Organ transplants in China: an optimistic assessment

There are optimistic statements about China's progress on developing a system of voluntary organ donation (to replace the prior system of obtaining organs for transplant from executed prisoners.)   Some of these statements originate with the Chinese press. The Vatican is also optimistic.  The Vatican also has wide ranging diplomacy with China concerning quite different issues.  The stories below collectively reflect each of these things.

Here's a story in the SF Chronicle
China to lead in organ transplants by 2020

"China is on track to lead the world in organ transplant surgeries by 2020 following its abandonment of the much-criticized practice of using organs from executed prisoners, the architect of the country’s transplant program said Wednesday.
Chairman of the China Organ Donation and Transplantation Committee Huang Jiefu said the voluntary civilian organ donations had risen from just 30 in 2010, the first year of a pilot program, to more than 5,500 this year.
That will allow around 15,000 people to receive transplants this year, Huang said. The U.S. currently leads the world in organ transplants, with about 28,000 people receiving them each year.
“We anticipate according to the speed of the development of the organ donation in China, the momentum, in the year 2020, China will become the No. 1 country in the world to perform organ transplantation in an ethical way,” Huang said in an interview at his office in an ancient courtyard house inside Beijing’s old city.
China is seeking to expand the number of willing organ donors, but it has run up against some cultural barriers: Family members are still able to block a donation, even if the giver is willing, and Chinese are averse to registering as donors by ticking a box on their drivers’ licenses, considering it to be tempting fate.
Instead, authorities are partnering with AliBaba, China’s virtually ubiquitous online shopping and payment platform, to allow people to register in just 10 seconds, Huang said. Huang said more than 210,000 Chinese have expressed their willingness to become donors, although that’s a drop in the bucket compared with the country’s population of 1.37 billion.
...
"Huang said China has adhered to a complete ban on the use of organs from executed prisoners that went into effect in 2015, although some in the field outside China have called for the country to allow independent scrutiny to ensure it is keeping to its pledge.
Critics have questioned China’s claims of reform and suggested that the World Health Organization should be allowed to conduct surprise investigations and interview donor relatives. The U.N. health agency has no authority to enter countries without their permission.
Chinese officials say China shouldn’t be singled out for such treatment while other countries are not.
Further moving on from the days when foreigners could fly to China with briefcases of cash to receive often risky, no-questions-asked transplant surgeries, China has also taken measures to stamp out organ trafficking and so-called “transplant tourism,” including by limiting transplants to Chinese citizens."
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China’s organ transplantation reform hailed by international community

"By CGTN’s Yang Jinghao

A sensitive issue just a decade ago, organ donation and transplantation in China has seen a remarkable shift during the past few years. A total of 7,000 organs were voluntarily donated between January and July this year, according to a conference on organ transplantation held in China over the weekend.

Comparatively, the number in 2010 was just 34 for the whole year.

The conference, held in Kunming, southwest China’s Yunnan Province, gathered top organ transplant professionals from major international organizations. They reviewed the achievements China has made and discussed how to strengthen international cooperation."
**********

And here's a story from Crux (whose subhead is "Taking the Catholic Pulse")
Chinese state media highlights Vatican official at organ trafficking conference in Beijing

"In a sign of the slow thawing of relations between China and the Vatican, a Chinese state newspaper reported positively on a Vatican official’s remarks at an organ trafficking conference taking place in Beijing.
Argentine Bishop Marcelo Sánchez Sorondo, the chancellor of the Pontifical Academies of Sciences and Social Sciences, attended the conference on Thursday, part of China’s ongoing efforts to convince the world it has reformed its organ donation procedures.
In 2015, the communist country announced it was stopping the practice of using organs from executed prisoners. In 2016, official statistics stated surgeons in China had harvested organs from 4,080 donors and performed 13,263 transplant surgeries, the second highest in the world. Officials said all donors were through a registered volunteer donor system. By 2020, China is expected to surpass the United States to take the top spot.
Last month the Pontifical Academy of Sciences, the World Health Organization , the Transplantation Society (TTS), and the Declaration of Istanbul Custodian Group (DICG) - four of the most influential societies in promoting global ethical practices in organ transplantation - sent a letter expressing their appreciation for China’s efforts in organ donation and transplantation reform.
Despite the assurances of the government, many human rights activists are skeptical such numbers could be achieved through an exclusively voluntary system, especially after decades of reliance on the organs of prisoners."
*************

Here are comments from Chancellor Marcelo Sanchez Sorondo commending the development of the China Model

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And here's a story about another realm in which China and the Vatican are simultaneously engaged.

