Results for “organ donation”
81 found

Rewarding Altruism: Blood for Money

Do pecuniary incentives increase blood donation or do extrinsic incentives crowd out intrinsic incentives? In Rewarding Altruism (NBER, free) an important and impressive new paper Nicola Lacetera, Mario Macis and Robert Slonim analyze a field experiment involving some 100,000 donors and find that pecuniary incentives significantly increase blood donations. The field experiment covers a wide geographic area and the donors are tracked for a significant period of time after donating so the authors can look for geographic and temporal spillovers. The authors offered potential donors gift cards of $5, $10 and $15.

Subjects who were offered economic rewards to donate blood were more likely to donate, and more so the higher the value of the rewards. They were also more likely to attract others to donate, spatially alter the location of their donations towards the drives offering rewards, and modify their temporal donation schedule leading to a short-term reduction in donations immediately after the reward offer was removed. Although offering economic incentives, combining all of these effects, positively and significantly increased donations, ignoring individuals who took additional actions beyond donating to get others to donate would have led to an under-estimate of the total effect, whereas ignoring the spatial effect would have led to an over-estimate of the total effect.

Some of the increase in supply came from temporal substitution but this is not without value. Incentives are not just about increasing supply but also about increasing supply at the right time, i.e. when blood is most needed so it’s useful to have a lever that can influence when donations are made.

Crowding out did receive some support in an odd context. The authors found that donors who were surprised with a gift card after they had donated were less likely to donate in the future. Thus, the donors did not reciprocate the unexpected gift and may have felt that their altruistic intention was being undermined. Once again we see the overwhelming importance of context when trying to understand incentives. To paraphrase Mises, an incentive is not an objective fact but a subjective interpretation.

The authors did not find any decline in quality ala Titmuss. Indeed, this is to be expected since modern blood donation is not a random shout-out to people on the street but instead relies predominantly on repeat donors with a long donation history.

Gift cards of $5, $10 and $15 are small incentives and the authors suggest that the benefits from the increased supply far exceed the costs. It’s notable that it takes longer to donate blood plasma and as a result the U.S. blood plasma industry (the “OPEC of blood plasma”) has always relied on paid donors.

Here are my powerpoint slides on Incentives to Increase Organ Donation and here is an older post on sperm exports.

April Speaking Events: Tyler Cowen, Alex Tabarrok

Here is a list of events that Tyler and/or I will be speaking at in the near future.

  • Tyler and I will both be at the APEE conference in Las Vegas, April 11-13.
  • Tyler will be speaking on “The Economics of the Jobless Recovery” at Emory University on Thursday April 22, 4-5:15 pm.  More information here.
  • Tyler and I will both be speaking at the Fifteenth Annual University of Kentucky Teaching Workshop on Saturday April 24.  I will be talking about “Seeing the Invisible Hand” and Tyler will talk about the “Impact of the Financial Crisis on the Teaching of Macroeconomics.”  More information and registration here.

Assorted Links

1. More on Israel's new "no-give, no-take" organ donation system.

…Robby Berman, founder and director of the Halachic Organ Donor Society,
a Jewish organization based in New York, said ultra-Orthodox Jews can't
have it both ways…. "Every Jew has a right to be against an organ donation, but then you can't come and say 'give me an organ.''

2. Are birds shrinking due to climate change?  At last, the climate change and evolution deniers can unite.

3. Not from the Onion: Apple: Free iPad With Every Replacement Battery.

4. Chinese airports at nowhere:

"…when the $57-million airport opened in late 2007. Local officials were
so confident that tourists would flock to this beautiful, mountainous
county in southwestern China that they made the terminal big enough to
accommodate 220,000 passengers annually…A grand total of 151 people flew in and out of Libo last year."


5. Inhalable chocolate and coffee.

6.  Matt Ygelsias, world's most underpayed blogger?

Hat tips to Daniel Lippman and Dave Undis.

No Give, No Take in Israel

In January, Israel will become the first country in the world to give people who sign their organ donor cards points pushing them up the transplant list should they one day need a transplant.  Points will also be given to transplant candidates whose first-degree relatives have signed their organ donor cars or whose first-degree relatives were organ donors.

