients use kidney brokers to locate sellers, who circumvent a ban on kidney sales by signing an affidavit swearing that they are not being paid. n82 Before the U.S. invaded Iraq in 2003, that country was known as "one of [the] world's best black marketplaces for human organs." n83 The lack of effective prosecution of these transactions extends beyond Asia and the Middle East to Europe, as recent cases in Estonia and Germany suggest. n84
U.S. doctors perform illegal transplants, too, often under hospitals' "don't ask, don't tell" policy regarding transplants involving foreigners who claim to be related
. n85 U.S. hospitals set their own rules for who can be a live organ donor, and organ brokers can locate hospitals that do not question a purported familial relationship between "donors" and "donees." n86
The lack of a regulated organ marketplace in the U.S. has resulted in exploitation of the poor throughout the world.
n87 Organ sellers often face debt, unemployment, and serious health problems; as such, they are easy targets for abuse. n88
Prisoners and the homeless are among those exploited. n89 Sellers of organs on the black market are often paid less than what they were initially promised, while their financial situations and health often grow worse after the transplants. n90 Data from the Indian black market trade in kidneys [*363] support the concern about sellers' lack of adequate information about the risks involved. In one study, 86% of the sellers there reported that their health had "deteriorated substantially" after their organ sales, and "four out of five sellers would not recommend that others follow their lead in selling organs." n91
In short, U.S. policy and its ban on organ sales have produced some of the same immoral and unethical consequences the ban was designed to avoid
. n92
Da Silva and Frontera 15 (Ivan Rocha Ferreira Da Silva, MD1; Jennifer A. Frontera, MD2 Neurocritical
Care Unit and Stroke Department, Hospital Copa D’Or, Rio de Janeiro, Brazil 2Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, Cleveland, Ohio “Worldwide Barriers to Organ Donation”
JAMA Neurol. 2015;72(1):112-118. doi:10.1001/jamaneurol.2014.3083. http://archneur.jamanetwork.com/article.aspx?articleid=1934718)
Globally, legislation guiding organ donation and transplant varies widely.
1
Only 20% of African nations report having a transplant
and organ
donation coordinating structure
, while 95% of countries in the Americas have such a system in place.
Even fewer countries have a mechanism for collection and analysis of data related to donation, donor safety, and transplantation activities
. Some countries report that liver and/or kidney transplants are performed despite a lack of legislation
. Such lack of oversight may promulgate illegal transplantation and organ trafficking
.
Even in countries that have legislation regulating organ trafficking
, there is weak
enforcement and few international regulations that can effectively police the problem
.43 A recent report by
Global Financial Integrity estimates that the illicit organ trade generates
illegal profits between $600 million and $
1.2 billion per

yea r.44 It is hypothesized that this market is fueled not only by profit but also by
cultural and religious barriers to organ donation and transplantation in some countries, long waiting lists for organs
, precarious infrastructure for transplants in the country of origin, and difficult access to chronic life support (in the case of renal replacement therapy).45
A growing number of countries report
that patients have
allegedly traveled to countries to buy organs on the black (illicit) market
, a practice known as transplant tourism.
The World Health Organization estimates that 5% to 10% of kidney transplants worldwide occur as a result of commercial transactions.46,47 A study of
American citizens
who received organ transplants abroad showed that roughly 90% were kidney transplants and that male sex, Asian race, resident and nonresident alien status, and college education were significantly and independently associated with foreign transplant.48 In 2006, patients from 34 states, plus the District of Columbia, received foreign transplants in 35 countries, led by China, the Philippines, and India
.48
Samadi 2012 – Vice Chairman of the Department of Urology and Chief of Robotics and Minimally
Invasive Surgery at the Mount Sinai School of Medicine (David, May 30, 2012, “Consequences of the rise in illegal organ trafficking,” Fox News, http://www.foxnews.com/health/2012/05/30/consequences-risein-illegal-organ-trafficking/,)
Earlier this week, the
World Health Organization (
WHO
) released a report demonstrating a rise in the number of human organs being sold on the black market
. According to the paper, in 2010 over 10,000 organs were sold, translating to more than one organ sold every hour.
Organ transplantation is a necessary treatment for many individuals whose organs have failed and has been in practice in the United States since the 1950s. In the U.S. organ donations are regulated by an independent non-for-profit organization, United Network for Organ Sharing (UNOS). Organs are given to those whose need is the greatest, regardless of wealth or position.
Unfortunately
, the need for organs greatly outweighs the current supply
. As of
March 2012 over 113,115 patients are currently waiting for an organ to become available.
An illegal market has capitalized on these individuals’ desperation
, and the prospects of large profits are creating unfortunate incentives
, with patients willing to pay up to $200,000 for a kidney
. According to the WHO report, 76 percent of organs sold were kidneys, reflecting the growing demand secondary to complications of high blood pressure and diabetes.
There are many ethical and health concerns surrounding the trafficking of human organs
.
In the majority of situations, those selling their organs represent members of vulnerable populations
.
In countries like Pakistan, China or India
, a person can sell a kidney for $5,000
, while those handling the transaction make a substantial profit
.
Prior reports
have also demonstrated that the recipients of illegal organs tend to fair worse than those who have received one legally
. A recent meta-analysis involving 39 original publications revealed that those obtaining organs abroad are at a higher risk of contracting transmissible diseases, such as hepatitis B or HIV
. Furthermore the patient and organ survival rates abroad are significantly lower
. These statistics might
even underestimate the risk as the data is vulnerable to survivor bias
; those who do not survive the procedure and return home are often not included in studies
. Additionally, given the duplicitous nature of illegal organ trade, there are many scams
. In 2010, a former psychiatrist was sentenced to more than 15 years in prison for offering false promises of organ transplants in the Philippines, while taking over $400,000 dollars from patients. Over five patients actually travelled to the Philippines only to find out that there was no organ awaiting them. One of these patients died in the Philippines. Regretfully, the number of individuals needing organs continues to grow while the number of donors remains stable

