(Polka Dot)
The organ donor waiting list in America is a long one. There’s far too much demand for a very limited supply. In 2010, 89,316 people were on the kidney transplant waiting list, while the number of living donors was only 6,282, and the number of deceased donor transplants was 10,622. Freakonomics is no stranger to the repugnant discussion of the organ market. America’s particular organ donation policies, however, aren’t practiced everywhere. Singapore and Israel give priority to potential recipients who were already registered donors. A new working paper written by Judd B. Kessler of Wharton, and Alvin E. Roth from Harvard further tests this idea of priority-to-participants in an incentivized game. Here’s the abstract:
Organ donations from deceased donors provide the majority of transplanted organs in the United States, and one deceased donor can save numerous lives by providing multiple organs. Nevertheless, most Americans are not registered organ donors despite the relative ease of becoming one. We study in the laboratory an experimental game modeled on the decision to register as an organ donor, and investigate how changes in the management of organ waiting lists might impact donations. We find that an organ allocation policy giving priority on waiting lists to those who previously registered as donors has a significant positive impact on registration.
Could this be it? A not-so-repugnant solution to all our organ donation woes? A way to increase the number of registered donors above the current 40% of the adult population in the U.S.? Maybe. The authors explain a little more about the nature of their thought experiment:
It may be that the donor-priority organ allocation policy increases registration rates in part because the allocation rules allow for non-donors to be excluded (or to have a smaller probability of receiving an organ), effectively turning the registry into a club good and generating an incentive to become a donor.
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What if we were to require anyone who wants to obtain a motorcycle license to be an organ donor, and then remove all helmet requirements? I’ve been friends with quite a few nurses and doctors who shake their heads whenever they see a motorcyclist w/o a helmet, calling them “Donor Bikers” because if they get into an accident w/o a helmet, they’re usually immediately braindead but with intact and usable organs.
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What if someone couldn’t be an organ donor? There’s several congenital disease that make it impossible for a person to be a tissue My father was told he couldn’t donate after he had cancer for at least ten years, and was advised by his oncologist to never donate, just in case some of the cells had gotten through the treatment and were hiding elsewhere in his system.
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In most of these systems, they assume that everyone will be eligible to donate something. Corneas, for example, are usually safe even in patients with solid tumors. (Of course, there’s no significant shortage of corneas in the US.)
The story from the transplant community is that everyone should sign up, even if you have been told that you are absolutely, permanently, completely ineligible, because eligibility rules change over time (e.g., although HIV+ donors are banned in most places now, that seems to be changing) and maybe the physicians who told you that you were ineligible were idiots.
The story from the patients in that position is “give me a guaranteed, legally binding method of saying ‘Do not use my toxic organs to kill innocent people’.”
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My wife says she would be happy to be an organ donor but only with a stipulation–that none of her organs get donated to patients whose organs have been damaged as a result of drug and alcohol abuse.
As for me, I think organ donation makes great sense in general but no sense for an individual. It’s kind of like trusting the clergy and the cops. Doctors are human too and if your organs will fit into someone they really care about, some doctors will harvest yours. Besides, there’s nothing in it for me.
Maybe a policy of being at the head of the list if you also choose to donate organs makes great sense.
Hey, my cold corpse will go to medical science. So it’s not a total loss.
Hot debate. What do you think?
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The physicians whose job is to save your life are NOT transplant specialists, do NOT have any idea who might get these organs, and do NOT know what all of your genetic match characteristics are.
Only about 1 in 3,000 Americans is on the transplant list. That means that most people, including most physicians (except transplant surgeons), don’t know anyone at all who needs a transplant.
There’s only about a 1 in 20 chance that if you die, you’ll manage to die in a way that makes transplantation possible (e.g., in a hospital or arriving in a hospital very shortly after death; without system infections; without invasive cancers; without serious damage to the target organ; etc). If your organs are in perfect condition, the chance that your organs might “fit” a specific patient on the order of 1 in 30,000.
So even if the physician knows someone who desperately needs a transplant, the odds of any given patient being a potential source for the transplant is about 1 in 600,000. That means that there is a 99.99983% chance that failing you would do no good whatsoever for the other person the physician knows.
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Isn’t it already the case that drug/alcohol abusers are at the bottom of the list (if they’re on it at all?)
As I was reading through this post, the hypothesis I was starting to develop was that if priority for organ donation were given to those who were already organ donors, more people would likely sign-up to be organ donors. I was happy to see that this was the finding of the study.
In the final excerpt, the authors flesh out their conclusions a little more. However, it is not clear to me whether or not they had one of their experimental groups faced with the possibility that “unless they were on the organ donor list, they could not receive an organ.” I wonder if this would increase the # of organ donors (higher than just the idea of “club good”), or if this would make people bitter and cause them to resent the system.
It’d be worth looking into.
With Love and Gratitude,
Jeremiah
That’s precisely what I want. Why should my organ go to someone who isn’t willing to do the same? I know there’s religious reasons that people don’t donate, but (unless their religion is Hypocrisy) that probably excludes them from receiving, as well. At the least, they should make “My organs go to registered donors ONLY” an option.