Vatican official hints at unofficial agreement with China on bishops
"HONG KONG (CNS) -- A senior Vatican official has hinted there is an unofficial agreement between the Holy See and Beijing on the appointment of bishops, even as negotiations to formalize arrangements continue to hit roadblocks, reported ucanews.com.

Argentine Bishop Marcelo Sanchez Sorondo, who attended a conference on the sensitive topic of organ donation and transplants in the southern Chinese city of Kunming, offered the hint during an interview with state-run Global Times Aug. 4.
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Here are my earlier posts on the positions taken by the Pontifical Academy regarding transplantation.

The Vatican celebrates Frank Delmonico

Here's the (November 29th) announcement from the New England Organ Bank:
We are very proud to announce that New England Organ Bank's Chief Medical Officer, Dr. Francis Delmonico, was inducted into the Pontifical Academy of Sciences this week.
"With this lifetime appointment, he becomes one of just 70 leaders in the field of science today to have this honor. Among other members are theoretical physicist Stephen Hawking and Human Genome Project founder Francis Collins. In addition to his long career as a kidney transplant surgeon, Dr. Delmonico leads the World Health Organization's efforts to prevent transplant tourism and organ trafficking."

Here's Frank's page at the Pontifical Academy: Francis L. Delmonico

Here's a photo he sent me:

Vatican statement on organ transplantation

When I posted recently about the Vatican conference on organ trafficking and transplant tourism I focused on the participation of China, and the reaction it drew.

Now I've had a closer second look at the conference statement  (whose title is Statement of the Pontifical Academy of Sciences Summit on Organ Trafficking and Transplant Tourism). (UPDATED LINK HERE: https://www.pas.va/en/events/2017/organ_trafficking/final_statement.html )

It's a very tough statement, which casts quite a broad net when talking about "crimes against humanity." Here's the opening paragraph:

"In accordance with the Resolutions of the United Nations and the World Health Assembly, the 2015 Vatican Summit of Mayors from the major cities of the world, the 2014 Joint Declaration of faith leaders against modern slavery, and the Magisterium of Pope Francis, who in June 2016, at the Judges’ Summit on Human Trafficking and Organized Crime, stated that organ trafficking and human trafficking for the purpose of organ removal are “true crimes against humanity [that] need to be recognized as such by all religious, political and social leaders, and by national and international legislation,” we, the undersigned participants of the Pontifical Academy of Sciences Summit on Organ Trafficking, resolve to combat these crimes against humanity through comprehensive efforts that involve all stakeholders around the world."

Here's the paragraph defining what those crimes against humanity are, which to my eye seems to conflate three very different things. It is number 1 in their list of recommendations.

"That all nations and all cultures recognize human trafficking for the purpose of organ removal and organ trafficking, which include the use of organs from executed prisoners and payments to donors or the next of kin of deceased donors, as crimes that should be condemned worldwide and legally prosecuted at the national and international level."

That is, if I read the full statement correctly (you should read it yourself), they are proposing that 

1. taking organs from executed prisoners, 
2. making payments to living donors, and 
3. making payments to next of kin of deceased donors 

should all be considered crimes against humanity.  

Incidentally, the phrase "crimes against humanity"  is one that I hear most often in the context of genocide, although I recognize that it is also used for other horrific crimes that target populations.

I am not encouraged that this will lead to a sensible discussion about either incentives for donation or (even) removing financial disincentives.

