Wednesday, November 22, 2006
Nineteen years ago, more or less, I wrote a paper for a law school seminar with the title "What you don't know won't hurt you: Toward a free market in transplantable organs." I don't think a copy survives and can't remember how I managed to occupy thirty pages or so, but I am fairly confident that the issues I raised in that paper remain unresolved today. We have a shortage of organs, meaning that people are dying or living miserably because we do not have enough organs to transplant. The shortage means that we have maddening rules for rationing the organs that we do have, rules that are probably "gamed" by various of the participants (as any fan of Gray's Anatomy at least suspects). One is forced to wonder whether all the justice and compassion have been squeezed out by our strange concern that neither living people nor their estates should be paid for donated organs.
I bring all of this up because Virginia Postrel, who quite famously donated a kidney to a person who was merely a friend, has written a couple of new posts about the idiocy of the system and the frail arguments against injecting well-regulated market incentives. Both are worth reading, including the links. And do not miss this editorial from The Economist, which notices that the Islamic Republic of Iran has a substantially more intelligent policy on the matter of kidney donations inter vivo than most Western countries.
It has long seemed to me that sheer neglect must have enormous influence over the supply of organs available for donation. Lots of people die without having given clear direction as to their wishes. Perhaps they live in a state that does not promote organ donation at the Department of Motor Vehicles (I note in passing that New Jersey seems to have become more active in the last decade or so), or perhaps they have not renewed their driver's license in a long time. Whatever the reason, why wouldn't we change the system from "opt in" (you have to choose to donate your organs) to "opt out" (you have to choose in advance to withhold donation or they will automatically be harvested when you die). Americans have proven through the profound success of the national "do not call" list that they can cope with an "opt out" system if they care enough to avail themselves of it. Why not create an opt out system for organ donation, allowing for registration on a touch-tone phone, via the web, or even by election on your income taxes?
The Economist does make mention of Spain's system, which it says is "opt out" and yet does not sufficiently alter the supply. Perhaps that is true, or perhaps there are limits in Spain's system that reduce its effectiveness. Either way, it seems to me that if we were to adopt an "opt out" system people would be brought into a discussion over organ donation that would be very healthy for the system, and which might break the hold of the altruism authoritarians who seem to dominate it today.
Apologies for not following the links, and just answering off the cuff.
How about people who are on organ donor lists go to the head of the line if they need organs? That would provide enormous incentive for people to make sure they got on the donor list. Like today.
Another off the cuff suggestion:
Not initially allowing folks to freely sell their organs, but allowing people who now are not donors to have their organs donated if a certain (large) sum would go to their estates. It would be a form of life insurance, that would allow a nice funeral, college for their kids, pay off the mortgage, or whatever. Setting the amount would be tricky, but it might motivate some people to be organ donors who do not under the current system.