One liver to the highest bidder


MICKEY MANTLE's recent operation for a new liver has raised some serious questions about the organ transplant system. Some people have questioned whether the 63-year-old former Yankee slugger received the liver so quickly -- only two days after going on a national waiting list -- because of his fame.

Although the normal waiting period in the transplant program is 130 days, patients as critically ill as Mr. Mantle generally receive new organs within an average of three days. Organ banks say Mr. Mantle received no special treatment because of his celebrity status.

But the main reason for questions about why and how Mr. Mantle received a new liver is because there are not enough livers to go around. Eight or nine Americans died waiting for an organ transplant on the day Mr. Mantle received a new lease on life.

As medical advances continue to expand the number of people eligible for transplants, this chronic shortage will only worsen. Currently 44,568 Americans are on the waiting list for an organ transplant, according to the United Network for Organ Sharing. That's an increase of 210 percent since 1987. But despite expanding the donor pool to include people over 55 and people who have hypertension or who have an infection, the supply of donor organs has increased only 2 percent to 3 percent annually. The tragic result: 3,100 Americans died last year while on the waiting list.

The actual number of deaths related to the organ shortage could be far higher. The supply of available organs limits the number of patients who can be helped, so transplant centers set extremely stringent standards for getting on a waiting list. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, has said that of the 25,000 Americans who die of liver disease each year, 15,000 might have been transplant candidates.

Elected officials need to re-examine the policies surrounding organ transplants. The primary goal of these policies should be to increase the supply of organs. The best way to do this is to compensate organ donors financially. But the National Organ Transplant Act of 1984 prohibits the purchase or sale of human organs.

Many people argue that organs should be provided solely by generosity and find the idea of buying and selling human organs repugnant. But why shouldn't a person whose organs save lives be financially compensated? Organ transplants are a lucrative enterprise for the doctors and hospitals that perform them and for the organizations that obtain the organs. No one is suggesting that they work for free. Everyone makes money on organ transplants -- the doctors, the hospitals -- but not the donor.

Even relatively small compensation might encourage more people to donate organs. And compensation could come in a variety of forms, cash or perhaps even an organ swap. A person could sign a medical directive to dispose of his organs like any other possession. After his death, serviceable organs would be harvested and his estate or beneficiary would receive a death benefit much like a life insurance policy.

Opponents of an organ market contend that only the rich would be able to afford organs and the poor would become organ banks for them. This is a paternalistic attitude that suggests that the poor are unable to make rational decisions. A person might be better off selling a kidney to rise out of poverty than keeping both kidneys.

While many may find the idea of selling body parts distasteful, the alternative is to condemn thousands of people to a needless death.

Ed Carson is a reporter for Reason, a social and political commentary magazine based in Los Angeles. He wrote this for the Los Angeles Times.

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