ECO2023 Florida International University Organ Trade Economics Paper He will be addressing the issue in the upcoming commission meeting and needs an economic analysis of the situation completed before then for review. Refer to the articles Black Market Bodies and Meat Market (posted below) to help you begin to your analysis. Use the articles and other references you may find to evaluate the limitations that exist with the current ‘solution’ to meeting organ demand in the US.
The governor asks that you draw upon your critical thinking and problem-solving skills in order to break down the complex problem that exists in the market for organs and help him examine, propose, and support potential solutions. You are encouraged to propose an original solution or contribution even if it deviates from mainstream solutions.
In your analysis you must include the following 6 Sections – DO NOT use section titles, just start a new paragraph:
Current State of the Kidney Market in the U.S.: What is the current state of kidney donation in the US according to the first article? Describe this market using supply and demand; reference your graph in your description. Include “Graph 1” of this market at the end of the paper (not included in page count).
Deregulation of the Kidney Market: Consider what would happen if the US did allow payment for kidney donation [if there is payment involved, can we still call it “donation?”]. Describe the deregulated market (no government intervention, free market system) using supply and demand; reference your graph in your description. Include “Graph 2” of the deregulated market at the end of the paper (not included in page count).
Equity and Efficiency in the Kidney Market: Who gains and who loses in the current state of the kidney market. Who gains and who loses in a deregulated market? Discuss the economic efficiency of the market in its current state and after deregulation; reference your graphs 1 and 2 in your discussion.
Donation Systems Around the World: Explore the policies that are currently implemented across the globe (i.e. those discussed in the articles – routine removal, presumed consent, organ donor points, “no give, no take”, etc.). Evaluate the limitations of these policies. Also consider how these policies fare in terms of the efficiency vs. equity debate. (You do not need to critique them all, just select 2 or 3 that you find interesting/appealing.)
New Policy Proposal: Come up with a policy proposal of your own that might help deal with the vast shortage of kidneys in the US. Use a supply/demand diagram to show how the policy will decrease the current shortage of kidneys and analyze the impact to society; reference your graph in your description. Include “Graph 3” of the market with your new policy changes at the end of the paper (not included in page count).
Recommendations: If you had to pick from one of the policies you described (current state of the market, deregulation, other policies, or your own proposal), which would you recommend for the US? Why? You must defend the policy you choose. If you recommend no changes to the current policy you must defend this recommendation.
Helpful Steps to Examine How a Market Change Will Affect Consumers and Producers:
Determine how the supply/demand curves will shift.
Determine how these shifts will change the equilibrium price/quantity and if a shortage exists/changes.
Determine if the market is more or less efficient.
Analyze how these changes will affect the consumers, producers, and society.
Note:
Paper should be in chicago style (in-text citations and references page), include all 3 appropriate graphs, must include all sections. ECO2023 #GEA1 Rubric
STUDENT’S
SCORE
Learning
Outcome
Component
4
3
2
1
Terminology relevant
to the assignment is
used appropriately in
the bulk of the
commentary.
Terminology
relevant to the
assignment is used
inappropriately
throughout the
much of
commentary.
Terminology relevant to
the assignment is used
inappropriately
throughout the
commentary.
Economic
Concepts
Appropriate use
of economic
terminology _______pts critical/analytical
thinking ‘like an
economist’.
_______pts
Theoretical
analysis
Applies a supply
and demand
diagram to the
policy issue
Terminology
relevant to the
assignment is used
appropriately
throughout the
commentary.
(2 or fewer
mistakes).
(5 or fewer
mistakes).
Clearly presents
and fully explains
the impact of the
proposed change
in terms of a
supply and
demand diagram
Presents and
explains the
impact of the
proposed change
in terms of a
supply and
demand diagram,
but explanation is
unclear
Presents and
explains the
impact of the
proposed
change in terms
of a supply and
demand
diagram, but
presentation
contains factual
errors
Does not present the
impact of the
proposed change in
terms of a supply
and demand
diagram or the
presentation
contains serious
factual errors
Correct
explanation of
the existing
policy. The
effects of the
policy are clearly
stated.