Jaycox 12 Michael P. Jaycox, teaching fellow and Ph.D. candidate in theological ethics at Boston
College,
Developing World Bioethics Volume 12 Number 3 2012 pp 135–147 COERCION, AUTONOMY, AND THE
PREFERENTIAL OPTION FOR THE POOR IN THE ETHICS OF ORGAN TRANSPLANTATION http://onlinelibrary.wiley.com/doi/10.1111/j.1471-8847.2012.00327.x/pdf
Pakistani surgeon and bioethicist Farhat Moazam offers the results of a recent study in which he interviewed thirty-two farm laborers in Pakistan, each of whom had sold a kidney within the past three years. 14
He found that almost all of these organ vendors were in significant debt to wealthy landlords at the time they sold their kidneys;
the average debt of each was 130,000 rupees at the time of sale.
Although the vendors were promised by third-party brokers an average price of 160,000 rupees per kidney, the amount actually received by the vendors was an average of 103,000 rupees. As a result, a majority
(17) of them were ‘either still in debt or had accumulated new debts’ at the time of their interviews. 15 Moreover, a majority of the vendors experienced long-term physical and psychological malady as a result of their nephrectomies, and a majority also expressed regret or shame for their decision because they were not freed from their debts and/or felt they had committed a morally wrong act.
When asked why they had made the decision, ‘the most common [Urdu] words they used were majboori (a word that arises from the root jabr, which means a state that is beyond one’s control) and ghurbat (extreme poverty).’16,
Moazam summarizes his findings with the conclusion that the sale of kidneys functions to reinforce the poverty of those who sell them:
In the words of the vendors, they sell a kidney...in order to fulfill what they see as obligations toward immediate and extended families in which they are inextricably embedded, and within systems of social and economic inequalities which they can neither control nor escape. They sell kidneys in hopes of paying off loans taken to cover their families’ medical expenses or to meet the responsibilities for arranging marriages and burying their dead. These are recurring expenses, and for most the debts rapidly accumulate again, even if they have been partially or completely paid back with the money from selling a kidney.
17 4 F. Moazam, R.M. Zaman & A.M. Jafarey. Conversations with Kidney Vendors in Pakistan: An Ethnographic Study.Hastings Cent
Rep 2009; 39: 29–44. Due to recent legislation (18 March 2010), the sale of human organs is now illegal in Pakistan, although the social effects of this new legislation remain to be studied; see T.M. Pope. Legal Briefing: Organ Donation and Allocation. J Clin Ethics
2010; 21: 243–263: 254.
Bowden 13 Jackie Bowden, 2013 J.D. graduate from St. Thomas University School of Law.
Intercultural Human Rights Law Review 2013 8 Intercultural Hum. Rts. L. Rev. 451 ARTICLE:
FEELING EMPTY? ORGAN TRAFFICKING & TRADE: THE BLACK MARKET FOR HUMAN ORGANS lexis
[*452] Introduction
Organ trafficking has been depriving innocent people of their fundamental right to life for decades
. n1
Imagine living in a poor country
, where you wake up in the morning and set out to find work and food for the day.
As you walk peacefully
to your home at the end of the day, you are grabbed and thrown into the back of an unmarked truck. n2 You wake up, screaming from excruciating pain, as a surgeon slices through your flesh to remove your kidney
. Due to the costs associated with such a procedure, no anesthesia is administered and no medication is given to prevent infection
. n3 In the event that the surgery does not go as planned, no forms of emergency assistance are available.
Your body is then dumped on a side street, and you are extremely lucky if you live
.
Should you report the incident to government officials? What if the government is actually involved in this inhumane activity? n4 [*453]

There are conflicting views on whether people are actually kidnapped for their organs. n5 In fact, many believe these stories are just myths. n6 However
, there are reported accounts suggesting that abduction of organs is a harsh reality of organ trafficking.
n7 Reports indicate organ trafficking is so prevalent that there is a surplus of organs available for transplantation. n8
Furthermore, there is evidence of governmental involvement, which contributes to and exacerbates the problem. n9 Fortunately, most countries have enacted laws to prevent and prohibit organ trafficking from occurring. n10
Francis L. Delmonico, Director of the Renal Transplantation Unit at Massachusetts
General Hospital, the medical director at the New England Organ Bank, and Professor of
Surgery at Harvard Medical School; and Nancy Scheper-Hughes.Director of Organs Watch and Professor of Medical
Anthropology at the University of California at Berkeley Zygon, vol. 38, no. 3 (September 2003)
WHY WE SHOULD NOT PAY FOR HUMAN ORGANS Ebsco
Although class distinctions are an almost naturalized part of social life in all complex societies, in this particular instance the exploitation of organ sellers veers dangerously close to human slavery, as argued by Giovanni Berlinguer (Berlinguer and Garrafa 1996). The pressures put by organ brokers upon the desperation of the world’s dislocated, refugee, and poorest populations to provide the scarce commodities reveals the limits of argu- ments based solely on individual autonomy. Yes, even the poorest people of the world “make choices,” but they do not make these freely or under social or economic conditions of their own making. Further, the pressure of organ brokers upon the poor makes their decision to sell an organ anything but a free and autonomous choice. These secular arguments reach a conclusion similar to one derived from Christian morality—that the sale of human organs is unethical. The most disturbing issue of organ sales to both Christian and secular ethicists is the formation of an economic underclass of organ donors throughout the world to serve the wealthy.
This is not to suggest that proponents of organ sales are in favor of exploiting the poor but, rather, that they are indifferent to the social and individual pathologies that markets in kidneys and other body parts produce, such as the documented evidence of postsurgery medical complications, chronic pain, psychological problems, unemployment, decreased earning power, social ostracism, and social stigma faced by kidney sellers in many parts of the world (see Zargooshi 2002; Jimenez and Scheper-
Hughes 2002a; Ram 2002).
Kelly 13 Emily Kelly, Executive Comment Editor for the Boston College International & Comparative
Law Review. Boston College International and Comparative Law Review Spring, 2013 36 B.C. Int'l &
Comp. L. Rev. 1317 NOTE: INTERNATIONAL ORGAN TRAFFICKING CRISIS: SOLUTIONS ADDRESSING THE
HEART OF THE MATTER lexis
[*1324] With regard to recipients, the dangers of receiving medical care in developing countries can outweigh the benefits of life-saving transplant tourism. n66
Because governmental disease control agencies do not monitor underground organ

