Monday, January 12, 2009

LoUC and Organ Trading

There was a recent news report speculating that a local tycoon who had been charged with attempting to buy a kidney had received an organ from an executed convict. See the article here.

Bearing in mind that the donation was a directed one (in which the donor specifies explicitly who is to receive his organs), and considering the rapidity with which Tang Wee Sung received the organ, his age, and his admittedly poor health that renders him a less than ideal organ transplant patient, it's tempting to speculate if any ex gratia payment was made by him to those Tan Chor Jin is survived by. 

Now far be it for me to impugn the character of anyone in this matter, or to speak ill of the dead. I am doing neither. I am merely using this to illustrate a possible effect of the Law of Unintended Consequences (LoUC) should organ trading be legalized. I am neither for or against organ trading. I simply am not wise enough to know which is the better option, hence I choose to reserve my opinions.

Many people have spoken of in favor or against organ trading. One prominent local blogger, for instance, has written on it.

One argument against legalizing organ trading is that it permits the poor and destitute to be exploited by those rich enough to pay for their organs.

I have a different take on this, and that is that legalizing organ trading could reduce the supply of organs for patients too poor to pay for them. Do bear in mind that this in no way necessarily means that I am against legalizing organ trading. I am merely exploring consequences here.

The strength of the legalization argument rests on the premise that it would immediately raise the number of organ transplants (lubricated by money), hence increasing the number of lives saved.

Economics tells us that by having a clear and transparent market for organs, the own price elasticity of organ supply should increase (when it is now exceedingly inelastic, being illegal), leading to a rise in the number of transactions (i.e. lives saved) and a fall in the market price for organs (the fall in price is relative to the presumable black market price for an organ, or any analogous illegal product, like a narcotic drug). The implicit assumption is that the demand for organs remains unchanged, which is a reasonable assumption to make, given that a person either needs or doesn't need an organ, and organs can't be stored. 

So far, it's all good. More lives saved, cheaper organs. But the key thing to note here is that the "cheaper" applies only to people who are willing and able to pay for organs anyway, even to the extent of going to the black market, like tycoon Tang did. What about patients who are too poor to pay the market price for organs? What then, since the demand for organs is almost always much higher than the available supply? What happens when something that was formerly a gift of a new lease of life is now commoditized and subject to the discipline of the market? Will poor organ transplant patients be priced out of the market?

And will it stop there? What if the donors who had formerly donated their organs now choose to hold back, seeking payments for themselves and their families? What will that do to the market clearing price for an organ? Will middle-class patients find themselves gazumped at the last minute, outbid by someone who is willing to pay more? In Singapore, where our society is already one of the most inequitable on Earth, will organ trading also lead to organ transplants being one more thing that will be reserved only to the rich?

Certainly, the story I highlighted above about Tang Wee Sung doesn't exactly lend confidence to the view that these things will not happen.


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