Why Is There a Shortage of Organ Donations?

organ-donation1.jpgI was watching a show on CNN about people in need of organ transplants going to China for organ donation tourism. China harvests organs from prisoners it executes, sometimes without their consent, and then offers them to “tourists” who come in need of transplants.

The show focused on the immorality of China’s practices, but I kept thinking about how needless all of this would be if we didn’t have such silly organ donation policies in the United States. The Department of Health’s website for organ donation provides the following statistic: “Each day, about 74 people receive organ transplants. However, 18 people die each day waiting for transplants that can’t take place because of the shortage of donated organs.” That’s about 6500 people who die every year in the United States waiting for an organ donation — two times the number dead in the 9-11 attacks. Why aren’t we doing anything about it?

About 2.4 million people die each year in the United States. Only a fraction are organ donors. Why are so many life-saving organs being thrown away?

One solution is to switch the default rule — to have the presumption be that people consent to donating their organs upon death unless they indicate otherwise. In other words, we could change organ donation from opt-in to opt-out. This might strike some as unfair, as there may be people who are uniformed who don’t realize their rights to opt-out. On the other hand, the value of saving thousands of lives each year is quite high. Those who have strong moral objections to organ donation will likely be informed about their opt-out rights because it is an issue that matters a lot to them.

Another idea is to have people check a box each year on their tax forms that they will be an organ donor (for the period of that tax year) and they will receive a tax deduction ($100 or $500 or some other amount). This would allow people to change their preferences — if they suddenly decide they no longer want to donate, they can not check the box the next year. For efficiency purposes, there would not be testing to see whether a person could actually donate or not; everybody willing to donate organs would get the deduction. One potential objection to this policy is that the less wealthy will be more inclined to donate organs, since the deduction means more to them. But I don’t see why organ donation after death is a bad thing. In fact, I think it’s a great thing, and it should be encouraged.

I remain quite baffled why little has been done to raise incentives for organ donation after death. There are some problems that are very hard, but this one seems to have some relatively easy solutions, unless I’m missing something.

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4 Responses

  1. I am just a humble practicing lawyer who stumbled upon this post because it deals with China, but I do like the issues you raise here. I find it fascinating how unwilling Americans tend to be to look at issues like this from new perspectives. I am NOT a cultural relativist by any means (and I have not eaten ANY meat for at least 15 years), but it never ceases to amaze me how Americans so quickly dub Koreans and Chinese as “inhumane” for eating dog and/or cat, without for a moment stopping to think that it is a cultural difference, not really a moral one.

    The Koreans get very offended by this and say that they cannot understand why Americans get so up in arms about Koreans eating dog while at the same time allowing so many people to go homeless.

    I wonder if we might be doing the same thing here with organ donations. I certainly am NOT calling for involuntary donations, but I agree we need to explore and talk about our various options.

  2. Kate Litvak says:

    Alternatively, you can tax people who refuse to become donors. Same result, better for the treasury.

  3. Chris says:

    I could be wrong, but even if you volunteer to be an organ donor the ultimate decision to actually donate the organs resides with the next of kin.

    Many next of kin refuse because they don’t want the body cut up after death.

  4. Mark says:

    I think you are right that the decision lies with the next of kin. That makes sense, because it is the family that deals with the negative consequences.

    One of my economics professors (David Kaserman) from college has kidney disease, and has written extensively on this issue. He argues for a free market approach where the family members of donors are directly compensated. There is a lot of opposition to this approach because people are uncomfortable with the idea of organs being bought and sold. I personally think the issue is blown out of proportion. People won’t get rich off of electing to give the organs (I think he argues that the market price would level off at less than $1000); it is simply a way to compensate familes for making an often hard decision during a very difficult time. Further, the argument that it is wrong to buy or sell organs can be applied just as strongly to the use of tax breaks or other incentives.

    The opt-out idea or the tax deduction would both work. However, I think the mandatory nature of the opt-out method is unnecessary, and the tax approach seems like it would be extremely inefficient. The bottom line is that there are costs associated with organ donation, and the current market price, i.e. $0, results in a shortage in the market. I think that it only makes sense to allow people who will benefit from the organs to compensate those who bear the costs of giving up the organs.

    Regardless of the method, it is an absolute tragedy that so many people die every year because of a problem that could be solved so easily. I think it is time for those who have a moral objection to any system that isn’t purely a “donation” need to look closely at the consequences.