Surprise: Money Still Beats Goodwill as Incentive for Organ Donors


If you’re a regular reader of this blog, you know we write a lot about organ donation and incentives. Like whether registered organ donors should get priority when it comes time to get in line themselves. Or whether the transplant market is too restrictive.

A recent Bloomberg column by Virginia Postrel highlights the difference between goodwill and cold hard cash as incentives to donate, not to mention the legal limits that exist to prevent transplants going to the highest bidder. Internet entrepreneur Amit Gupta is currently awaiting a bone-marrow transplant. But as he is of South Asian descent, odds of a close genetic match are lower than average, in the region of about 1 in 20,000. So Gupta’s friends turned to the web in an effort to encourage people to take a swab test to find a match. It turns out that goodwill alone wasn’t much of an incentive.

Author Seth Godin, Gupta’s friend, tells Postrel that while they got a lot of Internet attention, it amounted to little more than buzz. Or, as Godin puts it, “a lot of digital handshaking” that resulted in “a feel-good waste.”

Enter monetary incentives:

[Godin] wrote a post on his own blog offering to pay $10,000 to anyone who became a match for Gupta and made the stem-cell donation, or to give the money to that person’s favorite charity. The offer, he says, was “a chance to say to my readers, ‘Hey, I care about this. A lot. Money where my mouth is.’”

He picked $10,000 because, he says, it’s “enough money to matter to both the giver and the recipient, without being enough money to sue over, cheat over or corrupt.”

Michael Galpert, another tech friend, matched this, bringing the offer to $20,000 and increasing the number of people swabbing for Gupta, along with their twitter brags of #Iswabbedforamit.

However, the activity was illegal under the National Organ Transplant Act of 1984. So the official offer has been changed to a $20,000 award for a match, rather than the actual transplant.

From the article:

The law subscribes to what Viviana Zelizer, an economic sociologist at Princeton University, calls the “hostile worlds” view. This is the assumption that, as Zelizer puts it, “money and intimacy represent contradictory principles whose intersection generates conflict, confusion and corruption.”

As Gupta’s story illustrates, however, that’s not necessarily the case. Money can be an expression of commitment and a powerful spur to get people to act on their compassionate instincts. Financial incentives can overcome inertia and procrastination. They can steer people toward socially beneficial behavior. Nobel Prizes come with money, and we don’t, after all, expect every firefighter, nanny or transplant surgeon to work for free.



Money is always the most powerful incentive.


Simply not true. Many people do things without money as the incentive. And if there was a way to increase any other incentive arbitrarily as there with money, this would be more easily seen.

Many people forgo money for security (I am willing to work for a lower wage in a steady job than I used to make when working for myself because I prefer the lack of stress, the stability of the hours, and the freedom from responsibility).

Obviously, if we think about sex and whether everyone has their price (which is questionable), the better comparison would be if there was a way to increase the sexual incentive in the same way that the monetary price can be increased until a deal is reached. If there were, you might find that sex, respect, power, peace, security are all more powerful incentives for many people than is money.


so u think we should trade sex for kidneys?


Well, that one's legal. There's no law that prevents you from giving a kidney to your spouse or girlfriend.

Eric M. Jones

It always amazes me that, e.g. the Red Cross begs for voluntary blood donations but only pays people who live in back alleys for it (Let's hope this is an exaggeration). I know lots of people in great health who would be happy to sell you a pint of blood for $50.

The Red Cross doesn't do anything for free. Neither do hospitals. And the doctor needs another Mercedes.

So why are they such tightwads? Because they CAN be.

Enter your name...

The American Red Cross does not pay anyone for blood donations: it is absolutely illegal to do so, and has been for nearly two decades now.

Kathleen Lisson

I responded to Seth Godin's plea and signed up to get swabbed because of the humanization of the issue - one particular guy in San Francisco needed a transplant. I'm not South Indian, so I won't save him, or get the cash.
I did look at getting registered a few months ago, but I was dissuaded by the website's constant reminders that I was costing them $100 by registering and suggestions that I donate to defray the costs I was incurring. I wonder how much money they are 'losing,' what with all the new registrants?


I don't think Postrel can draw these conclusions. I think part of the reason is to avoid people resorting to selling their organs because they need money. I don't think there's any evidence that the financial incentive was spurring people to act on their compassionate instincts. I'm sure that was the case for some people, but I'm sure some people were motivated in ways that the law was intended to prevent

Virginia Postrel

As reported in the article, the pot is now up to $30,000. As to RJ's point, I made no claims that those were the ONLY effects of the offer only that those were among the effects. Godin's offer significantly increased the attention paid to the need for a donor including, as I noted in my article, a much-Tweeted article on TechCrunch. As to Kathleen's point, those tests aren't free. If no one makes financial contributions to support them, the Gupta-induced surge will in fact cost the registry a lot of money.


I am concerned that poor people would be encouraged by the financial gain to sell organs they could live without, without really having the capability to make an informed decision on the impact on their life/health. Sure, you can live with one kidney. But, if you have a poor diet (as many lower income people do), you could be at a higher risk for diabetes down the road and you may need that kidney. Bone marrow donation is less invasive, but still risky on the short term.

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Additionally, almost one in 50 people develop kidney cancer, which means that one in 50 donors will get kidney cancer, and—unlike people with two kidneys—they will not have the traditional "spare" that non-donors have if the cancerous kidney needs to be removed. You can't live very well with zero kidneys: that's why we do transplants in the first place.

The people who "really need the money" are the very people least likely to be able to understand these risks and decide whether the money is really worth it.


I can't say I'm surprised that cash is a bigger incentive, or that the government made it illegal to leverage that incentive.


there is still good will, incentive people, however temptation for getting pay for the thing that we were planning to do for free is much more higher.

Qiana Harrison

Well I understand both sides to this story. But as a current grad student I am in favor of becoming a living donor this would definitely take care of the amass college debt. I've racked up over my secondary education. I truly believe compensating these living donors will send them sprouting out the seams. It's just a small price to pay to keep this member of your family around physically a lot longer than God had intended. To me it's no different than being an egg donor which I'm glad to say I was able to be a part of 4 times previously. How dare the government dictate what rights their citizens have to their bodies...I'M PERPLEXED? Well with that Said I am all for becoming a living donor and breaking the rules and regulations especially to keep the people I love around abit longer. I am an O positive female 24 years old U.S. born Citizen may be reached @