From repugnant transaction to Nobel Prize in Medicine

The Nobel Assembly at Karolinska Institutet has today decided to award

The Nobel Prize in Physiology or Medicine 2010

to

Robert G. Edwards

for the development of in vitro fertilization

From the press release:

"These early studies were promising but the Medical Research Council decided not to fund a continuation of the project. However, a private donation allowed the work to continue. The research also became the topic of a lively ethical debate that was initiated by Edwards himself. Several religious leaders, ethicists, and scientists demanded that the project be stopped, while others gave it their support."


Since then,
"Approximately four million individuals have so far been born following IVF. Many of them are now adult and some have already become parents. A new field of medicine has emerged, with Robert Edwards leading the process all the way from the fundamental discoveries to the current, successful IVF therapy. His contributions represent a milestone in the development of modern medicine."


Afternoon update: Vatican official criticises Nobel win for IVF pioneer
"A Vatican official has said the awarding of the Nobel Prize for Medicine to British IVF pioneer Robert Edwards is "completely out of order".

Ignacio Carrasco de Paula, head of the Pontifical Academy for Life, said the award ignored the ethical questions raised by the fertility treatment.

He said IVF had led to the destruction of large numbers of human embryos."

Update 10/6/10: an Op Ed in the NY Times reminds us of some of the early reaction to IVF:
In Vitro Revelation
"Religious groups denounced the two scientists as madmen who were trying to play God. Medical ethicists declared that in vitro fertilization was the first step on a slippery slope toward aberrations like artificial wombs and baby farms.

"Fortunately, Louise Brown was not born a monster, but rather a healthy, 5-pound, 12-ounce blond baby girl."


Further update: here's an NPR broadcast: The Controversies That Still Lie Behind In-Vitro Fertilization?
"The Nobel Prize for medicine was awarded to Robert Edwards yesterday, who developed in vitro fertilization in the 1970. Controversial from its introduction, the practice was initially condemned by the Catholic Church. Today, while many of the original ethical issues have abated, new ones have arisen over questions about the in vitro industry's lack of regulation and the continuing debate surrounding stem cell research.


"Glenn Cohen, co-director of the Petrie-Flom Center, and assistant professof or law at Harvard University, believes the number one controversy today is the safety methods surrounding the practice."

Pope Benedict speaks about organ transplantation

Pope condemns organ transplant abuses as ‘abominable’, the Catholic News Agency reports. (stale link is updated at bottom of post)

 The Pope spoke to a conference at the Pontifical Academy for Life. "Pope Benedict began his address to the conference entitled, “A Gift for Life. Considerations on Organ Donation.” by applauding the great advances of medical science in the realm of issue and organ transplants. Though these measures give hope to people who are suffering, he lamented the problem of a limited availability of organs, as evidenced “in the long waiting lists of many sick people whose only hopes of survival are linked to a minimal supply which in no way corresponds to effective need." Despite the fact that the supply of organs is limited, the Pontiff emphasized that people can only donate, “if the health and identity of the individual are never put at serious risk, and always for morally-valid and proportional reasons. Any logic of buying and selling of organs, or the adoption of discriminatory or utilitarian criteria ... is morally unacceptable,” he stressed. " "The Pope went on to address abuses in the transplant plant of organs and tissues such as organ trafficking, which often affect innocent people such as children. These abuses, he said, “must find the scientific and medical community united in a joint refusal. These are unacceptable practices which must be condemned as abominable.”

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Update of stale links (June 2022)

NOVEMBER 7, 2008  UPDATED 14 YEARS AGO

Pope slams human organ trade, warns on transplants

Vatican conference on organ trafficking and transplant tourism

A recent meeting at the Pontifical Academy of Sciences of the Vatican:
Summit on Organ Trafficking and Transplant Tourism resulted in a statement and a number of news stories.  Here are several that caught my eye, with divergent views on the situation in China and how it is changing:

From the NY Times: Debate Flares Over China’s Inclusion at Vatican Organ Trafficking Meeting
"China has admitted that it extracted organs from death row prisoners for decades, in what critics have called a serious violation of the rights of inmates who cannot give genuine consent. Since Jan. 1, 2015, Chinese officials have said they no longer use prisoners’ organs, though doubts persist.