In the case of kidneys, for example, two points (on a 0-18 point scale) will be given if the candidate had three or more years previous to being listed signed their organ card.  One point will be given if a first-degree relative had signed and 3.5 points if a first-degree relative had previously donated.

In Entrepreneurial Economics I argued for a point allocation system like this–which I called a "no give, no take" system–as a way to increase the incentive to sign one's organ donor card.  One advantage of a no-give, no take system over paying for organs is that most people find this type of system to be fair and just–those who are willing to give are the first to receive should they one day be in in need.  

The new policy will be widely advertised in Israel and will be transitioned into place beginning in January.  I think this new policy is very important.  If organ donation rates increase in Israel, I expect that other countries will quickly follow suit.

By the way, is it peculiar that the two countries in the world with the best organ donor systems are now Israel and Iran?

Hat tip to Dave Undis whose Lifesharers group (I am an advisor) is working on implementing a similar system in the United States.

Robin Williams and Alex Tabarrok

I was asked to do a radio interview with KPCC while I was at TED.  The interview had just started and I’m talking about organ donation when into the studio walks Robin Williams!  Naturally all chaos ensues and Robin takes over… but not before I manage to squeeze in an economics joke with Robin playing the straight man!  Some kind of first there.  I’m not sure Robin got the joke but I think this made the host laugh all the more. No one can out talk Robin, however, so he riffs on organ donation and fiscal stimulus for some time.  Eventually Robin goes on his merry way and the host and I get back to organ donation, bounty hunters, voting and other cool stuff.  An amazing experience for me.  Real audio here (try here if that doesn’t work)

Repugnance is Repugnant

Many people find the idea of selling human organs for transplant to be repugnant which is why Roth argues that we should focus more on improving efficiency through kidney swaps.  I’m all in favor of swaps and have also suggested that one argument in favor of no-give, no-take rules is that they are ethically acceptable to more people than organ sales.

Nevertheless, I think Roth assumes too quickly that repugnance is a constraint to be respected rather than an outrage to be denounced and quashed.  People’s repugnance at inter-racial dating or homosexual sex is no reason to prevent free exchange – the same is true for organ donations.  Repugnance itself can be repugnant.

Is it not repugnant that some people are willing to let others die so that their stomachs won’t become queasy at the thought that someone, somewhere is selling a kidney?

What people think repugnant can change rather quickly with changes in the status-quo.  Adam Smith said that in his time there were "some very agreeable and
beautiful talents of which the possession commands a certain sort of
admiration; but of which the exercise for the sake of gain is
considered, whether from reason or prejudice, as a sort of public
prostitution."  What were these talents that people in Smith’s time thought akin to prostitution?  Acting, opera singing and dancing.  How primitive, how peculiar.

In the not to distance future I think people will look back
on the present and think us
primitive and peculiar.  Letting thousands of people die while organs that could have saved their lives were buried and
burned.  So much unnecessary pain; all for fear of a little exchange.  How primitive, how peculiar.  How repugnant.

Netherlands fact of the day

Some 12,000 more people have registered as organ
donors in the Netherlands since a Dutch TV hoax that featured a
"competition" for a kidney.

The Big Donor Show was revealed to be a hoax as the fake donor was apparently about to reveal her choice of patient.

But Dutch media say the number of people registering as
organ donors has jumped since the hoax. The usual monthly figure is
just 3-4,000.

Will this greater interest in organ donation last?  Here is the link and story.

Virginia Postrel is Mad

No one is more familiar with the ethics of organ donation than Virginia Postrel so when she says that the National Kidney Foundation is behaving reprehensibly you can be damn sure she is right.

The National Kidney Foundation
is behaving reprehensibly, especially given its mandate. When I first
got interested in organ donations, I naively thought that the
foundation would be in the business of doing everything possible to
encourage kidney donations. I was terribly wrong. The group vehemently,
and successfully, opposed a bill that would have allowed tests of incentives for organ donors. (CEO John Davis brags
here, scroll to second item.)