trafficking, recipients risk contracting infectious diseases like West Nile Virus and HIV
. n67 Tragically, transplant tourists also have "a higher cumulative incidence of acute [organ] rejection in the first year after transplantation." n68
Transplant tourism
also harms global public health policies
. n69 Most notably, the underground market impedes the success of legal organ donation frameworks. n70 For example, Thai patients have difficulty accessing health care because local doctors are preoccupied with the lucrative practice of treating transplant tourists. n71 In 2007, China banned transplant tourism because wealthy foreigners--rather than the 1.5 million Chinese on the waiting list--received an overwhelming amount of organ transplants. n72 Grisly tales of transplant tourism and conspiracy theories surrounding organ theft may also discourage individuals from agreeing to altruistic donation upon death out of fear that their bodies may be exploited. n73 This further contributes to the global organ shortage and exacerbates the underlying causes of OTC trafficking. n74
Additionally, transplant tourism and broader medical tourism facilitate the spread of antibiotic-resistant bacteria.
n75
Because such bacteria are frequently found in hospitals, tourists are easily exposed and transmit these unique strains across borders upon returning to their home countries
. n76 As a result of these effects, transplant tourism has drawn increasing attention to the root of the problem: organ shortages. n77
Franco-Paredes 10 Carlos Franco-Paredes, Jesse T. Jacob. Alicia Hidrona, Alfonso J. Rodriguez-
Morales,David Kuhara, and Angela M. Caliendoa all with Division of Infectious Diseases, Emory
University School of Medicine except Redriguez-Morales at Division of Immunoparasitology, Tropical
Medicine Institute, Universidad Central de Venezuela International Journal of Infectious Diseases
Volume 14, Issue 3, March 2010, Pages e189–e196 Transplantation and tropical infectious diseases http://www.sciencedirect.com/science/article/pii/S1201971209002045
More transplantation procedures are being performed annually, resulting in an increase in the number of immunocompromised hosts
.1, 2, 3, 4, 5, 6 and 7 Most of the literature in infectious diseases in transplantation has focused on common pathogens prevalent in industrialized Western countries, where most transplantation surgeries occur.1, 2, 4, 5, 6 and 7 However, in the last decade, there has been a growing identification of tropical infectious diseases occurring in transplant hosts in endemic and non-endemic settings
.3, 4, 7, 8, 9, 10 and 11
The epidemiologic reasons for the growing number of reports of tropical infections appearing in transplant recipients include
: (1) increasing travel of transplanted patients to the tropics and subtropics;8, 12 and 13 (2) increasing population immigration from endemic areas for tropical infections to non-endemic settings;6, 14 and 15 (3) increasing numbers of transplantation procedures taking place in tropical countries
;11, 16, 17, 18 and 19 and (
4) many individuals traveling overseas for ‘transplant tourism’ in countries with high prevalence of tropical infectious diseases
.20 and 21 In general, transmission of these infections occurs through three main routes: donor-derived infections,3, 4, 6, 15 and 22 reactivation or recrudescence of latent infections,16, 22, 23 and 24 or transmission de novo during the posttransplant period.4 and 16 Infectious pathogens may be carried by the graft or the infection may be acquired through transfusion of blood products during or after the transplantation.3, 4
Upchurch 12 Ryan Upchurch, Seton Hall Law 1-1-12 Seton Hall Law eRepository "The Man who
Removes a Mountain Begins by Carrying Away Small Stones: Flynn v. Holder and a Re-Examination of
The National Organ Transplantation Act of 1984" (2012). http://erepository.law.shu.edu/student_scholarship/18

By increasing the supply of available organs in the U nited
S tates
through compensation,
American
citizens would have less reason to travel elsewhere to pay for an organ
. For example, Aadil Hospital in Lahore, Pakistan advertises two transplant packages catered towards foreign patients: $14,000 for the first transplant and $16,000 for the second if the first organ fails.118
If demand dried up
from foreign citizens, transplant tourism in these countries would take a major hit
because brokers would fetch lower sums for organs they procure. Statistical information is difficult to come by for obvious reasons, but presumably American citizens make up a substantial percentage of the tourist patients seeking a new organ they cannot attain domestically. As one report about impoverished Bangladeshi villagers taken advantage of for their organs succinctly stated, “Most of those organs ended up transplanted into
American citizens
.”119 The black market for organs in other countries is not fueled by local patients. Rather, it is driven upwards and out of control by those American as well as European citizens who cannot acquire what they need domestically.120 One estimate is that the black market accounts for as high as twenty percent of all kidney transplants worldwide.121 Nadley Hakim, transplant surgeon for
St. Mary’s Hospital in London, offered an interesting take on this problem of the black market when he said, “this trade is going on anyway, why not have a controlled trade where if someone wants to donate a kidney for a particular price, that would be acceptable? If it is done safely, the donor will not suffer.”122 Within the past month, an indigent Chinese teenager sold his kidney so that he could purchase an iPad and iPhone.123 The unnamed teenager now suffers from renal deficiency.124 Sadly, the boy received roughly ten percent of what the buyer paid, with the rest going to the surgeon and others involved in coordinating the operation.125
If those American citizens with the means to purchase were not forced abroad to find an organ, it is very possible that stories like this would become much less commonplace.
Calandrillo 4 Steve P. Calandrillo, Associate Professor, Univ. of Washington School of Law. J.D.,
Harvard Law School. B.A. in Economics, Univ. of California at Berkeley. George Mason Law Review Fall,
2004 13 Geo. Mason L. Rev. 69 ARTICLE: Cash for Kidneys? Utilizing Incentives to End America's
Organ Shortage lexis
Moreover, if we cannot prevent the black markets in human organs that continue to thrive worldwide today, a thoughtful and responsible regulatory solution in America might be the best response
. Many scholars have chronicled the reality that today's black markets lead to a host of abuses, provide for no follow-up health care, and generally exploit the poor to the wealthy's advantage. n180 Stephen Spurr details the potential for misrepresentation and fraud against both buyers and sellers today, as prices spiral out of control for organs that are of dubious quality. n181 Gloria Banks decries the exploitation of society's most vulnerable individuals in the organ sale trade, and urges legal and ethical safeguards for their protection. n182 Susan Hankin
Denise adds that a properly regulated organ market may therefore be a better solution to the problem of scarcity than the outright ban we witness today. n183 FOOTNOTE ATTACHED n183 See Denise, supra note 72, at 1035-36 (arguing that regulated markets are superior to the existing ban on organ sales in the U.S.). Of course, even a well-regulated legalized market in the U.S. may not completely eliminate black markets worldwide if patients can still find organs more cheaply abroad.
However, it is reasonable to suspect that an American market would significantly reduce the demand for black
market organs, especially given the ability of a regulated market to better ensure the quality of its
product. Furthermore, a legalized market in the U.S. (with appropriate safeguards to prevent abuse of sellers) may lead to similar structures abroad.
On the other hand, one might argue that competing markets might lead to a "race to the bottom" in terms of regulatory standards, as each country tries to gain more market share.

