HANGING on for dear life, aperson clutches a lone branch on the side of an enormous cliff, struggling to hold on. This struggle parallels the struggle of the 90,000 -- plus people on the organ donation list in the United States, each of whom suffers declining health as each minute passes. Religious Studies Prof. James Childress spoke this past Tuesday on public policies that could increase the rates of organ donation in this country. Many options exist to increase organ donation, but it is clear that some action should be taken to shrink the gap between the supply and demand of organs.
Currently, the United States has an opt-in program for organ donation. Individuals can sign an organ donation card, but families of the individual are usually asked their preference as the individual lies close to death. This option has many positives, including the respect for each individual's right to govern his or her body after death and respect for the wishes and feelings of the families of deceased individuals. This respect is part of the guiding principles in creating public policy for organ donation, according to Childress. Because the policy is not producing enough organs, alternatives must be sought.
One much discussed alternative is to change from an opt-in to an opt-out program, one of presumed consent. Unfortunately, many ethical barriers exist in moving towards this option. It may take advantage of individuals who are not well-educated in the policy. Also, disparities in healthcare may increase even further. For example, a physician in a poor area may consider obtaining organs from a dying person more important than saving the life of the person, affecting the quality of care given.
Furthermore, this change may increase distrust in the system. Overall, Childress said that the amount of transplanted organs may actually decrease from this change, "based on reasons people give for not signing donor cards." People who refuse to sign donor cards often say they would fear their organs being removed before they really die (ie they do not trust the system). If we change the default in the system to one of donation, the government's sole interest appears to be to procure more organs. This will cause more distrust in the system and many people will choose to opt-out, resulting in a net decrease of organs. In light of this analysis, more creative alternatives become necessary.
One suggested option, sure to appeal to some of the economic majors out there, is to create a free or regulated market. Adam Smith's invisible hand guarantees that the huge gap between supply and demand will surely shrink. But is this fair? In either the free or the regulated case, the increase in supply would be based on the incentive of "producers," or organ donors, to acquire funds for their "products," better known as their organs. Though this adds an element of classifying organs as commodities, it is not entirely problematic.
The real problem would lie in the demand. Markets are praised for allocating products in an efficient manner to those who desire the product the most. We cannot, however, make a case that one person in need of an organ really desires an organ more than another. It is impossible to put a price on life. With a free market, we would merely be rewarding those with the most money. In a regulated market, the government would most likely be the one purchasing the organs and allocating them as they see fit. This plan of action could be incredibly costly. Thus, markets, as efficient as they usually are, do not appear to be appropriate for organs.
A well-placed medium of this economic plan and the current system would be to use non-financial incentives. These could come in many forms, but a system of family credits or points may work best. Currently, we do have a system of credits for living organ donors in case they need an organ in the future. This system could be extended to deceased donors. For example, a family member who passes away and donates organs (versus a family member who merely intends to donate) would give his or her family a "credit." Such credits would give the family preference in the future if an organ was necessary. It is important to note that the credits will not be the sole determinant for the waiting list but will help shape the list with factors such as medical need and length of wait.
There would be concerns with such a plan, but they would be less troublesome than the other plans. Practical concerns, such as creating a national registry and weighing the importance of family credits, would have to be sorted out. Some may say this proposal deemphasizes individual medical need in allocation, but, by increasing the number of organ donors, the system will actually address the overall medical need without raising disturbing new issues.
We all would love to believe that human beings would be glad to assist his fellow man in whatever way possible. But in the face of a decision that causes no benefit to self, besides perhaps a psychological one, incentives become necessary. While using incentives may appear superficial, the results would be anything but that.
Rajesh Jain is a Cavalier Daily associate editor. He can be reached atrjain@cavalierdaily.com.
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