David L. Kaserman

Although organ transplants provide the best, and often the only, effective therapy for many otherwise fatal conditions, the great benefits of transplantation go largely unrealized because of failures in the organ acquisition process. In the United States, for instance, more than 10,000 people die every year either awaiting transplantation, or as a result of deteriorating health exacerbated by the shortage of organs. Issues pertaining to organ donation and transplantation represent, perhaps, the most complex and morally controversial medical dilemmas aside from abortion and euthanasia. However, ... More Although organ transplants provide the best, and often the only, effective therapy for many otherwise fatal conditions, the great benefits of transplantation go largely unrealized because of failures in the organ acquisition process. In the United States, for instance, more than 10,000 people die every year either awaiting transplantation, or as a result of deteriorating health exacerbated by the shortage of organs. Issues pertaining to organ donation and transplantation represent, perhaps, the most complex and morally controversial medical dilemmas aside from abortion and euthanasia. However, these quandaries are not unsolvable. This book proposes compensating organ donors within a publicly controlled monopsony. This proposal is quite similar to current practice in Spain, where compensation for cadaveric donation now occurs “in secret,” as this text reveals. To build their recommendations, the authors provide a medical history of transplantation; a history of the development of national laws and waiting lists; a careful examination of the social costs and benefits of transplantation; a discussion of the causes of organ shortages; an evaluation of “partial” reforms tried or proposed; and an extensive ethical evaluation of the current system and its competitors.

The shortage of cadaveric human organs made available for transplantation has reached critical proportions and is now causing over 6000 deaths each year in the United States alone. Economically, this shortage appears to stem from at least two principal underlying causes, both of which are attributable to the 1984 National Organ Transplant Act: (i) a legal prohibition on payments to organ donors and/or their surviving family members; and (ii) the legislatively mandated structure of the organ procurement industry, which specifies a group of nonprofit regional monopsonists as collection agents.Here, we focus' on some consequences of the latter restriction. Using a frontier methodology, we estimate the magnitude of the inefficiencies exhibited by the individual procurement agencies (relative to the most efficient) after controlling for exogenous factors. Our findings show that, even if these inefficiencies could (somehow) be completely eliminated, the organ shortage would still persist.

The Supreme Court Opinion on local exchange competition in general and on pricing and unbundling in particular was much anticipated and will be much discussed. Because of the very technical nature of the pricing and unbundling rules facing incumbent local exchange carriers there is a considerable risk that students of the Court's Opinion will be mired in the details of that Opinion and miss what we believe is a clear, unequivocal meta-message embedded in the Opinion. Specifically, this decision unequivocally affirms a fundamental shift in regulatory policy reflected in the Telecommunications Act of 1996. That is, the Act dictates that regulators act not merely to disable monopoly but to adopt policies that affirmatively enable competition. The Court's Opinion now confirms this interpretation of the congressional intent behind the legislation. Thus, while it is fair to say that the Court's specific decision with respect to the pricing and unbundling issues represents an important component of a regulatory policy designed to promote competition in local exchange telephony, there is a larger lesson embedded in the Court's reading of the Telecommunications Act. In this paper we first consider in some detail the Opinion and how it reflects an unambiguous endorsement of a competition-enabling framework for the development of local exchange competition. Next, we point out that, despite the Court's unambiguous and clear ruling, a dispassionate scrutiny of economic and regulatory conditions present in local exchange markets — even in the wake of the Court's ruling — reveals a number of extraordinary obstacles to the successful emergence of effective local exchange competition that still remain.