Altruistic Kidney Donors Favoring Financial Compensation

by on February 6, 2014 at 7:29 am in Economics, Medicine | Permalink

Dmitri Linde joins Alexander Berger and Virginia Postrel as altruistic kidney donors who advocate for lifting the ban on financial incentives. Here is Linde:

Two policies would address the shortfall of kidneys in the U.S.: instituting a priority-scoring system for donors and their kin and paying donors.

Israel pioneered the former in 2012. Prioritizing organ allocation by donor status—a system that economist Alex Tabarrok termed “no give, no take”—incentivized people to register as organ donors. It also removed a hurdle to living donation: The incentive to abstain because of a hypothetical (What if my son needs a kidney?) went away since the policy guarantees that a donor’s kin will be prioritized in the event that they need a transplant. The results? Both living and deceased donations have gone up, and the number of people who have died on the waitlist fell by 30% between 2010 and 2013.

To obviate the kidney shortage, we should heed the recommendation of Nobel Prize-winning economist Gary Becker and others by making it legal to compensate donors.

Linde donated a kidney with the aid of the excellent National Kidney Registry. The registry matched him to a recipient whose own willing but incompatible donor donated to another patient in need. Bravo Dmitri.

Here are previous MR posts on organ donation.

dearieme February 6, 2014 at 7:35 am

I was on a list for a heart transplant once. Then my own heart recovered. “Just as well” I was told “because with your height and blood group you’d never have got one.”

I demand Justice for Tall Blokes with Blood Group O.

prior_approval February 6, 2014 at 9:05 am

So, any idea who is planning to sell a heart?

There are a number of stories of how that future might look like -

‘Organlegging is the name of a fictional crime in the Known Space universe created by Larry Niven. It is the illicit trade of black market human organs for transplant. The term organlegging is a portmanteau combining the words “organ” and “bootlegging”, literally the piracy and smuggling of organs.

The crime developed as a response to the Organ Bank Problem, a concept featured prominently in the early Known Space stories, particularly those set in the 21st and 22nd century. The Organ Bank Problem is a central theme in the novel A Gift from Earth, as well as the Gil Hamilton detective stories. As speculative fiction, the concept is a prime example of a Gedankenexperiment. It is an examination of the consequences to society of a new technology (in this case, the perfection of organ transplants) and an existing problem (organ shortage), carried to a logical conclusion.’ http://en.wikipedia.org/wiki/Organlegging

And since the demand for such organs as hearts tends to outstrip those willing to give up theirs, for either money or altruism, the state steps in – ‘On Earth, the problem led to a repressive society almost unrecognizable by today’s standards. Since the average citizens wished to extend their lives, the world government sought to increase the supply by using condemned criminals to supply the organ banks. When this failed to meet the demand, citizens would vote for the death penalty for more and more trivial crimes. First violent crimes, then theft, tax evasion, false advertising, and even traffic violations became punishable by the organ banks. This failed to solve the problem, as once the death penalty was passed for a crime, people stopped committing it. This resulted in nearly every crime meriting the death penalty.’

And to think back in the early 1970s, when Niven was writing these stories, people would have scoffed at the idea that any society would punish parking infractions by death. Yet, only a couple of decades later, a tenured professor at a public institution, notably affiliated with public choice theory, is seriously proposing that the market should be used to alleviate the need for transplantable organs.

Seriously, does anyone doubt that a state like China cares about voluntary market participation on the part of organ donors? No need to remain ignorant of our non-SF reality – ‘In China, organs are often procured from executed prisoners. Nicholas Bequelin, a researcher for Human Rights Watch, estimated that 90 percent of organs from China are from deceased prisoners.[3] Despite the legality of the process in the country, there is evidence that the government attempted to downplay the scope of organ harvesting through confidentiality agreements[4] and laws such as the Temporary Rules Concerning the Utilization of Corpses or Organs from the Corpses of Executed Prisoners.[5] Even with this lax regulation, China still suffered a shortage of organs for transplant.’ http://en.wikipedia.org/wiki/Organ_trade#China

Why pay someone to donate when you can just sentence people to death and sell the organs to anyone who can meet the price – no need to read old science fiction about such a thing, as it is the reality of the world we live in.

And if one doesn’t like the view of organ trading provided by a mainly totalitarian state, then we can look at another example, from a couple of decades ago – ‘Before the passage of the Transplantation of Human Organs Act in 1994, India had a successful legal market in organ trading. Low cost and availability brought in business from around the globe and transformed India into one of the largest kidney transplant centers in the world.[8] Several problems began surfacing during the period of legal organ trade in India. In some cases patients were unaware a kidney transplant procedure even took place.[9] Other problems included patients being promised an amount much higher than what was actually paid out.’

Anon February 6, 2014 at 9:37 am

One of the primary ways compensation can work is by changing the behavior of the next-of-kin. When there wasn’t a clear directive by the deceased, next of kin can be incentivized by payments to allow organ donations from their deceased family member.

So Much For Subtlety February 6, 2014 at 4:20 pm

And to think back in the early 1970s, when Niven was writing these stories, people would have scoffed at the idea that any society would punish parking infractions by death. Yet, only a couple of decades later, a tenured professor at a public institution, notably affiliated with public choice theory, is seriously proposing that the market should be used to alleviate the need for transplantable organs.

