How to Solve the Organ Donating Disaster

Exchanging goods and services has been a staple of every functioning society, proving its effectiveness. And yet we’ve failed to implement this economic concept in the organ donor market, which currently lies in a dire state. Although we buy and sell almost everything these days, the idea of selling organs for a monetary value is still revolting to most. The suggestion may be repulsive, but certainly not more than the 4,000 deaths that occurred in the U.S. in 2011 of people waiting for a kidney.

The increasing demand of organs each year in the U.S., coupled with the stagnant supply of donors, has caused a grave shortage in the organ market. In a normal market for a good, there would be a shift in the price of the good until demand and supply hit equilibrium. Since there’s an absence of price in this market, there’s no reason for the demand to decrease and, more importantly, no reason for the suppliers to give more. The absence of price means the absence of incentives. And an exchange based solely on altruism is sure to disappoint.

In 1984, under the National Organ Transplant Act, it became illegal for donors to receive any sort of compensation for their organs, including things as minuscule as a bouquet of thank-you flowers. Since a donor is to undergo major surgery and take a  number of days off of work for recovery, it’s an ambitious task to ask thousands to go through that for a stranger, without anything in return. Professor of law Michelle Goodwin thinks modifying this law to make it less stringent, such as compensating donors for lost days of work, could have a positive impact on the system.

While the U.S. is struggling to find an answer to this issue, the rest of the world has begun implementing incentives to resolve the large organ shortage. Israel has rewarded donors by prioritizing organ wait lists with those that have donated or plan to be deceased donors. This law was put in place too recently to gauge if there has been any concrete result, but I predict that it won’t have enough of an impact to facilitate a dramatic change. The policy is based on the assumption that people will take into consideration the low probability that they may be on the wait list themselves one day, and then make the decision to donate based on that assumption. Unfortunately, I don’t recall people being very keen on planning for the future.

Other countries have instated a “presumed consent” policy, where instead of having the choice to check a box on your driver’s license to be a donor, it’s assumed that you will donate your organs after death, unless you state otherwise. All the countries that have this policy in place are among the leading countries in deceased donors. This simple change can be easily implemented in the U.S. because it doesn’t affect a person’s choice directly; if people don’t want to donate, they can still opt out. Presumed consent just eliminates the chances of people not donating out of laziness, missing the donor box on a form or making an ill-informed decision at 16.

These options are simple and possibly effective, but would legalizing the sale of organs be the most effective solution to the shortage? In theory, yes, but there may be too many negative externalities. Mainly, the prevalent economic inequality would result in major and fatal disadvantages for the poor, for example, if the rich continually outbid them. The poor could also start performing self-surgical procedures and sell their organs because of a dire need to make money. With that, there may be an increase in crime with the temptation to steal and kill for organs. This black market for organs already exists, however, even with people asking for and selling organs through avenues like Craigslist. The black market for organs that is extremely prevalent in India and China has proven these possible externalities: the result is that either people are forced to give up their organs, which is further exploiting the poor, or people are voluntarily doing so in an unsafe manner.

On the other hand, Iran recently legalized the sale of organs and, though we don’t know the long-term effects, they do currently have an empty wait list. Donors are compensated between $2000-$4000…would that be enough to get you to donate?

You decide if we should make a change based on the facts (research done by Fareeha and illustrated by designer Joann Dzon):