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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.