“We urge the summit to consider the plight of incarcerated prisoners in China who are treated as expendable human organ banks,” wrote the 11 signatories, who included Wendy Rogers of Macquarie University in Australia; Arthur Caplan of the New York University Langone Medical Center; David Matas and David Kilgour, both Canadian human rights lawyers; and Enver Tohti, a former surgeon from the western Chinese region of Xinjiang."
*********


From Statnews.com
China moves to stop taking organs from prisoners, WHO says
"The World Health Organization says China has taken steps to end its once-widespread practice of harvesting organs from executed prisoners but that it’s impossible to know what is happening across the entire country.

At a Vatican conference on organ trafficking this week, a former top Chinese official said the country had stopped its unethical program, but critics remain unconvinced.

In an interview Thursday, WHO’s Jose Ramon Nunez Pena said he personally visited about 20 hospitals in China last year and believes the country has reformed. But he acknowledged that it was still possible “there may still be hidden things going on.” China has more than 1 million medical centers, although only 169 are authorized to do transplants.

Nunez Pena said he had seen data including organ transplant registries and was convinced the country was now shifting away from illegally harvesting organs.

“What is clear to me is that they’re changing,” he said. “But in a country as huge as China, we can’t know everything.”
...
"Campbell Fraser, an organ trafficking researcher at Griffith University in Australia, agreed the trends over the past few years have shown a drop in the number of foreigners going to China for transplants and an increase of organ seekers heading to the Middle East.

At a press conference at the Chinese Embassy in Italy following the two-day Vatican organ conference, Fraser said migrants — including Syrians, Somalis and Eritreans — sometimes resort to selling off a kidney to pay traffickers to get them or their families to Europe.

“Egypt is where the biggest problem is at the moment,” he said, adding that it has the best medical facilities in the region and can perform the live donor surgeries.

He estimated as many as 10 such illicit transplants could be happening per week, though he had no statistics and said he based his research largely on anecdotal information from recipients, law enforcement, doctors and even some organ “brokers.”

Fraser said he has access to transplant patient “chat boards” because he himself had a kidney transplant in his native Australia in 2003.

Nunez Pena said it was likely that organ trafficking would find its way to conflict-plagued regions.

“We’re hearing about a lot of problems in Egypt, Pakistan and the Philippines,” he said, predicting that authorities were poised to break up an organ smuggling ring in Egypt in the next few weeks. “Wherever you have vulnerable people, you will see these kinds of problems.”

*****************


From Science:

Study retraction reignites concern over China’s possible use of prisoner organs

By Dalmeet Singh ChawlaFeb. 6, 2017 , 4:15 PM

A journal has decided to retract a 2016 study because of concerns that its data on the safety of liver transplantation involved organs sourced from executed prisoners in China. The action, taken despite a denial by the study’s authors that such organs were used, comes after clinical ethicist Wendy Rogers of Macquarie University in Sydney, Australia, and colleagues authored a letter to the editor of Liver International on 30 January, calling for the paper’s retraction in the “absence of credible evidence of ethical sourcing of organs.”

For years, Chinese officials have come under fire for allegedly allowing the use of organs from executed prisoners for transplants, including for foreigners coming to the country for so-called medical tourism. In January 2015, it explicitly banned the practice and set up a volunteer donation system, but doubts persist that much has changed.

The disputed study—published online in October 2016—analyzed 563 consecutive liver transplantations performed before the ban (from April 2010 to October 2014) at a medical center in China. Suspicious, Rogers organized the protest letter to the journal. “Publication of data from prisoners is ethically inappropriate given that it [is] not possible to ensure that the prisoners freely agreed either to donate their organs, or to be included [in] a research program,” she tells ScienceInsider.

Transplant diplomacy between China and the Vatican

The Global Times, a publication of the Chinese Communist Party, reports on further discussion with the Vatican on organ transplantation, in connection with an anticipated agreement on the appointment of Catholic Bishops in China:

China to attend Vatican organ trafficking meeting
Beijing, Holy See exchanges promoting mutual respect
By Li Ruohan Source:Global Times Published: 2018/3/11 2 

"Chinese scholars will join an anti-organ trafficking conference in the Vatican on Monday and Tuesday, to share the country's experience and boost people-to-people exchanges between Beijing and the Vatican. 