Satel and Hakim, 08 – MD, Resident Scholar, American Enterprise Institute, AND MD, Transplant
Surgeon, Former President, International College of Surgeons (Sally AND Nadey, June 20, 2008, “What's
Wrong with Selling Kidneys?,” American Enterprise Institute, http://www.aei.org/article/health/whatswrong-with-selling-kidneys/,)
Unfortunately, much of the world transplant establishment
--including the
WHO
, the international Transplantation Society and the World Medical Association-advocate remedies that do not go far enough
.
They insist on obliterating organ trafficking but ignore the time-tested fact that trying to stamp out underground markets either
drives corruption further underground or causes it to flourish elsewhere
. The truth is that trafficking will only recede when the crying need for organs disappears.
Opponents also allege that a legal system of exchange will inevitably replicate the sins of the black market. This is utterly backward.
The remedy to this corrupt and unregulated system of exchange is its mirror image: a regulated and transparent regime devoted to donor protection
.
We suggest a system in which compensation is provided by a third party
( government, a charity or insurance
) and overseen by the government
.
Because bidding and private buying will not be permitted, available organs will be distributed to the next in line--not just to the wealthy.
Finally, we suggest that lump-sum cash payments not be offered
.
By providing in-kind rewards
--such as a down payment on a house, a contribution to a retirement fund or lifetime health insurance-the program would not be attractive to people who might otherwise rush to donate on the promise of a large sum of instant cash
.
The only way to stop illicit markets is to create legal ones
. Indeed, there is no better justification for testing legal modes of exchange than the very depredations of the underground market
.
Dr. David Kaserman is currently Torchmark Professor of Economics at Auburn University.
Issues in Law & Medicine Summer, 2007 23 Issues L. & Med. 45 ARTICLE: Fifty Years of Organ Transplants: The
Successes and The Failures lexis
In a truly ironic twist of logic, some opponents of the use of financial incentives for cadaveric organ donors have cited various human rights abuses and extraordinarily high prices associated with such black market activities as har-bingers of the sorts of outcomes likely to accompany legalized organ markets. n32 This line of "reasoning" is equivalent to arguing that legalization of liquor sales would lead to the sorts of mafia-related activities that arose during prohibi-tion. This argument stands accepted economic theory on its head. The truth is that the types of behavior and price levels that frequently accompany black market sales tend to disappear when trade is legalized. Legalized trade allows the market price to fall as legitimate businesses enter the market and increase supply. Moreover, costs decrease as the risks of both prosecution and violent actions by rival producers are eliminated. The outcome is lower prices, an increase in the volume of trade, and a cessation of criminal activities. Thus, the types of conduct associated with illegal suppliers involved in black market trade and the prices at which such trade takes place do not accurately reflect the behavior and prices likely to result from legalized sales. In fact, it has long been recognized that the most effective remedy for undesirable black

market activity is to eliminate restrictions on trade. Stated succinctly, the cure for black market abuses is legalized trade. That conclusion holds a fortiori, in the case at hand. Eliminating the shortage of cadaveric organs through legalization of financial incentives would greatly reduce, if not eliminate, the demand for living donor kidneys obtained through black markets. Therefore, if one is opposed to current black market activities, then one should favor financial incentives for cadaveric organ donors.

Stephen Wilkinson, Professor of Bioethics, Lancaster University (UK) 10-17-11 Stanford
Encyclopedia of Philosophy, "The Sale of Human Organs" http://plato.stanford.edu/entries/organs-sale/
. Different Kinds of Organ Sale System
The expression ‘organ sale’ covers a wide range of different practices.
People most readily associate it with the case in which one individual
(who needs or wants money) sells his or her kidney to another
(who needs a kidney).
But there are other possibilities too
. One (in countries where the prior consent of the deceased is required for cadaveric organ donation) is to pay people living now for rights over their body after death. Another (in countries where the consent of relatives is required for cadaveric organ donation) is to pay relatives for transplant rights over their recently deceased loved ones' bodies. Since the kidney is the most commonly transplanted organ and since the ethics literature on organ sale is mainly about kidney sale from live donors, that is the practice on which this entry will focus. ‘Organ sale’ as the term is used here does not include the sale of body products (a category which includes blood, eggs, hair, and sperm) since this is different in some important respects. For example, the risk of permanent harm is generally much less in the case of blood and hair donation; while, the donation of eggs and sperm raises additional issues relating to the creation and parenting of additional future people. That said, many of the fundamental issues are similar and the very same concerns about (for example) exploitation and consent arise in both cases. An important preliminary point is that almost all serious advocates of allowing payment for human organs argue not for an unfettered ‘free market’ but for a regulated one. Radcliffe Richards et al. (1998, 1950) for example, in their paper “The Case for Allowing Kidney Sales” say: It must be stressed that we are not arguing for the positive conclusion that organ sales must always be acceptable, let alone that there should be an unfettered market. While Wilkinson (2003, 132) is typical of organ sale defenders in wishing to distance himself from today's (largely ‘underground’) organ trade: … far from being a reason to continue the ban on sale, the dreadfulness of present practice may be a reason to discontinue prohibition, so that the organ trade can be brought ‘overground’ and properly regulated. Different scholars have different views about the precise scope and extent of the regulation required, but most support the requirements that organ sellers give valid consent, are paid a reasonable fee, and are provided with adequate medical care. Taylor (2005, 110) for example, says that: At minimum … a market should require that vendors give their informed consent to the sale of their kidneys, that they not be coerced into selling their kidneys by a third party and that they receive adequate post-operative care.
One noteworthy policy proposal comes from Erin and Harris
(1994; 2003) who suggest that a market in human organs should have the following features: It is limited to a particular geopolitical area, such as a state or the European Union, with only citizens or residents of that area being allowed to sell or to receive organs. There is a central public body responsible for making (and funding) all purchases and for allocating organs fairly in accordance with clinical criteria.
Direct sales are banned.
Prices are set at a reasonably generous level to attract people voluntarily into the market.
Charles A Erin and John Harris, Institute of Medicine, Law and Bioethics, School of Law,
University of Manchester J Med Ethics 2003; 29 :141 Janet Radcliffe Richards on our modest proposal http://jme.bmj.com/content/29/3/138.full.pdf+html
Thus when Radcliffe Richards says: “Of course there is something undesirable about a one way international traffic from poor to rich; but that is not enough to settle the all things considered question of whether it should be allowed” she is again right. It is not enough to settle that question. Our paper was not trying to settle that question. 2
We have proposed a scheme that would maximise
organ sales by meeting the most common and persistent objections to commerce in body parts.
In our paper we note that:“In 1994, we made a proposal in which we outlined possibly the only circumstances in which a market in donor organs could be achieved ethically, and in a way that minimises the dangers normally envisaged for such a scheme” and this is the proposal that we repeat in abbreviated form. The claim we make, which it seems Radcliffe Richards judges tobe too strong, is that our proposal outlines
“possibly the only circumstances in which a market in donor organs could be achieved ethically”; but note that there is a qualification to this claim, namely that if the first part of our claim is true it is so because it defends organ sales “in a way that minimises the dangers normally envisaged for such a scheme”. It may be that organ sales could be defended (possibly by Janet Radcliffe Richards and for that matter by the present authors) in a way that does not minimise such dangers. But that is not what we were trying to do in our paper.

