More Money, More Organs?

Abstract

Do you think that selling organs should be legal? What if it saved ten thousand lives? Twenty thousand? What if it also saved taxpayers billions of dollars per year? Do you think that the American public agrees with you?

In the United States, the law prohibits organ donors from receiving anything in exchange for their donation except for the “warm glow” that comes from a selfless choice. Unfortunately, this warm glow is not enough. For as long as organ donation has been medically possible, there have been thousands more people who need an organ than people willing to donate. In spite of this continued shortage, proponents of our current altruism-only system argue that it would be unwise to experiment with incentives for undecided donors; the resulting public disgust might undermine the entire organ donation system. However, neither these proponents nor anyone else has reliable information on what the opinions of the public actually are.  Without this knowledge, it is impossible to make informed policy decisions. I provide this knowledge through an original empirical analysis.  I designed a randomized survey to provide, to my knowledge, the first investigation into the nature of preferences of Americans toward paying families of deceased organ donors. I find that, contrary to the beliefs of the medical orthodoxy, most people support legalizing financial incentives for organ donation if those incentives would increase the supply of donated organs and save lives. At the same time, moral considerations strongly influence opinions: people are much more likely to support an alternative system if they believe it benefits rather than exploits donors and their families, respects individual autonomy, allows individuals to make fully informed choices without undue influence, is fair to patients waiting for a transplant, and promotes human dignity. I also examine attitudes toward making organ donation “opt-out” instead of “opt-in,” and provide preliminary insight into preferences between a variety of alternative systems, including giving priority to organ donors and their families if they ever need an organ, and giving health insurance premium discounts to donors. When they were given more than a binary choice, people preferred a priority incentive system, as long as it would increase kidney supply compared to the current system. In fact, the current, altruism-only system was the least popular. My analysis provides strong support that pilot studies of alternative systems would be useful and welcome to the general public. While they might not completely eliminate the organ shortage, they would be a great place to start.

Keywords: organ donation, health law, organs, kidney donation, kidneys

JEL Classification: I12, I14, I10