"This is the second time China has been invited by the Pontifical Academy of Sciences (PAS) to attend a meeting in the Holy See, as China's reforms on organ transplant have increasingly received papal and global recognition.

...

"In 2017, more than 5,100 deceased Chinese citizens had voluntarily agreed to donate their organs after death, saving, or improving the lives of more than 16,000 people, according to official data obtained by the Global Times on Sunday. 

"China criminalized unauthorized trading of organs in 2011, a crime for which the death penalty can be handed down in severe cases. From 2007 to 2016, 174 people were arrested in China for organ trafficking.
...
"China and the Vatican have no diplomatic relations. Lately there has been widespread speculation the two sides are close to a consensus on the appointment of bishops in China, a positive sign for improving relations between Beijing and the Vatican."
********

HT: Frank McCormick

Here's a story in the Washington Post about the larger diplomacy:
A Catholic bishop and his rural Chinese parish worry about a deal between Beijing and the Vatican   

By Emily Rauhala March 11

ASSA meetings in San Diego--Market design on Friday

The ASSA meetings are a cornucopia.  Here are some sessions related to market design that caught my eye in the preliminary program for the first day of conferencing, Friday January 3. No one can go to all of them, aside from interviewing junior market candidates, some of these sessions conflict with each other...:-(

Frontiers in Market Design
Paper Session
 Friday, Jan. 3, 2020   8:00 AM - 10:00 AM
 Marriott Marquis San Diego, Catalina
Hosted By: ECONOMETRIC SOCIETY
Chair: Eric Budish, University of Chicago
Targeting In-Kind Transfers through Market Design: A Revealed Preference Analysis of Public Housing Allocation
Daniel Waldinger, New York University

Approximating the Equilibrium Effects of Informed School Choice
Claudia Allende, Columbia University and Princeton University
Francisco Gallego, Pontifical Catholic University of Chile
Christopher Neilson, Princeton University

The Efficiency of A Dynamic Decentralized Two-Sided Matching Market
Tracy Liu, Tsinghua University
Zhixi Wan, Didi Chuxing
Chenyu Yang, University of Rochester

Will the Market Fix the Market? A Theory of Stock Exchange Competition and Innovation
Eric Budish, University of Chicago
Robin Lee, Harvard University
John Shim, University of Chicago

When Do Cardinal Mechanisms Outperform Ordinal Mechanisms?: Operationalizing Pseudomarkets
Hulya Eraslan, Rice University
Jeremy Fox, Rice University
Yinghua He, Rice University
Yakym Pirozhenko, Rice University
*********
Search and Matching in Education Markets
Paper Session
 Friday, Jan. 3, 2020   10:15 AM - 12:15 PM (PST)
 Marriott Marquis San Diego, Rancho Santa Fe 2
Hosted By: AMERICAN ECONOMIC ASSOCIATION
Chair: Eric Budish, University of Chicago

Simultaneous Search: Beyond Independent Successes
Ran Shorrer, Pennsylvania State University

Search Costs, Biased Beliefs and School Choice under Endogenous Consideration Sets
Christopher Neilson, Princeton University
Claudia Allende, Columbia University
Patrick Agte, Princeton University
Adam Kapor, Princeton University

Facilitating Student Information Acquisition in Matching Markets
Nicole Immorlica, Microsoft Research
Jacob Leshno, University of Chicago
Irene Lo, Stanford University
Brendan Lucier, Microsoft Research

Why Are Schools Segregated? Evidence from the Secondary-School Match in Amsterdam
Hessel Oosterbeek, University of Amsterdam
Sandor Sovago, University of Groningen
Bas van der Klaauw, VU University Amsterdam

***********
Market Design
Paper Session
 Friday, Jan. 3, 2020   10:15 AM - 12:15 PM
 Marriott Marquis San Diego, Del Mar
Hosted By: ECONOMETRIC SOCIETY
Chair: Sergei Severinov, University of British Columbia

