Nation of Beancounters

How can we boost organ donations, without a market?

Posted in Uncategorized by Navin Kumar on December 10, 2011

A very interesting New York Times oped generated a lot of buzz in the blogosphere, mainly because the writer has donated one of his kidneys (while still young and healthy) to a complete stranger for strictly charitable reasons. While the arguments used won’t be new to anyone who follows the organ market debate, one of the comments  caught my attention:

I sincerely hope that, once you have only one kidney, you never have to face the problem of your child or your life partner needing a kidney donation. I have also considered donating a kidney to a stranger, but did not, because I could not face the possibility that one of my family members might some day need one. Post-donation, I would find myslef (sic) unable to help the family member. I believe this is a reasonable fear that may deter many people. Please do not condemn those who have this reservation.

(I absolutely do not condemn anyone who refrains from donating a kidney for this (admittedly selfish) reason or indeed any other reason, including the desire to have a spare kidney, nor I suspect would the writer.)

The comment brings up a point that I’m sure the author never intended it to: if the difficulty of arranging a kidney later prevents us from donating a kidney now (as the author claims), wouldn’t making it easier for this kidney to be arranged for induce more people to donate a kidney now? If we flip her (quite plausible) conclusion, the answer is yes.

Imagine this: if you donate a kidney now, you get a card that says “kidney donor”. If, in the future, you or your spouse or one of your children, siblings or parents fall ill than you can use the kidney donor card to push the patient to the top of the waiting list, essentially guaranteeing him/her a kidney. This is perfectly fair: the person would have gotten a kidney from the donor but for the donor’s altruism – and we as a society ought be appalled by the idea of someone suffering for a good deed.

The interesting thing here is that we’re “incentivising” organ donations, although it’s more like un-disincentivising: removing a cost that exists.

Note, also, that this method circumvents the repugnance voters have against people “selling” their body parts as no money changes hands.

And it’s not unprecedented. In India, at least, when you donate a unit of blood, you get a card that entitles you to a free unit of blood should you ever need it.

Now, we could expand this: if a person dies and his family allows his organs to be donated posthumously, they would get a similar card. You can think of this as them “inheriting” his donor card. Or think of it this way – if we could invent a way for these organs to be put into cold storage so that a man’s children could use them in future (should they ever need to) would we refuse to let them? No? Okay. How is this any different, except that the technology is an entry in a register somewhere?

Given how unlikely it is that such a (non-transferable) card would ever be “cashed in”, one could give a person two cards for every donation.* We’re now in the “actively incentivising” zone,  where the repugnance usually kicks in. But since no money exchanges hand, we should be able to avoid triggering the repugnance reflex and fend off wails of “you’re commoditising the human body!”.

Yes, this might not be enough. But it’s definitely a boost over status quo.

Yes; an organ market would be better, but we economists have been lobbying for one for a long time and we’ve gotten nowhere. It’s time we started thinking of a series of band-aid solutions that may someday be cumulatively enough to fill the shortage. Indeed, if the supply of posthumous organs is highly elastic (kill me, kill me now) we may be able to fill this gap with just this one move. We need to think of more incentives that don’t feel like incentives.

Yes; this might have negative political implications in that it’ll make it harder for us to push for an organ market, but given how unlikely it is that we’ll ever accomplish this, we ought start thinking of something else.

*Yes, I can imagine a situation in which a parent, with two kids suffering kidney issues, donates in order to get a two-for-one. But it’s so unlikely that the cost would doubtlessly exceed the benefits i.e. the increase in the number of kidneys we get would exceed the number we “lose” (although that’s the not right word here; you are saving a life after all, so the extra cost is zero) to cases such as the above.

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  1. […] interesting aspect of the new policy is very close to what I had suggested earlier The Priority Law, which takes effect in April, will give holders of Adi donor cards priority if […]


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