You’ve made many good points about the subject. As moral and benevolent that current system of organ provision may seem, it simply does not work.

Leave it to the Dutch to mass broadcast such a powerful commentary on the status quo. They speak four languages, they smoke pot and love prostitutes…is there anything they can’t do?

While your suggestion of giving organs only to people who have agreed to do the same is a bit cruel, it also sounds quite fair. It also shortens the list of people waiting for organ transplants while creating a logical incentive for agreeing to donate their organs, so it’s a smart move in the right direction as well.

You commented that UNOS, the organization which manages the national organ allocation system could make this policy change. Well, why don’t they? Are they afraid such a bold move in the right direction would be bad for their public image? How many people would have to die waiting for an organ transplant until they do?

Were you aware that I am a huge fan of John Stossel? The minute I went to lifesharers.org I saw a quote from John Stossel calling your organization “the next best thing to an organ market”. Some people will definitely regard LifeSharers as cruel, but it is a very realistic approach to organ donation. These people are most likely to be liberals, who believe that resources should be seized and re-distributed among everyone, even to those who have submitted far less resources (or even none) than others. For many liberals, wanting something or not having something is the sole reason for deserving it. Your group’s approach deliberately rewards those who pledge to contribute their own biological resources.

Since you’ve taken it upon yourself to promote your organization on my blog, would you be so kind as to return the favor and list this blog entry on your web site’s press coverage page? You’ve made a convert out of me. I always had checked off the back of my NYS ID card, but I think I’m going to sign up with LifeSharers. Maybe we can do some more in-depth cross-promotion in the near future.

The Big Donor Show turned out to be a hoax. Instead of being a tasteless reality show on Dutch television in which three patients competed for a terminally-ill cancer sufferer’s kidney, it was a stunt to raise awareness of the shortage of organ donors. At which point all the commentators turned their outrage meters back to normal (merely frothing). What a pity. Now that we’ve had our awareness raised, we should be concentrating on some pesky ethical questions. Why, for instance, when we use markets to supply the essentials of food, energy and clothing, don’t we use one to supply us with kidneys? The standard response from ethicists is that kidneys, like life itself, are too important to involve filthy lucre. The supply of transplant organs is best left to good old altruism. But the result of this inability or unwillingness to understand how private greed can, with the correct incentives, be turned to public good. The average wait is two years – but that figure is masked by sufferers who can be on dialysis for nearly a decade. So in the name of ethics – and our refusal to consider an alternative system that actually works – we condemn a number of our fellow citizens to an early and painful death; after years of draining dialysis, of course. This might shock those who consider Iran to be an outpost of Barbary where crazed zealots hunger for a nuclear bomb – but there is no waiting list for kidneys in Iran. In Iran there is also a regulated market in which live donors get paid for their donation of a kidney. It is not a coincidence that when the State offers what amounts to roughly a year’s average income to those willing to save the life, lives actually get saved. It is worth pointing out too that kidney donation itself is of the same order of risk as carrying a surrogate child. In Britain, dialysis costs on average £50,000 a year. Imagine that sum, a figure well over the typical annual income, paid as a fee for a donation; it would surely tempt many to offer up a spare. No one is suggesting that there should be an unlimited market in which desperate would-be donors appear at the hospital, clutching a bloody, self-excised kidney and bargain a price with doctors. But what is surely feasible is a regulated market with financial incentives to encourage the saving of lives. It won’t happen, of course. The discussion will not even begin and preventable deaths will continue all because commonly accepted “ethics” prevent us from accepting that there are some things just too important not to have markets in. Now, that anti-market bias really is unethical.

In the mean time, there is an already-legal way to put a big dent in the organ shortage — allocate donated organs first to people who have agreed to donate their own organs when they die. UNOS, which manages the national organ allocation system, has the power to make this simple policy change. No legislative action is required.

Americans who want to donate their organs to other registered organ donors don’t have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. Non-donors should go to the back of the waiting list as long as there is a shortage of organs.