Market Design and Walrasian Equilibrium
Faruk Gul, Princeton University
Wolfgang Pesendorfer, Princeton University
Mu Zhang, Princeton University

Repeat Applications in College Admissions
Yeon-Koo Che, Columbia University
Jinwoo Kim, Seoul National University
Youngwoo Koh, Hanyang University

Entry-Proofness and Market Breakdown under Adverse Selection
Thomas Mariotti, Toulouse School of Economics

Who Wants to Be an Auctioneer?
Sergei Severinov, University of British Columbia
Gabor Virag, University of Toronto
**********
Transportation Economics
Paper Session
 Friday, Jan. 3, 2020   10:15 AM - 12:15 PM (PST)
 Marriott Marquis San Diego, La Costa
Hosted By: ECONOMETRIC SOCIETY
Chair: Tobias Salz, Massachusetts Institute of Technology

The Selection of Prices and Commissions in a Spatial Model of Ride-Hailing
Cemil Selcuk, Cardiff University

The Welfare Effect of Road Congestion Pricing: Experimental Evidence and Equilibrium Implications
Gabriel Kreindler, University of Chicago

Customer Preference and Station Network in the London Bike Share System
Elena Belavina, Cornell University
Karan Girotra, Cornell University
Pu He, Columbia University
Fanyin Zheng, Columbia University

Platform Design in Ride Hail: An Empirical Investigation
Nicholas Buchholz, Princeton University
Laura Doval, California Institute of Technology
Jakub Kastl, Princeton University
Filip Matejka, Charles University and Academy of Science
Tobias Salz, Massachusetts Institute of Technology
**********

Information (Design), Black Markets, and Congestion
Paper Session
 Friday, Jan. 3, 2020   2:30 PM - 4:30 PM
 Manchester Grand Hyatt San Diego, Torrey Hills AB
Hosted By: ECONOMIC SCIENCE ASSOCIATION
Chair: Dorothea Kuebler, WZB Berlin Social Science Center
An Experimental Study of Matching Markets with Incomplete Information
Marina Agranov, California Institute of Technology
Ahrash Dianat, University of Essex
Larry Samuelson, Yale University
Leeat Yariv, Princeton University

Information Design in Dynamic Contests: An Experimental Study
Yan Chen, University of Michigan
Mohamed Mostagir, University of Michigan
Iman Yeckehzaare, University of Michigan

How to Avoid Black Markets for Appointments with Online Booking Systems
Rustamdjan Hakimov, University of Lausanne
C.-Philipp Heller, NERA Economic Consulting
Dorothea Kuebler, WZB Berlin Social Science Center
Morimitsu Kurino, Keio University

Application Costs and Congestion in Matching Markets
Yinghua He, Rice University
Thierry Magnac, Toulouse School of Economics

Discussant(s)
Christian Basteck, ECARES Brussels
Lionel Page, University of Technology Sydney
Robert Hammond, University of Alabama
Ahrash Dianat, University of Essex
*******

Tech Economics
Paper Session
 Friday, Jan. 3, 2020   2:30 PM - 4:30 PM
 Marriott Marquis San Diego, San Diego Ballroom A
Hosted By: NATIONAL ASSOCIATION FOR BUSINESS ECONOMICS
Chair: Michael Luca, Harvard Business School

GDPR and the Home Bias of Venture Investment
Jian Jia, Illinois Institute of Technology
Ginger Jin, University of Maryland
Liad Wagman, Illinois Institute of Technology

New Goods, Productivity and the Measurement of Inflation: Using Machine Learning to Improve Quality Adjustments
Victor Chernozhukov, Massachusetts Institute of Technology
Patrick Bajari, Amazon

Double Randomized Online Experiments
Guido Imbens, Stanford University
Patrick Bajari, Amazon

Gary Becker's last paper: appropriately, on a monetary market for kidneys (with Julio Elias and Karen Ye, JEBO, 2022)

 Gary Becker, who passed away in 2014, has a new paper, finished by his coauthors Julio Elias and Karen Ye. It recounts how the shortage of transplantable kidneys has only increased as the demand has grown, and the argument for paying donors is as strong as ever.  (In the meantime, the obstacles to that approach haven't vanished.)