Clearly identifies
and summarizes
main problem,
question or issue.
Identifies
secondary or
implicit issues. If
applicable, notes
relationships
between factors
in the situation
and how they
Some effects are
stated but are not
complete or are
partially incorrect.
Summary of issue
is mostly accurate
but some aspects
are incorrect or
confused; nuances
and critical details
are absent or
glossed over.
Some effects
are stated but
are incorrect.
Summary of
issue is partly
accurate and
many aspects
are incorrect or
confused;
nuances and
critical details
are absent or
glossed over.
There is no
explanation and
evaluation of the
policy
Does not attempt to
or fails to identify
and summarize the
problem accurately
Evaluation
_______pts
Description
And Explanation
of the existing
policy
(8 or fewer
mistakes).
(9 or greater).
relate to each
other.
Problem Solving
Finds solutions
to difficult or
complex issues.
_______pts
Actively seeks
and suggests
solutions to
problems.
Proposed
solutions is
correctly
outlined
And/or
Writing
_______pts
Actively seeks and
suggests solutions
to problems.
Proposed solution
is slightly flawed
(when applying
economic
concepts).
And/or
Does not offer a
new solution
however,
Improves on
previously
existing solutions
Does not offer
new/improved
solutions, but
provides valid
argument for why
current
regulations are
sufficient
Well organized,
demonstrates
logical sequence
and sentence
structure.
Grammar,
spelling, and
punctuation are
correct (4 or
fewer mistakes).
Well organized but
demonstrates
illogical
sequencing or
sentence
structure. Few
grammar, spelling,
and punctuation
mistakes (8 or
fewer mistakes)
____________ Subtotal out of 20 #GEA1
Solution
offered is
extremely
flawed.
And/or
Does not try to offer
new solutions or
defend
existing/defense is
entirely flawed.
Does not offer
new/improved
solutions,
instead argues
current
regulations are
sufficient but
argument is
poor
Well organized,
but
demonstrates
illogical
sequencing and
sentence
structure.
Several
grammar,
spelling, and
punctuation
mistakes (12 or
fewer
mistakes)
____________ 1 point penalty for incomplete/incorrect/missing citations and references
Weakly/unorganized
Many grammar,
spelling, and
punctuation
mistakes (13 or
greater)
____________ 1 point penalty for Turnitin similarity score 30% and above
____________ 2 point penalty if assignment does not meet length and formatting requirements but reasonable (5 point
penalty if unreasonable, 10 point penalty if egregious)
____________ 5 point penalty for late submissions (additional 5 point deduction per 24 hours past due date/time)
____________ + 1 point Extra Credit #GEA1 assignment submitted by Nov 3rd
____________ TOTAL out of 20 #GEA1
Black Market Bodies: How
Legalizing the Sale of Human
Organs Could Save Lives
by Kristin Houser on November 6, 2017
Trafficking in Body Parts
When a failing heart, liver, or other vital organ proves resistant to all available
forms of treatment, a dying patient’s only shot at survival may be an organ
transplant. Unfortunately, there aren’t enough donor organs to save all the
patients who need one. Feeling desperate with precious time running out, some
patients may attempt to purchase an organ illegally. In fact, thousands of sales or
purchases of black market organs take place every year, according to the World
Health Organization.
In the 1980s, Iran had both a shortage of legally donated kidneys and subpar
dialysis equipment to treat the growing segment of the population with end-stage
renal disease (ESRD). It did have highly trained surgeons capable of performing
organ transplants, though. So in 1988, the nation decided on a bold (and
somewhat controversial) new strategy to eliminate the dangers that come with
procuring or receiving an organ illegally: they made it legal for a living person to
sell their kidney.
Nearly three decades later, Iran is one of the few nations without an organ
shortage— every Iranian who needs a kidney can receive one. Should other
nations follow suit?
