The Broken Economics of Organ Transplants | Wendover Productions

This video was made possible by Skillshare. Learn new skills and improve yourself for free for two months by being one of the first 1,000 to sign up at the link in the description. The economic system is a solution to scarcity.

In fact, money as a system is a solution to scarcity. Fundamentally, the world does not have enough of what people want so we've created this system to allocate things. If everyone in the world were offered a pineapple, free of charge, nearly everyone would probably

take that pineapple. If everyone in the world were offered any resource, in fact, they would probably take that resource. The problem is, the world doesn't have enough pineapples—there's a limited supply.

There aren't enough pineapples for everyone, so the market economy, at least in theory, matches them to those that want them most—those that will give up enough money to get that pineapple. Simultaneously, though, this system motivates people to produce more of what is scarce since

they get paid. At a fundamental level, whenever something needs to be allocated, it is monetized. This system does, however, have its flaws. How much someone is willing to pay isn't perfectly correlated to how much they need

or want a thing. In the purest form of this system, every participant would have the same amount of money and the same ability to pay so that what they would offer for a scarce resource would perfectly correlate to how much they want it, but that, of course, is not the case.

In the real world, some people have more money than others, and so this system breaks down. One poor person might really want a pineapple and offer a full percent of their money to get it, but a rich person with 11 times the money might sort of want a pineapple and offer one-tenth of a percent of their money to get it, and they will get the pineapple.

In this circumstance, the market system breaks down, as the person who wanted the pineapple less has received it. The overall social good is not maximized. Collectively, though, we have decided that perfect is the enemy of good, and that a certain

level of inequality is okay, especially as, according to some, it motivates people to create more value. Now, inequality in the pineapple market is somewhat unfortunate, but ultimately not a huge deal.

In other markets, though, human ethics have decided that a monetized market system, with that one fundamental flaw of inequality, would be wrong. When the allocation of a scarce resource means the difference between life or death, when whether a person gets something is that important, a market system's inequality is perpetuated

because people's willingness to pay is infinite—it's not proportional to how much they need or want a thing—and therefore, it will always go to who has more money. That is the issue with organs. In this case, allocation needs to happen a different way.

Every nine minutes in the US, a doctor makes a life-changing conclusion about their patient. They determine that that individual and their condition has progressed to the point that they will not survive without an organ transplant. As soon as that happens, the individual is placed into a nationwide system that works

to balance societal utility and human ethics to match organs to those that need and deserve them most. The core of all issues related to organ transplantation is the fact that there are more people waiting for transplants than there are organs available.

Just like pineapples, iPhones, or anything in the traditional economy, there are less of it than people want of it if the cost was zero. In the US, 112,000 people are on those lists, whereas only 39,718 transplants were actually performed in 2019.

This means that patients often have to wait years for a new organ. The exact time, though, varies dramatically depending on a number of factors. Patients with the most severe and urgent form of liver failure, for example, only have to wait a median of 6 days, whereas a patient at a lower priority for a heart transplant

would wait a median of 726 days. Now, when every name on that list is quite literally on the precipice between life and death, fairness is tough. Each country's transplant list works slightly differently, but most work fairly similarly

to the US's. There, much of an individual's position on the list is based on how much use they're going to get from the organ. Kidneys, for example, are the most commonly transplanted organ out there, and in the US,

the major determinant for those on the waiting list is their estimated post-transplant survival score. Essentially, one wants to give an organ to an individual for which it will provide the most additional years to their life. For example, a 30-year-old who has not had dialysis, does not have diabetes, and has never had an organ transplant before would have an EPTS score

of 2%, one of the highest, meaning their chances of surviving 10 years post-transplant are above 90%. Therefore, they would be at the top of the list, eligible to receive a kidney from the highest quality tranche, expected to function better than most other donor kidneys. Meanwhile, a 70-year-old who is on dialysis and has type 1 diabetes would gain an EPTS score of 89%, meaning their 10-year

survival outlook is less than 50%. Therefore, they would only be offered a transplant after all matches with a greater outlook are. Within these tranches, based on the EPTS score, further ranking is done based on other scores and waiting times.

Now, the list itself is certainly not just thousands of names ranked from 1 to 90,000 waiting their turn for the next available organ. It's an incredibly complex system, mixing factors including geography, compatibility, necessity, and more.

Kidneys themselves are unique among organs in that the human body has two, and, for the most part, individuals only need one. Therefore, an individual can donate one of theirs and be at only a very slight increased risk of kidney failure or other complications long term.

That is the living donor route, but the vast majority of kidneys still come from deceased