Michael Gill, Ph.D., Assistant Professor, Department of Philosophy, College of Charleston AND Robert
Sade, M.D.,Professor in the Department of Surgery and Director of the Institute of Human Values in Health Care,
Medical University of South Carolina. Kennedy Institute of Ethics Journal 12.1 (2002) 17-45
Paying for Kidneys: The Case against Prohibition http://muse.jhu.edu/journals/kennedy_institute_ of_ethics_journal/v012/12.1gill.html
First, we are arguing for the claim that it ought to be legal for a person to be paid for one of his or her kidneys. We are not arguing that it ought to be legal for a potential recipient to buy a kidney in an open market. We propose that the buyers of kidneys be the agencies in charge of kidney procurement or transplantation; that is, we propose that such agencies should be allowed to use financial incentives to acquire kidneys. We assume that allocation of kidneys will be based on medical criteria, as in the existing allocation system for cadaveric organs. Kidneys will not be traded in an unregulated market. 2 A similar system is currently in place for blood products: a person can receive money for providing blood products, but one's chances of receiving blood are distinct from one's financial status. We further note that transplant recipients or their agents—e.g., insurance companies, Medicaid—pay for organs now, compensating the organ procurement organization that organizes the organ retrieval, the surgeon who removes the organ, the hospital where the organ is procured, and so forth. The only component of the organ procurement process not currently paid is the most critical component, the possessor of the kidney, who is sine qua non for organ availability.
Second, we believe the legalization of kidney sales will increase the number of kidneys that are transplanted each year and thus save the lives of people who would otherwise die. We base this belief on two views that seem to us very plausible: first, that financial incentives will induce some people to give up a kidney for transplantation who would otherwise not have done so; and second, that the existence of financial incentives will not decrease significantly the current level of live kidney donations. The first view seems to us to follow from the basic idea that people are more likely to do something if they are going to get paid for it. The second view seems to us to follow from the fact that a very large majority of live kidney donations occur between family members and the idea that the motivation of a sister who donates a kidney to a brother, or a parent who donates a kidney to a child, will not be altered by the existence of financial incentives. Although we think these views are plausible, we acknowledge that there is no clear evidence that they are true. If subsequent research were to establish that the legalization of kidney sales would lead to a decrease in the number of kidneys that are transplanted each year, some of the arguments we make would be substantially weakened. 3 Third, we are arguing for allowing payment to living kidney donors, but many of the kidneys available for transplantation come from cadavers. [End Page 19] We believe that payment for cadaveric organs also ought to be legalized, but we will not discuss that issue here. If we successfully make the case for allowing payment to living donors, the case for payment for cadaveric kidneys should follow easily. The Prima Facie Case for Kidney Sales With these preliminary points in mind, we will proceed to the initial argument for permitting payment for kidneys. 4 This argument is based on two claims: the "good donor claim" and the "sale of tissue claim." The good donor claim contends that it is and ought to be legal for a living person to donate one of his or her kidneys to someone else who needs a kidney in order to survive. These donations typically consist of someone giving a kidney to a sibling, spouse, or child, but there are also cases of individuals donating to

strangers. Such donations account for about half of all kidney transplants. 5 Our society, moreover, does not simply allow such live kidney donations. Rather, we actively praise and encourage them. 6
We typically take them to be morally unproblematic cases of saving a human life. The sale of tissue claim contends that it is and ought to be legal for living persons to sell parts of their bodies. We can sell such tissues as hair, sperm, and eggs, but the body parts we focus on here are blood products. A kidney is more like blood products than other tissues because both are physical necessities: people need them in order to survive. Our proposed kidney sales are more like the sale of blood products in that both involve the market only in acquisition and not in allocation: the current system pays people for plasma while continuing to distribute blood products without regard to patients' economic status, just as we propose for kidneys. We do not typically praise people who sell their plasma as we do people who donate a kidney to save the life of a sibling. At the same time, most people do not brand commercial blood banks as moral abominations. We generally take them to be an acceptable means of acquiring a resource that is needed to save lives. 7 It is doubtful, for instance, that there would be widespread support for the abolition of payment for plasma if the result were a reduction in supply so severe that thousands of people died every year for lack of blood products. If both the good donor claim and the sale of tissue claim are true, we have at least an initial argument, or prima facie grounds, for holding that payment for kidneys ought to be legal. The good donor claim implies that it ought to be legal for a living person to decide to transfer one of his or [End Page 20] her kidneys to someone else, while the sale of tissue claim implies that it ought to be legal for a living person to decide to transfer part of his or her body to someone else for money. It thus seems initially plausible to hold that the two claims together imply that it ought to be legal for a living person to decide to transfer one of his or her kidneys to someone else for money. Of course, there seems to be an obvious difference between donating a kidney and selling one: motive. Those who donate typically are motivated by benevolence or altruism, while those who sell typically are motivated by monetary self-interest. 8 The sale of tissue claim suggests, however, that this difference on its own is irrelevant to the question of whether kidney sales ought to be legal, because the sale of tissue claim establishes that it ought to be legal to transfer a body part in order to make money. If donating a kidney ought to be legal (the good donor claim), and if the only difference between donating a kidney and selling one is the motive of monetary self-interest, and if the motive of monetary self-interest does not on its own warrant legal prohibition (the sale of tissue claim), then the morally relevant part of the analogy between donating and selling should still obtain and we still have grounds for holding that selling kidneys ought to be legal. There is also an obvious difference between selling a kidney and selling plasma: the invasiveness of the procedure. Phlebotomy for sale of plasma is simple and quick, with no lasting side effects, while parting with a kidney involves major surgery and living with only one kidney thereafter. It is very unlikely, however, that there will be any long-term ill effects from the surgery itself or from life with a single kidney. 9 Indeed, the laws allowing live kidney donations presuppose that the risk to donors is very small and thus morally acceptable. The good donor claim implies, then, that the invasiveness of the procedure of transferring a kidney is not in and of itself a sufficient reason to legally prohibit live kidney transfer. If the only difference between selling plasma and selling a kidney is the risk of the procedure, and if that risk does not constitute grounds for prohibiting live kidney transfers, then the morally relevant part of the analogy between selling plasma and selling a kidney still should obtain and we still have grounds for holding that kidney sales ought to be legal. The point of the preceding two paragraphs is this: if we oppose the sale of kidneys because we think it is too dangerous, then we also should oppose live kidney donations. But we do

