Perceptions of Efficacy, Morality, and Politics of Potential Cadaveric Organ-Transplantation Reforms

30 Pages Posted: 7 Sep 2013 Last revised: 10 Dec 2014

Christopher T. Robertson

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

David V. Yokum

University of Arizona - James E. Rogers College of Law; University of Arizona - College of Science

Megan S. Wright

Weill Cornell, Medical Ethics; Yale University - Solomon Center for Health Law and Policy

Date Written: December 9, 2014

Abstract

We sought to explore the political feasibility of potential policy reforms to address the shortage of cadaveric organs for transplantation in America. We recruited 730 human subjects from an online population and assigned them to writing tasks that experimentally manipulated the salience of moral and posthumous risks. Subjects read 95-word descriptions of six proposed policy reforms, rating efficacy, morality, and overall support for each. We created weighted estimates of the overall potential support for each reform (WEOS), correcting for the skew in our study population to very roughly approximate the political affiliations of the American public.

The data suggest that cultural cognition and perceptions of risk do not drive policy choices about organ reform. Qualitatively, the writing tasks revealed some ambivalence about the risk of having life-saving organs harvested without consent, and tangible frustration about the risk of a loved one dying for lack of a needed organ.

We found that Democrats were generally more supportive of reforms, while Independents were less supportive, and Republicans were middling in their support. In particular, we found support for the proposal to make the deceased person’s own organ choices controlling rather than deferring to next of kin (WEOS: 54%, with Democrat and Republican levels of support indistinguishable). Respondents did not see personal choice as particularly efficacious for resolving the shortage, but nonetheless morally important. In contrast, respondents perceived opt-out to be highly effective, but morally disconcerting. Nearly two-thirds of Democrats supported opt-out, and nearly half of Republicans did so, a significant difference. Two-thirds of Independents were opposed, however, drawing the WEOS down to 46%.

Even more clearly, we found broad consensus that a regulated market for organs could be effective but would be deeply problematic morally (WEOS: 16%, with no detectable political split). On the other hand, another incentive, the payment of vouchers for funeral expenses, enjoyed stronger support (WEOS: 51% with a majority of both Democrats and Republicans supporting the proposal, but with the former even more so, a 14% split). The voucher assuages moral objections about the market while maintaining apparent efficacy.

Our study also suggests that a package of reforms – including reciprocal preferences, opt-out, and elimination of the family veto – may be feasible politically (WEOS: 53%, and no political split detectable). This package of reforms neutralizes moral objections to a reform based on reciprocal preferences alone (WEOS: 41%, with a significant 10% split along party lines).

This study is best understood as a pilot for a future study with a demographically-valid sample. Still, the richness of the data suggests that Americans make nuanced policy distinctions, which depend on how proposals are packaged. We identify certain reforms that may enjoy broad-based support from across the political spectrum.

Keywords: cadaveric organs, transplant, market for organs, organ shortages, policy, reforms

Suggested Citation

Robertson, Christopher T. and Yokum, David V. and Wright, Megan S., Perceptions of Efficacy, Morality, and Politics of Potential Cadaveric Organ-Transplantation Reforms (December 9, 2014). 77 Law and Contemporary Problems 101 (2014); Arizona Legal Studies Discussion Paper No. 13-44. Available at SSRN: https://ssrn.com/abstract=2321771

Christopher T. Robertson (Contact Author)

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

David V. Yokum

University of Arizona - College of Science ( email )

1040 E. Fourth Street
Tucson, AZ 85721-0077
United States

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

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

Megan S. Wright

Weill Cornell, Medical Ethics ( email )

1300 York Avenue
New York, NY 10065
United States

Yale University - Solomon Center for Health Law and Policy ( email )

127 Wall Street
New Haven, CT 06511
United States

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