In The Meat Market, Tabarrok has raised the remarkable issue of a shortage of human organs for transplants in the United States. Due to the shortage of donor organs, thousands of organ receivers die each year in the hope that they would find an organ donor one day. Up to now, most donor organs have come from patients officially declared brain dead. The shortage of donor organs and the increasing number of organ recipients have forced the medical community and federal government to advocate the practice of donation after cardiac death (DCD) rather than brain dead. More than 100,000 people are waiting for transplant surgeries. According to official government statistics, this number is rising faster than the number of available donors. Of them, the majority of patients need kidneys (86,142), livers (16,022), and hearts (3,149). Bringing the fact from around the world, the case is even more frightening. Millions of people suffer from kidney disease, but only 64,606 kidney patients had kidney transplants in 2007. In America alone, 83,000 people wait on the kidney-transplant list, but only 16,500 people received a kidney transplant in 2008 while nearly 5,000 died waiting for one. Considering this burning problem of a shortage of human organs for transplant, Tabarrok suggests that payment to living donors can be a solution and to support his idea of purchasing organs from donors, he brings examples of some countries like Singapore, Iran, and Isreal.
To deal with the shortage of human organs, surgeons adopt several methods. The shortage has forced some countries to try unusual new methods to increase donation: the most extreme solution to the devastating shortage of organs worldwide is perhaps the routine removal of pieces of tissue from deceased patients for transplant without their, or their families', prior consent. Even in some States of America, doctors are harvesting corneas without notifying the family of the deceased one while conducting an autopsy. Although this practice is perfectly legal, it is not without controversy.
Legally it is only allowed to take human organs after the donor is declared dead by the doctor, but not their organs. Although it sounds easy, it is always debatable to be sure about the point when the donor will be declared dead. Nobody can identify the line between life and death. It is paradoxical that we have to draw the line to separate life from death that we are never sure of because the line must lie where donors are dead but their body organs are not. Because of this, we are not sure whether organs are harvested from a dead donor or a living one. In the past, brain-dead donors were the main source of organ donors but in recent days reduced crime and better automobile safety have led to fewer potential brain-dead donors. Nowadays, despite the controversy, attention is being given to donation after cardiac death. Cardiac death means no heart beating for two to five minutes (protocol differs) after the heart stops beating spontaneously. This has forced doctors to practice transplantation of those organs which was thought unsuitable; they transplant organs from aged or unhealthy people. This has pushed the recipients to have kidneys of over-aged or unhealthy people. This has caused more harm to health than benefits to the recipients, there are no other options left before the doctor except going with this undesirable organ transplantation.
Several countries going with the concept of "presumed consent" of donors to solve the extreme problem of the shortage of human organs. According to this concept, everyone is considered a potential organ donor unless they have denied it by signing a non-organ donor card. This concept is common in Europe like the U.K. and seems to raise donation rates modestly. Wales is thinking of introducing this practice while India is starting the presumed consent programme with the removal of corneas and later expanding to other organs, too. This is not getting support in the US; however, it is to be tested at the state level there. On the one hand, countries are looking for potential solutions to the shortage of organs and on the other hand, the black market is growing; ten per cent of worldwide transplantation comes from this illegal market. This in no way is a good practice basically for donors since they do not get proper postoperative care from anywhere else which is leaving a very harmful impact on their health, probably causing death. So, it is a good idea to legalize the sale of organs for the overall benefit of all.
The single country Iran has succeeded to solve the problem of the organ shortage for transplantation through the legal payment system for organ donation. Human organs are not sold and bought at the bazaar in this country. There is a non-profitable and volunteer-run organization called Dialysis and Transplant Patients Association (Datpa) that manages kidneys for transplantation if needed to anyone. Those who cannot manage a kidney from a deceased donor or from a related living donor apply to Datpa. Those donors are medically evaluated by transplant physicians, who have no connection to Datpa. The government pays donors $1,200 and provides one year of limited health insurance coverage, and the kidney recipients pay between $2,300 and $4,500. In case recipients are unable to pay the donors, they are supported by charitable organizations. Thus, in Iran, no patients are deprived of kidney transplants.
