From the January 23, 2008 Daily Telegraph
January 23, 2008
by Irwin Stelzer
The Government already appropriates to itself almost 45 percent of all the wealth created in Britain by those of its citizens who choose to toil in the workplace rather than watch television on the sitting-room couch. It wants more.
Unless you make it clear in writing that you don't want to do so, on your death your Government will take your house and car, and give it to someone it deems worthy - or likely to show appreciation by voting to keep it in office.
Well, not quite. It doesn't want your car. But it does want your heart, liver, corneas and what Polly Toynbee calls your "spare parts". The motives behind the latest proposal to snatch your organs, unless you have the foresight to "opt out", are noble.
There is what the Prime Minister calls "an avoidable human tragedy" created by the fact that the need for organs far exceeds the supply. No one can argue that reasonable steps to increase the supply of organs would be a good thing.
But it is important to clear the intellectual debris before starting a reasoned debate. The Prime Minister says he wants to "start a debate … about whether we should take steps to move towards a new system". Good idea. We should begin by being careful in our handling of the multiple statistics being bandied about.
Miss Toynbee, who leads the cheering section for the Prime Minister's opt-out proposal, wants our spare parts put to good use despite "a few vociferous people's misguided and primitive instincts about the sanctity and integrity of corpses".
Like Mr Brown, she notes that 90 per cent of us favour organ donation, but only 25 per cent make advance arrangements to become donors. From that, the opt-out advocates conclude that most of the non-donors are merely negligent: they forget to register. Really?
It is equally plausible that non-participants have no objection to the procedure, but simply do not want to participate, just as many (most) people have no objection to elections, but choose not to participate, for reasons sufficient unto themselves.
Equally fallacious is the proposition that the opt-out system is the best way to increase donations by those who, had they thought about it, would have become donors.
In my home state of Colorado, everyone applying for or renewing a driver's licence is asked whether he or she cares to be an organ or tissue donor, and, if the answer is "yes", is placed in the registry. Such a system eliminates the possibility that otherwise willing donors overlook the opportunity to participate in a donor programme.
So let's turn to the real issue: how do we increase the supply of organs so that we can accomplish the Prime Minister and Miss Toynbee's laudable goal of reducing the death rate and relieving the suffering of those in need of transplants?
Take some other government programmes as a model. The Government wants to pay youngsters to stay in school, so as to increase the supply of employable workers, agrees to massive payments to farmers to increase the supply of food, and raises nurses' and doctors' pay so as to increase the supply of healthcare workers. Is it not possible that sauce for these geese is sauce for the donor gander?
Instead of attempting to snatch organs from those who did not have the wit or the foresight to opt out, why not organise a market for organs?
There is no question that paying living donors for a kidney has increased the world supply of kidneys, although Britain's prohibition of such an arrangement confines that new supply to those wealthy enough to travel abroad to connect with willing donors. And it drives some of the trade underground, unnecessarily increasing the risk to both parties to the transaction.
Many people find the prospect of being carved up after death - or perhaps while still alive, but brain-dead - grisly and off-putting, just as many people find going to work off-putting. But pay them, and they overcome their aversion to rising early, facing the agony of the transport system and missing an opportunity to catch up on the latest television soap opera.
So, too, with organ donation. Yes, there are a number of people whose desire to do good will impel them to sign up as donors, for which we should be thankful. But there are not enough, leaving an estimated 5,000 people waiting in pain, and in many cases dying, for lack of a donor.
Imagine, now, that one of two systems was put in place. System one: private parties can negotiate to buy organs. That is simple in the case of live donors of kidneys. For other organs, there would be a registry of potential buyers.
Anyone who wishes to become a donor on death, so that he can leave his family an inheritance, can register, and at the time of his passing become a paid-for donor, with the proceeds passing to his estate, tax-free if the Government wants to give the programme a bit of a boost.
That, of course, will immediately rouse the ire of those who don't like the way markets distribute goods and services. In this delicate policy area, the objection that only the rich will get organs is worthy of careful consideration. But keep in mind that those fortunate enough to buy organs from those who make them available only in return for payment will relieve the pressure on the supply of freely donated organs.
Still, it is possible to meet this objection by another system: have the Government buy the organs, and distribute them according to any criteria that it deems fair - although be warned: politicisation of this process might just create as much unfairness as would a market-based system, perhaps leavened with subsidies to those who need transplants and have rendered special service to the state, such as defence of the realm.
I agree with the Prime Minister, if he really intends to have a debate on this issue, and with Miss Toynbee, who says the problem of just how to increase the supply of organs warrants "an important battle of ideas". Let reason and mercy prevail.
Irwin Stelzer is a Senior Fellow and Director of Economic Policy Studies for the Hudson Institute. He is also the U.S. economist and political columnist for The Sunday Times (London) and The Courier Mail (Australia), a columnist for The New York Post, and an honorary fellow of the Centre for Socio-Legal Studies for Wolfson College at Oxford University. He is the founder and former president of National Economic Research Associates and a consultant to several U.S. and United Kingdom industries on a variety of commercial and policy issues. He has a doctorate in economics from Cornell University and has taught at institutions such as Cornell, the University of Connecticut, New York University, and Nuffield College, Oxford.
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