Kidney Donor Chains

Virginia Postrel has an excellent piece in the online Atlantic on the shortage of transplant organs, it includes a very good discussion of both the promise and limitations of kidney swaps and donor chains.  Imagine that Mrs. Smith and Mr. Jones each need a kidney transplant.  Mr. Smith is willing but due to an incompatible blood type unable to donate a kidney to his wife.  Similarly, Mrs Jones is willing but unable to donate a kidney to her husband.  In a kidney swap, Mr. Smith donates to Mr. Jones and Mrs. Jones donates to Mrs. Smith.  Everyone is happy.

Donor chains extend this idea.  We start with an altruistic donor willing to give to anyone – by careful arrangement it's then possible to produce many transplants.  Recently, a single donor led to a chain of ten transplants!

Despite the promise of these techniques they are being underutilized.  Amazingly, the National Kidney Registry, which coordinates swaps and chains, has donors who are waiting to give.  A clear reminder that $500 bills aren't always picked up as quickly as we would like. 

Even the maximal use of swaps and chains won't solve the crisis, however. For that we are going to need better incentives to encourage more donors.


Alex, what do you think of the NY Times op-ed today on the subject?

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As for paying live donors, people recoil at the idea because they worry about exploitation. They imagine a financially strapped person handing over a warm kidney in exchange for a stack of cash. But cash is not the only possible incentive: we could give them lifelong health insurance, discounts on higher education, two yearly payments of $500 for the rest of their lives, etc. Don't these long-run incentives eliminate the worry about short-run exploitation?

If you are a Socialist, you feel that these people have a right to those things for free from the state in the first place. In the Socialist mindset, by denying health insurance, higher education, guaranteed income etc., which Socialists believe are basic human rights, you are essentially saying to the donor "We will deny you your basic human rights unless you give up an organ".

The "New Socialist Man", who will emerge once Capitalism is destroyed, would gladly donate their organ for free out of sense of duty to society. Therefore, all people who die waiting for organs because of a lack of donors are "murdered by capitalism". Clearly, the only solution to the organ donor problem is to destroy Capitalism and the profit system.

Many people who aren't very political themselves will go along with the general distrust of paying organ donors, because Socialist intellectuals set the tone of the debate.

Now, I think this is ridiculous. I agree it isn't any more exploitative to pay an organ donor (or their family) than it is to pay a doctor, nurse, or medical equipment supplier for their contribution... but the belief against paying organ donors is ideologically consistent with Socialism, it isn't really a contradiction on their part. I disagree with the premise, not the conclusion.

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Not only did ten people get a kidney, but thirteen people got their names on a paper published in the New England Journal of Medicine!

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Number of people who died on transplant waiting list in 2005, according to UNOS: 6,902

Number of completed suicides in the United States in 2005, according to the CDC: 32,000

Suicide and Organ Donation: A System to Save Lives?

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This is stupid. I refuse to celebrate it (though if I needed a kidney I suppose I would get over it).

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Well, how about an a anarchist libertarian solution to both health care and organ transplant.

You join a mutual euthanasia society in which you can discharge potential future debts by committing beforehand to euthanasia and sale of your body parts to society members. The money collected would go to the society so it could settle all outstanding debt.

I heard an interesting analogy today, that of Ulysses tied to the mast by his crew, begging to be freed; was his crew taking away his liberty, his right to free will, or was he merely bound by his rational contract entered into when he could chose rationally that he should be bound by his crew against his will?

Likewise, people would join the euthanasia society when rationally deciding on future restrictions on their free will. If they run up debt and those debts are called, then while it might seem they are being euthanized against their will, that unwillingness is merely an emotional and irrational attempt to over ride their earlier rational decision to limit their future free will.

This can be viewed as economic creative destruction; a risk is taken, but if the risk turnout badly, even after periods of success, creative destruction serves the greater good of all at the cost of the risk taker who is better off by being freed of an ongoing burden to himself and to the group at large.

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dude, the invention of currency ended this double coincidence of wants crap.

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An older article re: the paired-donation concept:

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all depends on attitude! ...Attitude makes altitude. ...Attitude is everything. ...

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