No-give, No-take Policy Would Ease Organ Shortage

Two years ago, while suffering from primary sclerosing cholangitis (the same disease that killed Chicago Bears running back Walter Payton in 1999), Chris had a liver transplant that saved his life. His story is an inspiring one about strength, perseverance and the gift of life. But it also serves as a grim reminder of just how many people are not so lucky.

Thousands of people die every year while waiting for vital organs to be donated. As medical technology increases the number of potential recipients, the organ shortage worsens and the waiting lists get longer.

The policy that produced this grievous result has been in place since kidney transplants first became feasible in the 1950s. It was codified into law under the National Organ Transplant Act of 1984, which outlawed the purchase or sale of human organs. Since then, the nation’s organ procurement system has relied solely on goodwill to motivate organ donors.

But goodwill alone has never produced enough organs to meet demand. Although organ donation increased by 10 percent over the last decade, the number of individuals in need of a transplant increased by 30 percent.

That the current policy has persisted for so long is a moral outrage. Even its defenders have difficulty claiming that the policy is successful. Instead, they argue that market-based alternatives, such as compensation for organs, are unethical and deter current “gift givers.”

More outrageous is the fact that supporters of the current system advocate its continuation on humanitarian grounds. What is so humanitarian about letting people continue to die while awaiting transplants, just so we can feel good about “giving”? Clearly we’re not generous enough if approximately 6,000 people die annually, while another 79,000 or so are relegated to waiting lists.

Recently, the medical community has moved closer to recommending compensation for organ donation as a remedy for the shortage. The American Society of Transplant Surgeons has already endorsed payment for cadaveric organs. And the American Medical Association’s governing house of delegates will meet in June in Chicago to vote on a pilot program that would test the effects of different motivators, including payment, for cadaveric organ donations.

Supporters of creating a market for organs are convinced that financial incentives are the only way to end the shortage, while defenders of the current system, segments of the medical community, and perhaps most Americans, are still uncomfortable with the idea of paying for donated organs.

But money and goodwill are not the only incentives available. What about self-responsibility?

Under the current system the general public takes no responsibility for maintaining supply. The United Network for Organ Sharing, the nonprofit group that coordinates transplants for the federal government, currently takes the position that organs are a “national resource,” which means that access to organs is entirely separated from the supply of organs. In other words, non-donors have just as much access to the organ pool as donors.

Because there are no consequences for refusing to donate, it’s no surprise that so many people choose not to sign a donor card. At present, the costs or benefits of agreeing to be a donor are no different from those of a non-donor. Why not adopt a “no give, no take” policy as proposed by economist Alexander Tabarrok?

In the new book, Entrepreneurial Economics, Tabarrok argues that giving priority for organ transplants to those who have already agreed to donate creates an incentive to sign an organ donor card (and imposes a penalty for those who don’t sign), thus increasing the number of transplantable organs.

If the current organ shortage has led the AMA to reconsider the idea of compensation for organs, perhaps it’s also time to reconsider who’s entitled to obtain them. Given the scarcity of transplantable organs, to whom should public policy grant moral priority? Those who are willing to give, or those who have expressed only a willingness to take?

Moreover, a no-give, no-take policy would alleviate most existing concerns. It would increase supply without “reducing human beings to a commodity,” and would allow those who donate solely out of goodwill to do so without being deterred by compensation.

Children would be automatically eligible for organs until they reached the age of consent. And those who declined to sign donor cards would still be eligible for surplus organs. If Americans remain fearful over compensation for organs, then a no-give, no-take rule would be a fair and reasonable solution to the current organ shortage.