not oppose live kidney donations because we realize that the risks are acceptably low and worth taking [End Page 21] in order to save lives. So, it is inconsistent to oppose selling kidneys because of the possible dangers while at the same time endorsing the good donor claim. Similarly, if we oppose kidney sales because we think people should not sell body parts, then we should also oppose commercial blood banks. But most people do not oppose blood banks because they realize that the banks play an important role in saving lives. So, it is inconsistent to oppose selling kidneys because it involves payment while at the same time endorsing the sale of tissue claim. 10 The considerable emotional resistance to permitting kidney sales may be based on a combination of distaste for payment and worry about risk. But if neither of these concerns on its own constitutes defensible grounds for opposing payment, then it seems unlikely that the two of them together will do so. This initial argument does not imply that we should legalize the sale of hearts and livers. The initial argument holds only that, if it is medically safe for living people to donate an organ, then people should also be allowed to sell that organ. But it is not medically safe for a living person to donate his or her heart or liver. Our reliance on the good donor claim does, however, commit us to the idea that if it is morally correct to allow someone to donate an organ or part of an organ, then it is morally correct to allow someone to sell that organ or organ part. If, therefore, it is morally correct to allow people to donate liver lobes and parts of lungs, then, according to our initial argument, it ought to be legal for a person to sell a liver lobe or part of a lung as well. Our proposal does not address the purchase of kidneys, which is a separate question. Many of the arguments against legalizing the purchase of kidneys do not apply to the sale of kidneys. For example, one argument against permitting the buying of kidneys is that it will lead to fewer kidneys for transplantation overall.
Another argument is that while allowing individuals to purchase kidneys might not reduce the overall number of kidneys available for transplantation, it will reduce the number of donated kidneys and harm the poor who will not be able to afford to buy a kidney. Both arguments rest on empirical claims that are often stated as fact, yet have no supporting evidence. Even if the empirical claims were accurate, moreover, their moral importance could be disputed. Perhaps there are powerful moral reasons to legalize the buying of organs even if doing so leads to fewer organs overall or reduces the chances of a poor person's receiving a kidney transplant. Then again, perhaps a negative effect on the overall supply of kidneys or on the transplantation prospects [End Page 22] for the poor will turn out to be a conclusive reason not to legalize the buying of kidneys. The important point is that our proposal will not be affected either way. As already noted in our preliminary points, our proposal can be reasonably expected both to increase the overall number of kidneys for transplantation and to increase the chances that a poor person who needs a kidney will receive one.
Therefore, in arguing for the legalization of kidney sales, we put aside the separate question of whether buying kidneys ought to be legal as well. government purchaser avoids exploitation
Erin and Harris 3 Charles A Erin and John Harris, Institute of Medicine, Law and Bioethics, School of
Law, University of Manchester, J Med Ethics 2003;29:137-138 An ethical market in human organs http://jme.bmj.com/content/29/3/137.full
While people’s lives continue to be put at risk by the dearth of organs available for transplantation, we must give urgent consideration to any option that may make up the shortfall.
A market in organs from living donors is one such option.
The market should be ethically supportable, and have built into it, for

example, safeguards against wrongful exploitation. This can be accomplished by establishing a single purchaser system within a confined marketplace.
Inequality in ability to purchase is avoided with central purchasing
Radcliffe-Richards et al 98 J. Radcliffe-Richards, Department of Philosophy, the Open University,
Milton Keynes et al J; Daar, A S; Guttmann, R D; Hoffenberg, R; Kennedy, I; Lock, M; Sells, R A;
Tilney, N The Lancet Volume 351(9120) 27 June 1998 pp 1950-1952 The case for allowing kidney sales http://elsa.berkeley.edu/pub/users/webfac/held/157_VIII.pdf
Another familiar objection is that it is unfair for the rich to have privileges not available to the poor.
This argument, however, is irrelevant to the issue of organ selling as such. If organ selling is wrong for this reason, so are all benefits available to the rich, including all private medicine, and, for that matter, all public provision of medicine in rich countries (including transplantation of donated organs) that is unavailable in poor ones. Furthermore, all purchasing could be done by a central organization responsible for fair distribution
. [12]
Margaret R. Sobota, J.D. Candidate (2005), Washington University School of Law. Washington
University Law Quarterly Fall, 2004 82 Wash. U. L. Q. 1225 NOTE: THE PRICE OF LIFE: $ 50,000 FOR AN EGG, WHY NOT
$ 1,500 FOR A KIDNEY? AN ARGUMENT TO ESTABLISH A MARKET FOR ORGAN PROCUREMENT SIMILAR TO THE CURRENT
MARKET FOR HUMAN EGG PROCUREMENT lexis
A. Arguments Opposing a Market for Organ Procurement
The main argument against establishing a market for organ procurement is economic coercion. n141
Market opponents insist that poor, destitute people from around the world will be forced into selling their organs without making an in-formed decision. n142 There are several flaws with this argument. n143 First, the economic coercion argument is based on the false premise that the prices donors will be paid for their organs will be high enough to override their doubts and ethical concerns about becoming a donor. n144 In the proposed market system for organ procurement, either OPOs or the state will be paying the donors; thus preventing potential wealthy recipients from driving up the prices paid for organs. n145 With only moderate prices being paid to organ donors, economic incentives would likely not outweigh a donor's moral objections to donation, and thus no economic coercion would occur. n146 Additionally, the current market system for egg donation suggests that economic coercion would not be a problem in a market for organ procurement. n147 A majority of
egg donors are not poor or minority women, and the amounts paid to them for their donations are usually not an "undue inducement to undergo the medical [*1246] risks involved." n148 These facts suggest that if a system of financial compensation for organ donation were established, comparable to the system already in place for egg donation, there would similarly be no economic coercion of donors.