The success of the Iranian system and the black market have clearly shown the world that the shortage of organs for needy patients can be solved by paying living donors. It is effective and cheaper. The Iranian system that began in 1988 solved the shortage of kidneys just in 11 years by 1999. Nobel Laureate economist Gary Becker and Julio Elias estimated that a payment of $15,000 for living donors is likely to minimise the shortage of kidneys in the U.S. and it can be paid by the federal government. Even after the significant payment to donors, it could be cheaper than dialysis for the government.
Some countries are trying to bring different policies of payment systems. Although Singapore legalised payment of around $50,000 to encourage donors, its implementation is not clear yet. On the other hand, America is testing noncash compensation in the forms of funeral expenses for deceased donors and health and life insurance or tax credits for living donors.
The world governments are gradually getting success in harvesting kidneys from living donors than from deceased donors to solve this problem through payment systems. On the one hand, it seems a great success to manage kidneys from living donors as donors can live a normal life with other kidneys even after donating one kidney but, on the other hand, it is an ugly practice to harvest kidneys from the living donors. It cannot be wise and justifiable to do so as a number of kidneys that could save lives are being buried and burned every day. Instead of managing kidneys from living donors, the government should introduce new policies and programmes to encourage donors to donate their organs after their death. Singapore and Isreal have brought nonmonetary incentive systems for potential organ donors. There is a presumed consent system in Singapore. People in Singapore can choose not to participate in the presumed consent system but those who deny this system will have low priority on the transplant waiting list in case they need organs in the future. This "no give, no take" is believed to encourage people to donate organs by following the concept of the presumed consent system. Although people find the idea of paying for organs disgusting, they accept "no give, no take" has an ethical foundation. This, no doubt, has helped to solve the problem of organ shortage as it pushes people to sign one's organ donor card.
Isreal has a flexible version of the "no give, no take" system to systematize organ transplants in an effective and fair manner. In the Israeli system, people can score points if they deliberately sign their organ donor card. Points will push them up on the transplant list if they need organs sometime.
The shortage of organs is going to get worse worldwide before it gets better, but we do have options. However, it can be solved if we follow the success stories of different nations, and innovate new methods. Presumed consent, financial compensation for living and deceased donors, and point systems would surely increase the availability of transplant organs.
Comprehension
1. What, according to Tabarrok, is “the great paradox of deceased donation” (5)? Why is this paradox significant?
The great confusion is that there is no accepted procedure for identifying the borderline between life and death, which is necessary for harvesting organs from the deceased. This is a concern because it makes the practice of obtaining healthy organs from the deceased debatable, puts medical professionals in danger of legal action, and reduces the number of organs obtained from donors.
2. What positive developments in the last several decades have “led to fewer potential brain-dead donors than in the past” (6)?
The advancement in the development of improved automotive safety and reduced crime have positively caused a sharp decline in the number of brain-dead donors.
3. Tabarrok uses a definition in paragraph 7. What does he define, and how does this definition help him achieve his essay’s purpose?
Organs that would be deemed unfit for transplantation even in the absence of a lack of donated organs are referred to as "expanded-criteria organs" by Tabarrok. Organs from elderly donors or those with health problems fall under this category. The fact that Tabarrok used this term in his essay helps to highlight how serious the situation is. These organs have a higher chance of malfunctioning or even cancer. Due to the lengthy waiting list for transplant recipients, many are compelled to accept low-quality donors due to a lack of available options.
4. Tabarrok identifies one country that has eliminated shortages in transplant organs. Which country? How has this been accomplished?
According to Tabarrok, Iran has succeeded to eliminate the shortage of transplant organs. The system that Iran has developed to fight this problem is compensation for donations. In this country, donors are legally paid if they donate their organs.
Purpose and Audience
1. What is your reaction to Tabarrok’s title? To his essay’s opening sentence? Do you think these are the reactions he expected readers to have? Explain.
When I read the title of this essay, I assumed it should be all about the actual meat market and the consumption of animals, but when I read it thoroughly, I found it a little unexpected and unpleasant as well to know that it was referring to human organs. This is most likely the response Tabarrok was hoping for because it grabs the readers' attention and makes them want to keep reading.
2. Tabarrok’s introduction relies on certain assumptions regarding his readers’ attitudes toward organ harvesting. What are these assumptions? Do you find this introduction effective? Why or why not?
