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Unlocking the Organ Supply March 16, 2007

Posted by David Bookstaber in Healthcare, Human Markets, Regulation.

Sally Satel makes the easy case that allowing incentives for donation will increase the currently scarce supply of human organs. She misses the other significant damper on organ supply: discretion.

Why do many people decline to donate their organs after death? A 2005 Gallup survey turned up two interesting results: 21% of people agreed with the statement “Transplants often go to undeserving people” (my emphasis), and 79% agreed that “Discrimination prevents minority patients from receiving the organ transplants they need.”

Many people are hesitant to dump their body parts into the labyrinth of rules devised by the United Network for Organ Sharing and hope that their own values are considered. What if they don’t want an elderly alcoholic to get their liver just because he has been on a waiting list longer than a young diabetic? Or what if they don’t believe a mother should be in line behind a violent felon to receive their heart?

Individual incentives and discretion are both keys to unlocking the supply of human organs.


1. federalist - March 27, 2007

Dr. Seth Haber has an excellent letter in the WSJ following this:

Donors of organs and tissues, whether dead or alive, are the only participants in the lifesaving transplantation procedures who do not get paid; who cannot get paid. It makes no difference whether that donor is a cadaver, an altruist or a relative. That is why we are so very short of transplantable tissues and organs. “Tissues” are generally nonviable, such as tendon, ligament, bone, blood, cornea, blood vessels, and skin, and can be harvested leisurely from cadaveric donors. “Organs” are living, and include heart, lungs, liver, kidneys, pancreas, small intestine, colon and bone marrow. They may come from a live donor or harvested from a dead donor immediately after death.

The members of the “harvest team,” the nurses and technicians, the surgical team, the anesthesiologists, and the internists who will manage the rejection reaction, all get paid. Neither they nor the hospitals consider transplant surgery among their obligatory charitable activities.

A society that recycles paper and glass should do as well for its members. Cadaveric donors might be “partsed out,” like an automobile, and the donor’s family compensated by price list or auction. Yes, it sounds callous, but anything is better than the current situation in which thousands of persons are needlessly sacrificed each year because the unmotivated potential donors are, instead, giving up their valuable organs and tissues to worms and anaerobic microbacteria.

Those responsible for the current untenable situation, including physicians, legislators, insurance companies, moralists and ethicists, might militate for paying donors if they or someone they loved needed a transplant and was near the bottom of the list.

2. federalist - April 5, 2007

LifeSharers is an interesting fascist solution to the problems with the UNOS system. Apparently all states allow directed donations, so LifeSharers agree to give each other preference in organ donations.

Thanks to MarginalRevolution.

3. federalist - November 13, 2007

WSJ today reports, “Kidney Shortage Inspires A Radical Idea: Organ Sales“:

The federal ban on organ sales dates back to 1983, when Virginia physician Dr. H. Barry Jacobs proposed buying kidneys — mostly from the indigent — and selling them to whomever could afford to buy. His plan was met with widespread outrage. In Congress, then-Rep. Al Gore (D., Tenn.) introduced legislation banning the sale of organs. The bill became law in 1984.

Since then, the gap between demand and supply has widened. In 1988, the first year for which data are available, there were fewer than 14,000 patients waiting for a kidney transplant and about 7,000 deceased-donor kidneys. Today, the waiting list has grown more than fivefold — an increase fueled partly by higher rates of diabetes — but the number of deceased-donor kidneys has only inched up. Some of the gap is made up by living donors, but demand still far outstrips supply. Last year, about 4,400 people died on the waiting list.

Kidney sales are common in some developing countries, including Pakistan and the Philippines, though they are technically against the law. Iran is the only country with a government-sanctioned market. Outside medical observers say that sellers in these places are often exploited. Much of the fees go to unscrupulous brokers, for instance, and there is little screening to ensure donors are healthy enough to withstand surgery.

A 2004 paper by Arthur Matas notes that “the government could spend $95,000 to evaluate and compensate a donor and still break even. The reason: Medicare pays for dialysis for all Americans who need it. Transplant recipients no longer need the costly procedure, which translates to huge savings.”

4. federalist - November 17, 2007
5. federalist - May 19, 2008
6. Moral Hazards in Life Insurance: The Suicide Exclusion | Federalist - October 9, 2013

[…] irony: Our government forbids anyone from being compensated for donating organs to save the lives of others (supposedly because of the moral hazard of such an incentive), yet it […]

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