Michael Gill, Ph.D., Assistant Professor, Department of Philosophy, College of Charleston AND Robert
Sade, M.D.,Professor in the Department of Surgery and Director of the Institute of Human Values in Health Care,
Medical University of South Carolina. Kennedy Institute of Ethics Journal 12.1 (2002) 17-45
Paying for Kidneys: The Case against Prohibition http://muse.jhu.edu/journals/kennedy_institute_ of_ethics_journal/v012/12.1gill.html
The international black market in kidneys is worthy of moral condemnation, and the popular press has been right to expose it. But the horrible stories do not constitute justification for a blanket rejection of payment for kidneys in this country because there are two crucial differences between the international black market and the legal domestic program we propose.
First, in our proposal the medical setting in which legal kidney transfer would take place is that of contemporary transplantation, safe and medically sophisticated. Screening would select only potential kidney sellers whose kidneys are suitable for transfer and whose medical condition predicts minimal risk. Follow-up care would be scrupulous. Sellers would receive exactly the same medical attention and treatment that living kidney donors now receive in this country. The people to whom the kidneys are transferred will also receive the same medical attention and treatment that kidney recipients currently receive.
Second, the domestic program we propose involves money only in the acquisition of kidneys, unlike the international black market. Allocation of kidneys would be based on medical criteria, as it is today. No private individual would be able to buy a kidney outside the system. Poor individuals will have just as much chance of receiving one of the kidneys.
J. Randall Boyer, J.D. candidate, April 2012, J. Reuben Clark Law School, Brigham Young University.
2012 Brigham Young University Law Review 2012 B.Y.U.L. Rev. 313 COMMENT: Gifts of the Heart ... and Other
Tissues: Legalizing the Sale of Human Organs and Tissues lexis
B . Commoditization Has Already Happened The societal interests supporting the prohibition of organ sales also assume that quantifying the value of the human body is bad. n137 However, the current system, to which no ethical qualms are raised, in fact quantifies the value of the human body. n138
As such, an analysis of the consequences of quantification does not have to be simply hypothetical, but can be based on current observation. In the context of this current commoditization, the ethical objections to the sale are simply not as grave as when viewed in isolation. On an empirical level, there is no disputing that the human corpse now has a substantial economic value. n139 And while the law has prohibited at least the initial sale of organs, it has not prohibited the purchase of an organ. n140 Simply put, to say that the law prohibits attaching a price tag to a donated organ is to ignore reality. n141 The high demand and willingness to pay for organs, coupled with the short supply, has created a lucrative business for organ-brokering middlemen, who flip essentially costless,

donated organs for large profits. n142 In fact, the prices at which organs are traded are [*334] so high that they have enticed many to undertake more creative methods of procurement. n143
Further, organs are often subject to a string of transactions in which they are appraised and exchanged for money. Organs are first donated by individuals, then sold by hospitals to tissue banks, then sold by tissue banks to biotech companies, then processed and refurbished before being sold to hospitals and dentists, and finally implanted into the "end-consumer." n144 At each of these transfers - with the exception of the very first - money is exchanged for the organ. n145 Perhaps more importantly, current jurisprudence recognizes a legal interest in the organ of each of these players in each transaction - again with the exception of the first - and has validated sales contracts for human tissue. n146 Thus, both markets and the law itself treat organs as a commodity in all but one of the series of transactions from donor to recipient.
Steve P. Calandrillo, Associate Professor, Univ. of Washington School of Law. J.D., Harvard Law
School. B.A. in Economics, Univ. of California at Berkeley. George Mason Law Review Fall, 2004 13 Geo. Mason
L. Rev. 69 ARTICLE: Cash for Kidneys? Utilizing Incentives to End America's Organ Shortage lexis
The objections to human organ sales detailed above all contain some merit, but lose some of their force upon closer analysis and further ignore the reality that markets in human body parts and products are, for all practical purposes, unavoidable. n176 Morality concerns opposing commodification of the human body are somewhat hypocritical when one considers that we allow the explicit payment of cash for human tissues, blood, semen and ova. n177 We also have no moral qualms about requiring individuals to pay for medical care in general, without which their health and lives can be expected to suffer. The argument regarding the distributive justice impact of allowing sales (i.e., that the poor would be sellers, and only the rich could be buyers) ignores the fact that organ transplants are still rationed on the basis of ability to pay today. n178 Further, distributive inequity could be partially cured by providing government subsidies to enable the poor to have equal access to available organs. n179 [*106]
J. Randall Boyer, J.D. candidate, April 2012, J. Reuben Clark Law School, Brigham Young University.
2012 Brigham Young University Law Review 2012 B.Y.U.L. Rev. 313 COMMENT: Gifts of the Heart ... and Other
Tissues: Legalizing the Sale of Human Organs and Tissues lexis n150. As mentioned previously, the price for a kidney has reached $ 90,000. Steinbuch, supra note
96, at 1562. Further, research institutions pay large sums of money for fresh and frozen cadavers or parts thereof. Cheney, supra note 12, at xv. For an interactive display based on the same information, see Body Parts Pipeline, USA Today, http://www.usatoday.com/money/graphics/body_parts/flash.htm (last visited Jan. 18, 2012). Also, one website has set up a cadaver calculator whereby, after answering a series of questions regarding lifestyle, one can find out how much her body would be worth in the event of her death. The Cadaver
Calculator: How Much Is Your Body Worth?, Cadaver Calculator, http://www.oneplusyou.com/bb/cadaver (last visited Jan. 18, 2012).