Assuming that the concept of "organ harvesting" from live donors will conjure up images of horror films in readers' minds, Tabarrok predicts that his readers will be suspicious of the idea. He probably thinks that the reader would identify paying for organs with the illegal market when he talks about nations that are compensating those who are willing to donate. These presumptions are reasonable in light of the prevalence of these motifs in American culture. This beginning of the article works well because it asks the reader to admit that they have certain opinions on organ donation before gradually urging the audience to challenge those opinions.
3. According to Tabarrok, presumed consent “has less support in the U.S.” (9) than in other countries. What does he think might change that? Does he support “presumed consent”?
Presumptive consent, in Tabarrok's opinion, may be more widely accepted if it were first subjected to a test at the state level. He also advises creating rewards for organ donors, such as money for burial costs or reduced license fees.
4. In paragraph 5, Tabarrok raises one of the most profound questions influencing the debate about organ donations: what is the dividing line between life and death? However, he avoids further discussion of this issue in his essay. Why? Would his essay have been stronger if he had elaborated on the subject? Why or why not?
Tabarrok made the proper choice by avoiding further discussion on this subject. As he previously stated, there is no conclusive method to determine where the boundary between life and death lies. It is a highly nuanced philosophical subject that would be very challenging for him to attempt to answer adequately.
Style and Structure
1. Tabarrok is an economist. Do you think he approaches the subject differently from the way a member of the clergy, a lawyer, or a physician would? What advantages does his perspective give him?
Tabarrok is aware of the ways in which monetary considerations influence people's behaviour and form a society in a way that doctors or members of the clergy would not be able to. He adopts a more analytical viewpoint, concentrates on the concept of supply and demand, and applies this viewpoint to consider how the organ donation system may be improved. This approach works well for him.
2. Tabarrok uses cause and effect several times in the essay. Identify two examples. How effective are they? How do they support his overall purpose?
In paragraph 3, Tabarrok discusses how surgeons frequently extract tissue from dying patients without the patient's or the patient's family's consent as a result of the difficulty of finding organ donors (cause) (pg 608). Tabarrok analyzes how Iran's legal payment system (cause) solved the scarcity of donor organs (effect) in paragraph 11. (pg 609).
These two illustrations effectively support Tabarrok's arguments. The first scenario, which he portrays as being entirely legal, serves to highlight how rare transplantable organs are in the US. The second illustration demonstrates how successful programs that offer rewards may be in promoting organ donation.
3. In paragraph 12, Tabarrok uses inductive reasoning. Does his inference seem justified? Why or why not?
4. Tabarrok repeatedly writes in the passive voice — for example, in paragraphs 4 and 8. Would rewriting such sentences in the active voice make the sentences — and the writer’s argument — stronger? Why or why not?
I don't think it's necessary to rephrase these paragraphs in the active voice because I think the passive voice fits here.
Tabarrok states in the passive voice that "innovation has occurred" in the US in paragraph 4. The passive voice works effectively in this context because it is not necessary for Tabarrok to specify who promoted these advances or to use personal pronouns because this information is unrelated to his point.
In paragraph 8, Tabarrok writes that "everyone is considered to be a potential organ donor..." This works well in the passive voice for a similar reason. The passive voice allows Tabarrok to talk about how citizens are viewed across countries with similar laws without having to use said countries
5. Evaluate Tabarrok’s title. Given his purpose, audience, and subject matter, do you think it is appropriate? Explain.
I acknowledge that Tabarrok probably meant this title to be a sarcastic attention-getter, but I don't think it was the right choice for what he was trying to accomplish. To those engaged in the organ donation procedure, it could be perceived as too inhuman, and it also makes the notion look gruesome.
Vocabulary Projects
2. In paragraph 10, Tabarrok refers to the “growing black market in transplants.” What is a black market? What connotations does the term have? How does Tabarrok view this market for organs?
A black market is a market where products are purchased and sold illegally; the phrase has a negative connotation and is typically seen to be unsavoury and dangerous. Since the patients are involved in the illegal donation of organs, Tabarrok sees this organ market negatively and thinks it is a result of organ scarcity.
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