Usually I don’t bother with such obvious and asinine trolling, but you may notice there is a world of difference between taking organs from prisoners condemned to death for running red lights and supporting compensation for organ donors. Your little bit of outrage glides neatly from one to the other without providing anything to connect them whatsoever. So what if someone suggests a market in organs is sensible? Where’s the outrage? We are talking about kidneys, not hearts.

Seriously, does anyone doubt that a state like China cares about voluntary market participation on the part of organ donors? No need to remain ignorant of our non-SF reality – ‘In China, organs are often procured from executed prisoners.

China doesn’t execute enough prisoners for this to have a sizable dent in the organ market. I agree they do it. But there are so many people who need an organ and only so many counter-revolutionaries.

But why shouldn’t we do this? The prisons are full. They are expensive. We can have a Three Strikes rule whereby anyone with three felony convictions is an involuntary donor. Save a lot of time and money – and reduce the prison rape rate.

Now it sounds bad, but it is one of those issues where the initial distaste wears off after a while. Why not do it? We would save a lot of lives.

Hojat February 6, 2014 at 8:30 am

“Two policies would address the shortfall of kidneys in the U.S.: instituting a priority-scoring system for donors and their kin and paying donors.

Israel pioneered the former in 2012.”
Funny, since Iran pioneered the latter, paying the donors. And it works. No American Iranian will wait in the list for Kidney in the US, they will fly to Iran to get a non expensive and relatively simple surgery and save their life.

Z February 6, 2014 at 8:42 am

Of course China has landed on the solution the West will eventually follow. They simply take the organs from prisoners who soon will not be needing them anyway. What do you think those FEMA camps are for?

Nick_L February 6, 2014 at 9:43 am

It’s eventually going to be a non problem, as kidneys will just be printed on demand..

Hojat February 6, 2014 at 2:03 pm

Many are dead before that. Many hundreds of thousands. Millions in the world.

paternoster February 6, 2014 at 10:12 am

I do not know Tabarrok’s private life but if he is not himself a kidney donor, I find that his “Bravo Dmitri.” sounds very paternalistic if not downright despising/ disgusting.

DK February 6, 2014 at 10:22 am

+1

Ray Lopez February 6, 2014 at 10:39 am

Said the nym ‘paternoster’. Besides, what’s wrong with being a hypocritical cheerleader? Clearly you will never be a politician nor a good lawyer if you cannot assume a role for effect.

JWatts February 6, 2014 at 11:13 am

“I do not know Tabarrok’s private life but if he is not himself a kidney donor, I find that his “Bravo Dmitri.” sounds very paternalistic if not downright despising/ disgusting.”

I find that comment inexplicable. How is it despising or disgusting to commend someone for doing something, that you might not have the courage to do?

Ray Lopez February 6, 2014 at 10:40 am

Alex’s kidney donor scheme will rebut Mankiew’s “fifth” point below. – RL

http://pubs.aeaweb.org/doi/pdfplus/10.1257/jep.28.1.243

Fifth, Solow tries to revive utilitarian logic without
calling himself a utilitarian by claiming that redis-
tribution leads to a better “social state.” But what
he means by social state, other than something like
total utility, is unclear. In response to my critiques
of utilitarianism, he says: a) people don’t endorse
more foreign aid because they don’t feel solidarity
with those in other nations, and b) people aren’t
in favor of kidney redistribution because they don’t
view kidneys as fungible. I agree. In fact, Solow’s
arguments seem more like restatements of my
observations than refutations of them. If people
were maximizing a conventional social welfare
function behind a veil of ignorance, they would
treat foreigners equally with their fellow citizens
and they would treat kidneys as fungible. That they
do not do so is evidence that our innate moral intu-
itions are far from utilitarian.

mulp February 6, 2014 at 12:46 pm

Isn’t true free market healthcare the solution? Treat medical doctors like auto mechanics, treat ambulances like tow trucks, treat hospitals like auto shops.

When someone needs to be picked up off the highway or public place, the tow truck owner gets a lien on the body, which he transfers to the hospital in exchange for promise of payment. The ER adds its own lien for its services. If the person has no money or insurance on the body, then the person has a fixed time to arrange payment, or the body becomes the property of the hospital which can sell it in whole or in part to cover sunk costs.

Young invincibles would provide a good supply of organs by driving drunk too fast, ski boarding on black diamond slopes, playing football, getting involved with gangs, or simply having parents who owned guns.

Why isn’t the human body simply considered property to be bought and sold like cars?

Turkey Vulture February 6, 2014 at 3:42 pm

Just a friendly reminder that people die while perfectly good organs rot because we insist on capping the market price at $0.

Roy February 6, 2014 at 10:08 pm

I would just like a tax deduction for the cost of searching among my donors for a kidney that matched me. Currently the cost of testing each potential donor is near $10k and only Idaho, not the Feds nor any other state will let me count this as part of my medical expenses on my taxes. And most insurance won’t cover the cost because medicare pays for dialysis, so why should they care.

John Galt III February 13, 2014 at 9:02 pm

I have three kidneys. Many people have three, well one out fifty do. I have a duplex on one side and a single on the other. Pay me enough and I will give the single up. I need my liver though, as I drink too much.

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