The shortage of kidneys for transplant: Altruism, exchanges, opt in vs. opt out, and the market for kidneys*  by Gary S.Becker, Julio Jorge Elias, and Karen J.Ye, Journal of Economic Behavior & Organization, Volume 202, October 2022, Pages 211-226 (Another link to the paper is here, temporarily.)

Abstract: "In 2007 we published a paper on organ transplants that used data from 1990–2005. We proposed a radical solution of paying individuals to donate kidneys, and claimed that this would clean out the waiting list for kidney transplants in a short period of time. In this paper, we revisit the topic, and examine 14 years of additional data to see if anything fundamental has changed. We show that the main altruistic based policies implemented, such as kidney exchanges or opt out systems for organ procurement, have been unable to solve the problem of shortages. Our analysis suggests that, because of the reaction of direct living donors to increases in other sources of donations, the supply curve of kidney transplants is highly inelastic to altruistic policies. In contrast, a market in organs would eliminate organ shortages and thereby eliminate thousands of needless deaths."

Here's the most relevant part of the first footnote:

*"We started working on this paper together with Gary Becker in 2011. In 2012, we presented the paper at the Law and Economics Workshop and the MacLean Center's Seminar Series of the University of Chicago. The paper was unfinished when Becker passed away in May 2014. In this version of the paper, we updated the data and made some additions. The paper preserves all the economic analysis that was developed in the last version that we collaborated with Becker.

"Becker wrote his first article about the organ shortage in 1997, as part of his monthly BusinessWeek Column. The article was entitled How Uncle Sam Could Ease the Organ Shortage. In the article, he “suggest(s) considering the purchase of organs only because other modifications to the present system so far have been grossly inadequate to end the shortage.”

"In the 2000s, Julio Elias collaborated with Becker in a paper that uses the economic approach to analyze the consequences of legalizing the purchase and sale of kidneys for transplants from both deceased and living donors. In 2014, Becker published with Julio Elias a column in the Saturday Essay section of the Wall Street Journal entitled Cash for Kidneys: The Case for a Market for Organs. For Becker, the problem of the organ shortage and finding ways to solve it was a lifelong project. This paper reflects some of his last thoughts on this problem."

Here are their conclusions:

"The current state of the market of kidney transplants is a disaster. Over the last years, the waiting list has grown in over 4000 individuals each year, while transplants have grown by only about 250 per year. The result has been longer and longer queues to receive organs. 4000 patients died each year while waiting 3 and a half years on average for a transplant. According to our estimations, the annual social cost of those who die while waiting for kidney transplants is over $7 billion.

"Neither kidney exchange programs nor opt out systems nor educational campaigns to increase donations from altruistic donors have solved the problem of shortages. The main reason for their mild effects, as we show in this paper, is that the altruistic supply curve of kidney transplants is highly inelastic to these type of policies because of the reaction of direct living donors to increases in other sources of donations.

"The only feasible way to eliminate the large queues in the market for kidney transplants is by significantly increasing the supply of kidneys. The introduction of monetary incentives could increase the supply of organs sufficiently to eliminate the large queues and thereby eliminate thousands of needless deaths, and it would do so without increasing the total cost of kidney transplant surgery by a large percent.

"A market for the purchase and selling of organs would appear strange at first. However, much as the voluntary military today has universal support, the selling of organs would come to be accepted over time. " advantages of accepting payment for organs would eventually become clear, and people will wonder why it took so long for such an ovious and sensible remedy to the organ shortage to be implemented.

***********

Some related earlier posts:

Another take on compensating donors:

Tuesday, August 16, 2022

Kim Krawiec interviews Frank McCormick on the kidney shortage (and how to end it)

Commentary on the  legal monetary market for kidneys in Iran (and how it differs from illegal black markets):

Monday, June 27, 2022

A Forum on Kidneys for Sale in Iran, in Transplant International

The Pontifical Academy of Science says that compensating donors is a crime against humanity:

Friday, February 17, 2017

Vatican statement on organ transplantation

All my posts on compensation for donors (not just kidney donors) are here.