So determined is the NKF that kidney donors should never, ever, in any
way be compensated for their organs–no matter how many kidney patients
current policy kills–that the organization is now trying to stamp out public discussion of the idea. When they heard that AEI is planning a conference
on the subject for June 12, they wrote a letter to AEI president Chris
DeMuth suggesting that the conference shouldn’t be held. The letter
from NKF chief Davis (PDF available here) opens:

The officers and staff of the National Kidney Foundation (NKF) were
surprised to learn that AEI has scheduled a forum entitled "Buy or Die:
Market Mechanisms to Reduce the National Organ Shortage" that will be
held on June 12, 2006. …we believe that the concept of financial
incentives has been adequately debated for 15 years, begining with the
National Kidney Foundation’s 1991 workshop on "Controversies in Organ
Donation," and culminating in the definitive Institute of Medicine
(IOM) report that was issued late in April 2006. We don’t see how an AEI forum would contribute substantively to debate on this issue. [Emphasis added.]

In other words, "We’d like to maintain our monopoly on the policy debate, so please shut up."

…For more background on the policy debate, see previous posts here, here, and here. Marginal Revolution blogger and GMU economist Alex Tabarok takes a detailed look at incentives here.

Dutch Treat

Holland’s Health Minister has proposed a system for organ donation similar to what I have called (in Entrepreneurial Economics) "no-give, no-take."  Under the proposed system people who sign their organ donor cards would receive points which would raise them on the waiting list should they one day need an organ.

My main argument for no-give, no-take has always been efficiency, it would increase the incentives to donate.  It’s fairness, however, especially as it intersects with the politics of immigration that is driving the change in Holland.   

The Liberal VVD minister defended his proposal by pointing out that
Muslims often refuse to donate organs based on religious beliefs. This
is despite the fact they are willing to receive an organ if they are
ill. "That creates a bad feeling," he said.

"If you say: ‘I refuse to donate an organ because of my religion,
but I don’t want to receive one either’, than I will respect it. But I
won’t respect a one-sided attitude of receiving and not giving. I find
that problematic," Hoogervorst said.

Thanks to Dave Undis for the pointer.

Further thoughts on artificial hearts

A number of people emailed me or blogged (eg. here and here) on my post, Artificial heart won’t save lives. The number of transplants is constrained by the number of donated organs thus the main effect of the artificial heart, which is just a temporary stop-gap, is to redistribute organs. The artificial heart makes some people better off at the expense of other people who are made worse off. No one challenged this conclusion but it seemed to make some people uncomfortable. Two arguments were raised in opposition, both of which are weak.

First, the heart does allow some people to live a little bit longer – this is a benefit, but a few weeks of life while chained to a big machine doesn’t seem like a big breakthrough to me. Second, the artificial heart could allow for better matching. Theoretically true, but there are already many more patients on the waiting list than there are hearts available so the opportunity for better matching is negligible. Consider, that for a given heart there are now 3500 people on the waiting list to choose from – how much better is the match going to be if we add a few more people to this list?

I am not against artificial hearts (some people say I have one!) perhaps one day the technology will improve enough so that someone on an artificial heart can be taken off the list, but the issue is comparative. Suppose that we put the funds gong into artificial hearts into programs to increase organ donation. One donated organ is say good for 10 years of extra life. Average time on the artificial heat is 77 days and it is not clear how many of these days represent extra days of live. Let’s say very charitably that 50 days are extra then this means that one real heart is worth 73 times as much as an artificial heart (10*365/50) and that is before adjusting for quality of life.

Dollars for Donors

The shortage of human organs for transplant grows worse every year. Better immuno-suppressive drugs and surgical techniques have raised the demand at the same time that better emergency medicine, reduced crime and safer roads have reduced organ supply. As a result, the waiting list for organ transplants is now 82,000 and rising and more than 6000 people will die this year while waiting for a transplant.

The economics of the shortage are so obvious that one popular textbook, Pindyck and Rubinfeld’s Microeconomics, uses the organ shortage to explain the effect of price controls more generally!

Perhaps because the shortage is growing, opposition to financial compensation for cadaveric donation (compensation for live donors is a distinct issue) appears to be lessening. The AMA, the American Society of Transplant Surgeons and the United Network for Organ Sharing have agreed that tests of the idea would be desirable. (A group of clerics, doctors, economists (I am a member) and others has formed to lobby for the idea – see our letter to Congress.) Currently, even tests are illegal but Representative James Greenwood (R, Pa.) has introduced a bill (H.R. 2856) that would create an exception.

