SOUTH BEND, IND. — SOUTH BEND, Ind. -- Despite campaigns to improve public awareness of the benefits of organ donation, the sharp upswing in demand for human organs has not been accompanied by a corresponding increase in supply.
While solutions of both the carrot and the stick variety have been offered to reverse the donor dearth, none has proved successful. The unmet demand for organs has fostered commercialization and, at times, exploitation of donors and their families.
"Market-based" methods of organ procurement have been proposed but are little more than a euphemism for buying and selling of body parts. Prospective "organ vendors" could "opt-in" to an organ "futures market." After their deaths, their estates would share in the substantial financial benefits currently enjoyed by a few for-profit tissue brokers. So-called "rewarded gifting" -- a contradictory term concocted to blunt the funny aftertaste that comes from knowing you've just put your innards up for sale -- is unlikely to gain wide acceptance.
Before organ transplantation, laws regarding disposition of a dead person's body made it clear that executors of an estate could not make it an item of commerce. The body was not considered "property" in the legal sense, thus not a part of the person's estate. But as transplantation succeeded, living organs acquired value and laws were adapted to fit the new reality.
Under the Uniform Anatomical Gift Act, which regulates procurement and distribution of human organs for medical purposes, it is still illegal to sell the dead body or its parts, but not to give them away.
So some nonprofit procurement groups pitch donation to surviving family members, then charge hefty processing fees to for-profit distributors. At times, the same people run both operations. The problem is that these organizations deliberately blur the distinction between giving and selling.
In his insightful book, "The Gift," Lewis Hyde proposes two contrasting "economies": a "market economy," where things are valued, bought and sold in a calculated exchange; and a "gift economy," where goods are given freely without calculation.
Gifts cannot be purchased or traded, only bestowed on one person by another. Gifts are not capital: Rather than foster competitive self-interest and social fragmentation, they create and strengthen bonds between individuals.
We all like to give and receive gifts because they express values that money can't buy: the esteem of one person for another; the desire that others may experience good fortune and share in the prosperity of the giver. Gifts unite. Capital divides. The practice of organ transplantation occupies the intersection of these two economies: One man's gift becomes another man's capital.
Costs incurred by processing organs should in fairness be covered, and some could argue that a reasonable profit may be made in the process. But the organ itself, the generosity of the donor's family and the life that is prolonged are values that resist an economic paradigm.
According to Mr. Hyde, "Transactions that involve life itself seem to constitute the primary case in which we feel called upon to distinguish the right of bestowal from the right of sale."
The industrial age we are leaving behind was characterized by the conflict of capital and labor. As the new era of biotechnology begins, the new dialectic may be defined by the dichotomy of commodity and gift.
Biotechnology forces us to put price tags on the priceless, to confuse gift and commodity, persons and property. The tension created by these contrasting values -- already evident in the debates on gene patenting, and use of stem cells or fetal tissue for the treatment of disease -- may introduce original and unexpected notions of value and wealth.
Life is the ultimate gift: It is bestowed, not taken, made or earned. And it is a gift of incalculable value. Hopefully, we'll discover that we have much to gain by giving away what never really belonged to us.
Jose Bufill is a medical oncologist in South Bend, Ind.