I’m seeing the possibility of abuse here. Someone can sign up to be an organ donor to get preferential treatment. I would suggest that they require a person be an organ donor for at least a year (or some other number that works better) before they can receive preferential status on donor waiting lists.
Didn’t they account for that with the following: “those who previously registered as donors”
Anyway, I think this is a better solution than the often opted “presumed consent” due to the legal difficulties with presumed consent.
http://www.lorihartwell.com/GlobalOrganDOantionPolicies.pdf
I also agree with Erik Jones’ wife that not all patients have the same “right” to my organs. However, I can’t see a good solid (legal) policy which could account for that, and what would happen when my organs are not compatible with patients who need organs due to ‘force majeur’ but is for a patient who needs one due to alcohol/drug abuse. Who am I to decide who’s life is “more valuable”?
Due to the many ethical problems surrounding organ donation, the medical difficulties in making a transplant succeed and the impact death has on family and friends, I am not (yet) registered as a donor but have ‘agreed’ with my mother that in case I die (before her) she may make the decision whether or not to donate my organs. I think, however, that when push comes to shove she’d rather not have “them cut me up”.
It is an interesting dilemma though because we all wish there were more donors when we are in desperate need of an organ.
If I’m hearing you right, you’re saying you’re mother would prefer that your no longer needed bio-hazardous waste (your dead body) be supplied to bug and microbes as a food source instead of being used to save the life of a dying human.
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That is correct.
But as I have recently (last March) experienced with the death of my father the process surrounding such a situation and the time-limit in which organs must be harvested (correct me if I’m wrong but you’d have to die in a hospital) leave little room for a well balanced decision. At that particular moment I believe she couldn’t care less (and as stated before the chances of a successful transplant are limited)
Just to clarify: My wife’s opinion on who gets her donated organs is based on drug and alcohol users being far more likely to “misuse” the organs–not on deciding whose life is more valuable.
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Yeah, I got that, but the implication of making a difference between different groups of people in a possible life-saving situation is, in my opinion, the same as determining the “right” or “value” with regard to such a group.
Isn’t this the obvious problem here? Seems like a simple concept, but in execution extremely difficult. When do you count organ donor volunteership? Because a new 70 year old organ donor volunteer is worth a whole lot less than a new 20 year old donor volunteer, even if both live only 10 more years.
That’s why we use money in most markets. It’s a lot easier. This idea sounds like health insurance in America. Another model of broken allocation of resources.
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Actually, age isn’t as significant a factor as most people think. A healthy 70-year-old donor (e.g., without high blood pressure) is not worth much less than a healthy 20-year-old donor. If you put a 70-year-old liver into a 20-year-old recipient, it is not unreasonable to expect that liver to last for many decades to come (minus the risk of rejection, of course).
The issue with “age” is really an issue with “disease”. A random 70-year-old donor is far more likely to have kidneys damaged by decades of undiagnosed high blood pressure than a random 20-year-old donor.
This blog seems to be obsessed with influencing other people’s behavior.
Hot debate. What do you think?
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Uh, yeah that’s kind of the point of economic policy.
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Then I hope for your sake that your party is always in power.
Hot debate. What do you think?
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A social science whose purpose is social engineering. You are enemies of personal freedom and self-determination. Your condescending patronage is astounding. You should be ashamed.
Hot debate. What do you think?
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What exactly did you think behavioral economics was about?
Is there any truth to the conspiracy theory that there is some risk to being an organ donor as doctors may not say your life to instead use your organs to save a few lives?
A few people have given me this theory when I tell them I’m an organ donor, and at first I laughed it off, but after more than one person said it, and some even said they had heard it from friends in the medical industry, I got a little nervous.
None at all. In fact, by law, it’s not even the same people doing these two “halves” of the job. The doctor who is trying to save your life has you as his SOLE patient, and losing you is kind of a blot on his reputation. The transplant doctor doesn’t get to do anything except stand around until your doctor thinks it’s likely to be hopeless. Most hospitals require two separate physicians to verify that you’re actually dead before the transplant process can be done.
There aren’t very many transplant doctors, so unless you’re at a major research hospital with its own transplant program, rather than a regular community hospital, the transplant doctor almost always is imported from some other hospital. This means that the doctors probably don’t even know each other, much less each other’s patients, and at the time the decision is made, nobody in the world knows which patient(s) will receive the organs. It is normal for an organ to travel hundreds of miles to a well-matched patient.
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how about if someone is HIV+? should he register as organ donor.
Previously, the answer was NO. However, there is an effort to permit HIV+ people to donate organs to HIV+ recipients. (The immune suppression needed for organ transplants does not appear to harm HIV+ people, so they are able to receive donated organs about as safely as anyone else.)
HIV is something they always test for, so if you choose to register and you die in a way that permits a donation to be made, they are unlikely to accidentally give HIV to someone along with an organ.
One way to handle this is to write a specific explanation in a “living will” that says something like, “I’d be happy to donate my organs if anyone can use them, but I have HIV, and the transplant team must inform any potential recipients of this fact.”
You can also write something similar if you have any condition that makes your blood or organs unsafe (or unsafe for people who don’t have your rare genetic quirk, or whatever the situation is).
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