From Free Riders to Fairness: A Cooperative System for Organ Transplantation

41 Pages Posted: 12 Jun 2009 Last revised: 6 Nov 2013

See all articles by Christopher T. Robertson

Christopher T. Robertson

Boston University; University of Arizona - James E. Rogers College of Law; Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics

Date Written: September 1, 2007

Abstract

In America alone almost 100,000 people are suffering while waiting for organ transplants, and more than 7,300 of these patients will die waiting. Given that tens of thousands of useable cadaveric organs are buried or incinerated every year, the organ shortage is a social, political and legal problem, one that is inherent in the conceptual design of the current organ system. While the system is supposed to turn on individuals’ autonomous choices, it instead depends on default outcomes and the decisions of next of kin. While we tend to think about the organ choice as one of altruism (viz. -- "giving the gift of life"), it is not clear that cadaveric organ donations are actually altruistic, nor is it clear why promotion of altruism should be a goal of our organ system.

Most importantly, the status quo system facilitates free riding by alienating the decisions to give and take organs. In contrast, original empirical research suggests that respondents intuitively understand the relationship between these two decisions, and that many will decline to free ride when given the opportunity to think of themselves as potential takers of organs. Even worse, the current system creates an injustice, violating basic principles of reciprocity, by giving scarce organs to those who have refused to contribute organs themselves. As a result, these free riders take organs that could save the lives of others. The bottom line: Under any such system that allows rampant free riding, the fact of a shortage should be unsurprising.

This essay proposes an integrated system for procuring and distributing cadaveric organs, based on the notion of a cooperative project. Under this paradigm, individuals would join the organ system as both potential suppliers of cadaveric organs and potential recipients of organs. This cooperative system should operate on an opt-out basis, so that all persons would be participants, unless they chose to remove themselves, and would depend on a national donor registry. This approach respects autonomy, resolves the injustice, reflects the value of cooperation, and holds promise for minimizing the shortage.

Keywords: organ transplantation, rationing, shortage, reciprocity, cooperation, altruism, autonomy, fairness, bioethics, justice

JEL Classification: D45, D3, D64, D61, C91, I1

Suggested Citation

Robertson, Christopher T., From Free Riders to Fairness: A Cooperative System for Organ Transplantation (September 1, 2007). Jurimetrics, Vol. 48, No. 1, 2007, Available at SSRN: https://ssrn.com/abstract=1416950

Christopher T. Robertson (Contact Author)

Boston University ( email )

765 Commonwealth Avenue
Boston, MA 02215
United States
6179100649 (Phone)
02215 (Fax)

University of Arizona - James E. Rogers College of Law ( email )

P.O. Box 210176
Tucson, AZ 85721-0176
United States

HOME PAGE: http://www.law.arizona.edu/faculty/getprofile.cfm?facultyid=714

Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics ( email )

23 Everett Street
Cambridge, MA 02155
United States

Here is the Coronavirus
related research on SSRN

Paper statistics

Downloads
270
Abstract Views
1,777
rank
125,299
PlumX Metrics