Aside from the obvious benefits of saving lives, financial compensation for organ donation would likely save money. Here is a back-of-the-envelope calculation. There are some 285,000 people on dialysis in the US. Transplants are cheaper than dialysis by something like $10-$25,000 per year. About a quarter of those on dialysis are on the waiting list but perhaps as many as half could benefit from a transplant (fewer people are put on the list because of the shortage.) Let’s take the lower numbers. Assume that a quarter of the patients on dialysis could benefit from a transplant and that cost savings are $10,000 a year for five years. Then ending the shortage would save 3.5 billion dollars. Note again that this is a lower estimate. How much would it cost to end the shortage? No one knows for certain but I think a $5000 gift to the estates of organ donors would increase supply enough to greatly alleviate the shortage – that would involve doubling the supply to 12,000 for a paltry cost of $60 million. If this is not enough – raise the gift – anyway you cut it, the savings from dialysis exceed the costs of compensating donors by a large margin.

We should in fact count the value of the lives saved. If we can save 6000 lives and value each life at 3 million dollars (a lower value than what the US government typically uses in its calculations) then that is a further gain of 18 billion dollars.

A Tragedy of the Commons?
Economics provides another way of looking at the crisis. Currently we have organ socialism – anyone who needs an organ is allowed access to the organ pool regardless of whether or not they contributed to the upkeep. As with other resources owned in common we get over-exploitation and under-investment. Consider, instead a “no-give, no-take policy” – only those who have previously signed their organ donor cards are allowed access to the pool. Not only is this more moral than the current policy it creates an incentive to sign your organ donor card. Signing your card becomes the ticket to joining a club – the club of people who have agreed to share their organs should they no longer need them. Equivalently signing your organ donor card becomes analogous to buying insurance. I discuss the idea further in Entrepreneurial Economics.

An organ club has in fact been started – I am not just an adviser, I’m also a member! You can join too at

The Ukrainian economist who is fighting the Russians with logistics

This Bloomberg piece by Scott Duke Kominers is an interview with the heroic Tymofiy Mylovanov.  He is an economist, also of the University of Pittsburgh, who is organizing many of the logistics in Ukraine and also running the Kyiv School of Economics.  I am honored to know Tymofiy, here is one bit of a much broader story:

Mylovanov: Within the first couple of days, you see how people respond differently. Some people get traumatized; some become dysfunctional; others become almost super-efficient, like me and my team. But you have to figure out how to function in war or you die. Your loved ones will die. And we had a plan — war-time protocols at the university. We even had a war committee, and everyone was responsible for specific tasks, and they have to start executing them. Otherwise we collapse.

If someone doesn’t show up to a meeting, that doesn’t matter. Decisions are made without them. No wavering, no trembling hand. You either do it or you don’t do it and you accept the consequences. So we managed to shut down our facilities and put security in our buildings and the people there had food and water, and they’ve been staying there for two weeks.

There is much more detail in the article, which is interesting throughout.  And:

Mylovanov: One specific thing: We need 307,000 medical kits. I have the specification. Let’s say Israel can only supply 30,000 and Canada probably can supply 20 or 30,000. But we have suppliers who can provide the medical kits. We give this specification to [Ukraine’s] Ministry of Health, and our charitable foundation will pay. So tag me or email me or ping me on Twitter — and then donate, please donate.

All the fundraising goes directly to logistics. I have a website at the university of the charitable foundation [Kyiv School of Economics Humanitarian Relief Fund], and there is a Twitter post at my account. If I get a hundred dollars on that charitable foundation, it goes towards medical kits and it’s likely going to save a life.

By the way, Tymofiy Mylovanov is widely published in economics journals, including Econometrica and JET.  Here is Tymofiy on Twitter.

From Ryan Petersen at Flexport

“I just couldn’t sit around watching this humanitarian crisis in Ukraine without doing anything about it. So Flexport is organizing a massive airlift of relief goods to refugee camps in Eastern Europe starting next week.

You can read more about the full operation below. It’s inspiring stuff.

We’re looking to raise money to pay for more flights—Flexport is covering the first full cargo plane full of relief goods, but we’re asking others to donate including potential corporate sponsors to help us pay for more flights.

Donations are open at and fully tax-deductible through our 501c3 partners.”