And here's my 2007 paper on repugnance (that came out in the same issue of JEP as the Becker and Elias paper), and was a first attempt at understanding some of the obstacles that face proposals to compensate donors of kidneys (and other things):

• Roth, Alvin E. "Repugnance as a Constraint on Markets", Journal of Economic Perspectives, 21:3, Summer, 2007, pp. 37-58.

I'm slowly writing a book that will expand on it.

Pope Francis on euthanasia and in vitro fertilization

In connection with recent developments concerning medically assisted suicide/death with dignity, the Catholic Church has strongly reaffirmed its opposition to that and other repugnant transactions, particularly involving reproduction.

Pope Francis denounces euthanasia as 'sin against God'. The Pope strongly condemns the 'right to die' movement, and warns against abortion, IVF and stem cell research

"Pope Francis denounced the right to die movement on Saturday, saying that euthanasia is a sin against God and creation.

"The Latin American pontiff said it was a “false sense of compassion” to consider euthanasia as an act of dignity.

"Earlier this month, the Vatican’s top bioethics official condemned as “reprehensible” the death by assisted suicide of a 29-year-old American woman, Brittany Maynard, who was suffering terminal brain cancer and said she wanted to die with dignity.

“This woman (took her own life) thinking she would die with dignity, but this is the error,” said Monsignor Ignacio Carrasco de Paula, the head of the Pontifical Academy for Life.

“Suicide is ... a bad thing because it is saying no to life and to everything it means with respect to our mission in the world and towards those around us,” he said, describing assisted suicide as “an absurdity”.
...
"The Pope also condemned in vitro fertilization, describing it as “the scientific production of a child” and embryonic stem cell research, which he said amounted to “using human beings as laboratory experiments to presumably save others.”

“This is playing with life,” he said. “Beware, because this is a sin against the creator, against God the creator.”

"The Pope considers the assisted suicide movement as a symptom of a contemporary “throw-away culture” that views the sick and elderly as a drain on society.

"Francis urged doctors to take “courageous and against-the-grain” decisions to uphold church teaching on the dignity of life."

Frank Delmonico and the recent organ transplant meeting at the Vatican

When I was in Trento, I participated in a panel on markets for human organs, and had the chance to ask Dr. Ignazio Marino about the recent

Vatican statement on organ transplantation, which I pointed out seemed to conflate killing prisoners for their organs with much more ordinary attempts to increase voluntary organ donation.  Dr Marino replied that this had been part of the diplomacy involved with the Chinese delegation.

Here's an article about the backstory to some of that diplomacy, and the role played by my old friend Frank Delmonico

One doctor’s war against global organ trafficking
By Ryan Connelly Holmes And Dan Sagalyn May 29, 2017

"A controversy was brewing. Delmonico, a leading voice on ethical organ transplantation, had planned a February 2017 summit in Rome for representatives of more than 40 countries to discuss the ethics of transplanting organs and to sign a pledge to uphold high standards.

"But there was a hitch: A key invitee to the forum was Dr. Jiefu Huang, who has led reform of China’s organ donation practices. Critics, including some in the Vatican, wanted at the summit no representatives of China, which for years sold and transplanted organs from executed prisoners.

"Delmonico, however, saw the Chinese presence as a good thing. It was “an opportunity for them to proclaim a new day and be accountable” that the practice has stopped, he said. In fact, some of the Chinese old guard have attacked Huang because of his efforts to stamp out unethical and corrupt methods of obtaining organs.
...
"Pope Francis did not attend, but Marcelo Sánchez Sorondo, the chancellor of the Pontifical Academy of Sciences did. In a significant development, China signed the summit’s statement condemning the use of organs from prisoners and advocating the creation of national laws to prosecute transplant-related crimes. Beijing’s two delegates were joined by 75 other signatories representing more than 50 institutions and more than 40 nations at the conference. Delmonico called it a “seminal event” in the fight for global reform."
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I hope that this effort at diplomacy, aimed at ending the practice of using executions as the primary source of organs in China, will not be a source of confusion regarding attempts to increase the availability of organ transplants by ethical means.