In 2014, 4,761 Americans died waiting for a kidney transplant.
In 2016, legally donated organs met less than 10 percent of global need,
according to a report from ONT-WHO Global Observatory on Donation and
Transplantation, the world’s most comprehensive source on transplant-related
data. In 2014, 4,761 Americans died waiting for a kidney transplant, and another
3,668 dropped off the list because they became too sick to receive one, notes
the National Kidney Foundation (NKF), an organization dedicated to the
awareness, prevention, and treatment of kidney disease.
Given this substantial need, perhaps it’s not a surprise that people turn to the
black market to save their lives. While exact figures are hard to come by (the
black market doesn’t exactly have any official ways to track it), the illegal trade of
all organs generates between US$840 million and $1.7 billion annually and
accounts for an estimated 10 percent of transplanted organs, according to a 2017
report from Global Financial Integrity (GFI), a non-profit research and advisory
organization focused on illicit financial flows.
Kidneys are the most-frequently sold organs for a fairly simple reason: humans
have two and can live a healthy life with just one. Selling kidneys, then, might
seem like a simple matter of supply and demand — the demand for kidneys is
high, so willing donors should, in theory, be able to negotiate their price from a
position of strength.
However, the population supplying the organs is nothing like the people receiving
them. GFI researchers found that kidney buyers are usually middle- to high-
income individuals from developed countries, while kidney sellers are typically
from the world’s most vulnerable populations. For poor and uneducated citizens
of developing countries, selling a kidney may seem like the only way to escape
poverty or settle a debt.
Recipients may pay upwards of $200,000 for a kidney, but the donor may receive
as little as $5,000 of that (a broker pockets the rest), according to the WHO.
Some donors aren’t paid at all, and because the sale is illegal, they have little
recourse to obtain the money they are owed.
Even worse, inadequately trained surgeons may perform the surgeries under
unhygienic conditions. Donors may be left with dangerous, painful complications
that could force them to miss work or require expensive follow-up care, leaving
the donor in a more financially precarious situation than prior to selling his or
her organ.
A Market Unlike Any Other
By legalizing the sale of kidneys from living donors, Iran has been able to avoid
these pitfalls of a black market, and today, about 55 percent of all kidneys
donated in the nation are from living donors, according to government
statistics obtained by the Associated Press. For comparison, only about 38
percent of kidney donations in the U.S. are from living donors. The rest come
from deceased donors, and those organs aren’t as likely to keep recipients healthy
in the long term.
The process of buying or selling a kidney in Iran is fairly straightforward, a 2011
paper shows. A doctor writes a letter stating that a patient needs a kidney, and
the patient then brings that letter to an office of the Kidney Foundation of Iran, a
nonprofit organization that facilitates the nation’s kidney transplants. The
organization adds the patient to a list and sorts by his or her blood type. Patients
in the midst of a medical emergency and disabled soldiers are placed higher up
on the list, according to the paper.
To be approved as a living donor, interested Iranians go to one of the
foundation’s offices to undergo medical testing (the donor pays for the tests). If
the foundation believes the kidneys are healthy enough for transplantation, they
approve the donor. Next, the foundation will contact the person nearest the top of
the list for that donor’s blood type, taking into consideration other factors such as
the donor’s physical build — a particularly small kidney might go to a child or
female patient even if they are listed below average-sized men because a closer
match between the size of a donated kidney and a recipient’s original kidneys
results in a better long-term outcome.
The Iranian government pays for the transplant surgery itself as well as one year
of health coverage for the donor after the surgery. The recipient (or their family)
pays the donor, using the foundation as an intermediary, Farshad Fatemi, a
micro-economist at Sharif University of Technology and author of the 2011 paper,
told Futurism. The base price is set at $4,600, but if the donor isn’t willing to sell
their kidney for that price, they and the recipient can privately negotiate a higher
amount shortly after a match is set up. In 2011, Fatemi estimated that organ
recipients will sometimes pay an extra $530 to $1,060 on average.
