Incentives for Organ Donations

A new paper from Nicola Lacetera, Mario Macis, and Sarah S. Stith (abstract; PDF) looks at whether various incentives are helping in getting more organ donations and bone-marrow donations:

In an attempt to alleviate the shortfall in organs and bone marrow available for transplants, many U.S. states passed legislation providing leave to organ and bone marrow donors and/or tax benefits for live and deceased organ and bone marrow donations and to employers of donors. We exploit cross-state variation in the timing and passage of such legislation to analyze its impact on organ donations by living and deceased persons, on measures of the quality of the organs transplanted, and on the number of bone marrow donations. We find that these provisions did not have a significant impact on the quantity of organs donated. The leave legislation, however, did have a positive impact on bone marrow donations. We also find some evidence of a positive impact on the quality of organ transplants, measured by post-transplant survival rates. Our results suggest that these types of legislation work for moderately invasive procedures such as bone marrow donation, but may be too low for organ donation, which is riskier and more burdensome to the donor.

Are we perhaps inching closer to a legal market in organs?

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  1. Seminymous Coward says:

    I bet a free $2,000 inflation-indexed, no-exceptions, immune-to-creditors life insurance policy prominently mentioned when asking about the driver’s license check box would have an effect.

    Knowing that my employer would likely count a donation as (unlimited) sick days instead of vacation days made me feel more secure when I signed up with the National Marrow Donor Program ( http://marrow.org/ ).

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  2. SunnyvaleCA says:

    Simple solution: priority for receiving an organ is proportional to the length of time being signed up as a donor. Those who aren’t signed up as donors can hope to receive an organ from other non-donors. Seems fair to me.

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    • Enter your name... says:

      Your idea already exists.

      At least one “club” in the US does this (all members agree to be donors, and to direct their organ donations first to any club member and only then to release the organs to non-members), and it hasn’t worked. Very few people sign up for it. I believe that a high percentage of the members joined only because they or their family members are hoping to receive a donation, making that pool have a lower-than-average donation rate for kidneys.

      The entire country of Israel does this, and it is being gamed. You sign up, so that you can get priority for donations, and then you tell your rabbi that you don’t actually want to donate any organs, and direct him to issue a religious veto when you actually die. By then, it’s too late to punish you: you already got your life-extending, health-improving kidney transplant. (One does wonder why a person who believes organ donation is immoral would be willing to accept a donated organ, but apparently it happens.)

      I’d guess that the lack of success in these systems is partly because most legitimate potential donors (excluding hypocrites who *say* they’re willing to be donors) have a primarily altruistic motive: when I die, I won’t need my kidneys, so why not give them away? If they stay with my body, my kidneys will just be so much hazardous trash.

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    • Seminymous Coward says:

      As you’ve stated it, this puts a 90-year-old who has been on the donation list since he was 70 (and therefore never likely to be a useful donor) ahead of a 19-year-old who has been on the donation list since he was eligible at 18. I assume there’s some modification to your scheme to fix this issue, but I can’t guess it.

      Also, are you intentionally proposing a scheme where non-donors will never get an organ, even in the case of there being a donated organ that no one registered as a donor can use?

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  3. Eric M. Jones. says:

    You just KNOW the poor donate the organs the the rich get them….

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    • Harvey Mysel says:

      Many, or even most poor people aren’t healthy enough to donate. And if a compensation system was established, the donor would not get cash…the compensation would be tied to some long term process, i.e. free health care, contributions to a 401K etc.

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  4. RAY THOR says:

    Hidden due to low comment rating. Click here to see.

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  5. draypresct says:

    Cynical thoughts about the ideas suggested so far in this thread:

    “We should prioritize people who are willing to donate”
    People who need an organ will opt in; the problem with this is that the people who need organs tend to be the ones whose organs no-one else wants. Net increase in usable organs: zero.

    “We should allow people to charge for their organs”
    I’ve never seen this done in a way I’d want to live under. The Philipines did it for a few years, and it was a disaster, and it’s no longer legal to get cash for organs there. There are similar horror stories from other countries that have tried this.

    Did I miss any?

    An article about paid organ donation in the Philippines:
    http://www.ahc.umn.edu/bioethics/prod/groups/ahc/@pub/@ahc/@bioethics/documents/asset/ahc_asset_177829.pdf

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    • Seminymous Coward says:

      The idea is to prioritize people who are willing to donate before they discover they need a donation. The “before” part is obviously important.

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      • draypresct says:

        Most of the people who will eventually need a kidney (by far the largest group of organ transplant candidates and recipients) will have some pretty strong clues that they will need a kidney eventually long before they need dialysis or a transplant. For example, someone with diabetes, hypertension, and a family history of ESRD might be cautioned by their doctor about the likelihood of dialysis or transplant decades in advance, e.g. “if you don’t closely monitor your glucose levels and start to watch what you eat, you’re going to need dialysis.”

        Part of my cynicism comes from working a booth trying to sign up donors, and only having people who were in wheelchairs or motorized scooters approach me to sign up. I’m pretty sure at least some of these people believe that there already is a system in place to prioritize people willing to donate (I tried to correct this the few times someone actually brought itup). Yes, I know it’s anecdotal, but I have faith in people’s ability to game a system.

        It’s easy to game a system when A) it’s easy to cheat and B) there is no realistic way to penalize the people who cheat. For example, how do you propose to penalize someone who indicated willingness, but either changed their mind shortly before death or whose relatives objected after their death? Keep in mind that few (if any) surgeons will be willing to risk going against the objections of the family.

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      • Seminymous Coward says:

        You make an excellent point. On reflection, I suppose defining the instant at which they discover they need a donation is actually quite challenging. Is it when they get a diagnosis of a manageable long-term condition that might lead to a need (e.g. diabetes), when they have a family history of something, when they get genetic test results saying they are predisposed to a particular disease, when they get told by a doctor that they will eventually need an organ, or when they get told by a doctor that they’ve been put on the transplant list? Some of those could occur before birth and all could occur before the age of majority.

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  6. Hank says:

    Stem cell should render this all obsolete someday

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