Organ grinders.

• Author: DeLong, James V.

The federal government's idea of "fairness" may exacerbate an already deadly organ shortage.

A few decades ago people joked that the human body, once its divine spark was extinguished, was worth about $2.00, which was the market value of its constituent chemicals. Times change, and the revolution in organ transplant technology has turned our bodies into mines of valuable spare parts.

But restrictions on the procurement and distribution of organs hamper the use of this resource, with deadly consequences. A new federal rule is apt to make matters worse.

In 1996, 281 hospitals performed almost 20,000 of the five most common major-organ transplants (kidney, liver, pancreas, heart, and lung), at a cost of more than $5 billion. (See table.) The main constraint on the system is the supply of organs. The 19,366 transplants in 1996 relied on organs from 5,417 cadavers and 3,553 living donors. Eighty-six percent of the latter involved transfers between relatives, usually of kidneys. More bodies are needed, but only 10,000 to 15,000 of the 2.4 million deaths in the United States each year produce recyclable organs, and the number of people on waiting lists keeps [TABULAR DATA OMITTED] growing, from 27,805 on the list at some time during 1988 to 72,386 in 1996. More than 4,000 patients will die this year waiting for organs.

These waiting list numbers actually understate the shortfall. No one gets on a list until he passes "the green screen" by demonstrating his ability to pay for the operation, which in practice means that he must have first-class health insurance coverage. Medicare/Medicaid pays for 39 percent of all transplants, private insurance for 38 percent. For 20 percent of patients, the type of payment is unknown. The remaining 3 percent is spread among miscellaneous sources such as "other government" and "self." The number of patients filtered out by the green screen, who could benefit from transplants if the price came down enough for them to pass it, is conjectural.

Corneas are not in short supply. Many more suitable organs are available, and in many states dead patients' family members are presumed to consent to the harvest unless they specifically say no. Since few know about this policy, few refuse. The average cost of a cornea transplant is $8,000, and 45,000 are performed each year. Other transplants are much more expensive: $172,000 for a kidney, $317,000 for a heart, $394,000 for a liver (including five years of follow-up).

The National Organ Transplant Act of 1984 bans the sale of human organs. The donor is supposed to be inspired solely by the spirit of giving. Doctors and hospitals, however, may charge substantial sums...