If the donor and recipient agree on terms, both undergo tissue testing to make
sure the recipient would be unlikely to reject the new kidney. If the results are
favorable, the patient and donor sign an agreement and are given a list of centers
and doctors that can perform the transplant. The center will hold the check from
the recipient during the surgery and hand it over to the donor afterward to ensure
payment is made.
A Viable Model?
While the Iranian system does speed up the process of organ donation for
patients — the average wait between reaching out to the foundation and receiving
a kidney is five months — Fatemi said the legal kidney market is not without its
shortcomings.
One issue is that doctors often fail to follow up with donors post-surgery. It’s
important to follow donors for several decades after donation to see how the
process affects them, Fatemi stressed, but said doing so would be difficult, as
donors often try to hide their identity to avoid the stigma associated with selling a
kidney. Educating the public on the benefits of donation, paid or not, could help
solve this problem, Fatemi said.
Fatemi also noted that, just like the illegal kidney market, the poorest, more
vulnerable members of society are still the ones donating in Iran’s legal market,
and they typically only do so because they feel they have no other option to
escape poverty. “I have been to the foundation. The people who are donating are
young and full of energy, but they are poor and selling a part of their body to
solve what may amount to very small problems in their everyday lives,” Fatemi
said.
Given the lack of follow-up, no one even knows for sure if these vulnerable
citizens benefit from the sale.
Though Iran’s market may be imperfect and only stops the illegal sale of one type
of organ, Fatemi believes it’s better than the alternative of having a black market.
The system protects disadvantaged donors by ensuring they are paid what they
are owed and taken care of medically, and it also gives recipients a second chance
at life that they may not get otherwise.
“With these transplants, people can live two, three decades longer than they
would without them,” said Fatemi. “During that time, they have good times with
their families. They are productive members of the economy. That’s the positive
side.”
For now, Iran still stands alone in allowing citizens to legally sell their kidneys,
and no other nation appears on the cusp of doing so. However, that’s not to say a
new legal kidney market couldn’t emerge. A 2015 study published in the
journal American Economic Review concluded that U.S. citizens were more open
to the idea of organ sales when presented with information on their potential
benefits, so at least one barrier to creating such a market — public disapproval —
could potentially be eliminated through education programs.
Still, Iran didn’t decide to legalize kidney sales until the situation was dire, so if
history is any indicator, the next nation to test a system will likely be one facing a
similar situation, perhaps somewhere like India where end-stage renal disease is
becoming more common and the black market is thriving. Meanwhile, nations
where the frequency of end-stage renal disease has stabilized over the last decade,
such as the U.S., may choose to continue with the status quo until new
technologies and treatments render the kidney market, both legal and illegal,
obsolete.
“Every time I go to the foundation, I wish for the day when we can clone a kidney
for a person,” said Fatemi. Until that happens, he said, Iran’s system is a good
one.
THE WALL STREET JOURNAL. | LIFE & STYLE
THE SATURDAY ESSAY | JANUARY 8, 2010
The Meat Market In a race to prevent thousands of needless deaths
a year, countries from Singapore to Israel are launching innovative new programs
to boost organ donation. Alex Tabarrok on paying donors for kidneys, favoritism
on waiting lists and the shifting line between life and death.
By ALEX TABARROK
Harvesting human organs for sale! The idea suggests the lurid world of horror movies and 19thcentury grave robbers. Yet right now, Singapore is preparing to pay donors as much as 50,000
Singapore dollars (almost US$36,000) for their organs. Iran has eliminated waiting lists for
kidneys entirely by paying its citizens to donate. Israel is implementing a “no give, no take”
system that puts people who opt out of the donor system at the bottom of the transplant waiting
list should they ever need an organ.
Millions of people suffer from kidney disease, but in 2007 there were just 64,606 kidneytransplant operations in the entire world. In the U.S. alone, 83,000 people wait on the official
kidney-transplant list. But just 16,500 people received a kidney transplant in 2008, while almost
5,000 died waiting for one.