Meskill 09
(David, professor at Colorado School of Mines and PhD from Harvard, “The "One Percent Doctrine" and Environmental Faith,”
Dec 9, http://davidmeskill.blogspot.com/2009/12/one-percent-doctrine-and-environmental.html)
Tom
Friedman's piece
today in the Times on the environment (http://www.nytimes.com/2009/12/09/opinion/09friedman.html?_r=1) is one of the flimsiest pieces by a major columnist that I can remember ever reading. He applies Cheney's "one percent doctrine"
(which is similar to the environmentalists' "precautionary principle") to the risk of environmental armageddon. But this doctrine is both
intellectually incoherent and practically irrelevant.
It is intellectually incoherent because it cannot be applied consistently in a world with many potential disaster scenarios. In addition to the global-warming risk, there's also the asteroid-hitting-the-earth risk, the terrorists-with-nuclear-weapons risk
(Cheney's original scenario), the super-duper-pandemic risk, etc. Since each of these risks, on the "one percent doctrine,"
would deserve all of our attention, we cannot address all of them simultaneously. That is, even within the one-percent mentality, we'd have to begin prioritizing, making choices and trade-offs
. But why then should we only make these trade-offs between responses to disaster scenarios?
Why not also choose between them and other,
much more cotidien, things we value? Why treat the unlikely but cataclysmic event as somehow fundamentally different
, something that cannot be integrated into all the other calculations we make? And in fact, this is how we behave all the time.
We get into our cars in order to buy a cup of coffee, even though there's some chance we will be killed on the way to the coffee shop. We are constantly risking death, if slightly, in order to pursue the things we value. Any creature that adopted the "precautionary principle" would
sit at home - no, not even there, since there is some chance the building might collapse. That creature would neither be able to act, nor not act, since it would nowhere discover perfect safety
. Friedman's approach reminds me somehow of Pascal's wager - quasi-religious faith masquerading as rational deliberation (as
Hans Albert has pointed out, Pascal's wager itself doesn't add up: there may be a God, in fact, but it may turn out that He dislikes, and even damns, people who believe in him because they've calculated it's in their best interest to do so). As my friend James points out, it's striking how descriptions of the environmental risk always describe the situation as if it were five to midnight. It must be near midnight, since otherwise there would be no need to act. But it can never be five *past* midnight, since then acting would be pointless and we might as well party like it was 2099. Many religious movements
- for example the early Jesus movement - have exhibited precisely this combination of traits: the looming apocalypse, with the time (just barely) to take action
.
Yudkowsky 06 [Eliezer, 8/31/2006. Singularity Institute for Artificial Intelligence Palo Alto, CA.
“Cognitive biases potentially affecting judgment of global risks, Forthcoming in Global Catastrophic
Risks, eds. Nick Bostrom and Milan Cirkovic, singinst.org/upload/cognitive-biases.pdf.
The conjunction fallacy similarly applies to futurological forecasts
. Two independent sets of professional analysts at the Second International Congress on Forecasting were asked to rate, respectively, the probability of "A complete suspension of diplomatic relations between the USA and the Soviet Union, sometime in 1983" or "A Russian invasion of Poland, and a complete suspension of diplomatic relations between the USA and the Soviet Union, sometime in 1983". The second set of analysts responded with significantly higher probabilities. (Tversky and Kahneman 1983.)
In Johnson et. al. (1993), MBA students at Wharton were scheduled to travel to Bangkok as part of their degree program. Several groups of students were asked how much they - 6 - were willing to pay for terrorism insurance. One group of subjects was asked how much they were willing to pay for terrorism insurance covering the flight from Thailand to the US. A second group of subjects was asked how much they were

willing to pay for terrorism insurance covering the round-trip flight. A third group was asked how much they were willing to pay for terrorism insurance that covered the complete trip to Thailand. These three groups responded with average willingness to pay of $17.19, $13.90, and
$7.44 respectively.
According to probability theory, adding additional detail onto a story must render the story less probable
. It is less probable that Linda is a feminist bank teller than that she is a bank teller, since all feminist bank tellers are necessarily bank tellers.
Yet human psychology seems to follow the rule that adding an additional detail can make the story more plausible.
People might pay more for international diplomacy intended to prevent nanotechnological warfare by China, than for an engineering project to defend against nanotechnological attack from any source. The second threat scenario is less vivid and alarming, but the defense is more useful because it is more vague. More valuable still would be strategies which make humanity harder to extinguish without being specific to nanotechnologic threats - such as colonizing space, or see Yudkowsky (this volume) on AI. Security expert Bruce Schneier observed (both before and after the 2005 hurricane in New Orleans) that the U.S. government was guarding specific domestic targets against "movie-plot scenarios" of terrorism, at the cost of taking away resources from emergency-response capabilities that could respond to any disaster.
(Schneier 2005.)
Overly detailed reassurances can
also create false perceptions of safety
: "X is not an existential risk and you don't need to worry about it, because A, B, C, D, and E"; where the failure of any one of propositions A, B, C, D, or E potentially extinguishes the human species. "We don't need to worry about nanotechnologic war, because a UN commission will initially develop the technology and prevent its proliferation until such time as an active shield is developed, capable of defending against all accidental and malicious outbreaks that contemporary nanotechnology is capable of producing, and this condition will persist indefinitely."
Vivid, specific scenarios can inflate our probability estimates of security, as well as misdirecting defensive investments into needlessly narrow or implausibly detailed risk scenarios
.
More generally, people tend to overestimate conjunctive probabilities and underestimate disjunctive probabilities
. (Tversky and Kahneman 1974.) That is, people tend to overestimate the probability that
, e.g., seven events of 90% probability will all occur
. Conversely, people tend to underestimate the probability that at least one of seven events of 10% probability will occur
. Someone judging whether to, e.g., incorporate a new startup, must evaluate the probability that many individual events will all go right (there will be sufficient funding, competent employees, customers will want the product) while also considering the likelihood that at least one critical failure will occur (the bank refuses - 7 - a loan, the biggest project fails, the lead scientist dies). This may help explain why only 44% of entrepreneurial ventures3 survive after 4 years. (Knaup 2005.)