To combat yet another shortfall,
some American doctors are routinely
removing pieces of tissue from
deceased patients for transplant
without their, or their families’, prior
consent. And the practice is perfectly
legal. In a number of U.S. states,
medical examiners conducting
autopsies may and do harvest
corneas with little or no family
notification. (By the time of autopsy,
it is too late to harvest organs such as
kidneys.) Few people know about
routine removal statutes and perhaps
because of this, these laws have effectively increased cornea transplants.
Routine removal is perhaps the most extreme response to the devastating shortage of organs
world-wide. That shortage is leading some countries to try unusual new methods to increase
donation. Innovation has occurred in the U.S. as well, but progress has been slow and not
without cost or controversy.
Photo illustration by Mick Coulas, photos: Alamy (heart), Photo Researchers (lung, kidney)
* 3,363; Americans who died waiting for a kidney transplant, January to October 2009
Organs can be taken from deceased donors only after they have been declared dead, but where is
the line between life and death? Philosophers have been debating the dividing line between
baldness and nonbaldness for over 2,000 years, so there is little hope that the dividing line
between life and death will ever be agreed upon. Indeed, the great paradox of deceased donation
is that we must draw the line between life and death precisely where we cannot be sure of the
answer, because the line must lie where the donor is dead but the donor’s organs are not.
In 1968 the Journal of the American Medical Association published its criteria for brain death.
But reduced crime and better automobile safety have led to fewer potential brain-dead donors
than in the past. Now, greater attention is being given to donation after cardiac death: no heart
beat for two to five minutes (protocols differ) after the heart stops beating spontaneously. Both
standards are controversial—the surgeon who performed the first heart transplant from a braindead donor in 1968 was threatened with prosecution, as have been some surgeons using donation
after cardiac death. Despite the controversy, donation after cardiac death more than tripled
between 2002 and 2006, when it accounted for about 8% of all deceased donors nationwide. In
some regions, that figure is up to 20%.
The shortage of organs has increased the use of so-called expanded-criteria organs, or organs that
used to be considered unsuitable for transplant. Kidneys donated from people over the age of 60
or from people who had various medical problems are more likely to fail than organs from
younger, healthier donors, but they are now being used under the pressure. At the University of
Maryland’s School of Medicine five patients recently received transplants of kidneys that had
either cancerous or benign tumors removed from them. Why would anyone risk cancer? Head
surgeon Dr. Michael Phelan explained, “the ongoing shortage of organs from deceased donors,
and the high risk of dying while waiting for a transplant, prompted five donors and recipients to
push ahead with surgery.” Expanded-criteria organs are a useful response to the shortage, but
their use also means that the shortage is even worse than it appears because as the waiting list
lengthens, the quality of transplants is falling.
Routine removal has been used for corneas but is unlikely to ever become standard for kidneys,
livers or lungs. Nevertheless more countries are moving toward presumed consent. Under that
standard, everyone is considered to be a potential organ donor unless they have affirmatively
opted out, say, by signing a non-organ-donor card. Presumed consent is common in Europe and
appears to raise donation rates modestly, especially when combined, as it is in Spain, with
readily available transplant coordinators, trained organ-procurement specialists, round-the-clock
laboratory facilities and other investments in transplant infrastructure.
The British Medical Association has called for a presumed consent system in the U.K., and
Wales plans to move to such a system this year. India is also beginning a presumed consent
program that will start this year with corneas and later expand to other organs. Presumed consent
has less support in the U.S. but experiments at the state level would make for a useful test.
Rabbis selling organs in New Jersey? Organ sales from poor Indian, Thai and Philippine donors?
Transplant tourism? It’s all part of the growing black market in transplants. Already, the black
market may account for 5% to 10% of transplants world-wide. If organ sales are voluntary, it’s
hard to fault either the buyer or the seller. But as long as the market remains underground the
donors may not receive adequate postoperative care, and that puts a black mark on all proposals
to legalize fi…
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