April 4, 2006

Finally, an approach to organ donation better than complete apathy

The state of organ donation is simply devastating in the United States. The present system, in which individuals are assumed not to be organ donors unless they denote otherwise, ends in the needless death of thousands simply because many are too lazy to go through the miniscule effort of becoming an organ donor (it is as simple as signing the back of one’s driver’s license). There are numerous effective mechanisms that would drastically decrease this shortage, the most prominent being an opt-out system where individuals would be assumed to be donors unless they denoted otherwise. Studies have shown that this would allow the small percentage of those who are truly opposed to their organs being donated to avoid that, and the vast percentage who are just too lazy to change their donor status would end up donating (in first-world countries that opt out instead of opt in, the percentage of donors is drastically higher).

This debacle is the result of a debilitating free-rider problem. Despite polls that indicate massive percentages of respondents are willing to donate organs post-mortem, only a fraction actually go through with the effort of signing up. Sadly, this is because there is apparently little utility gained by an individual going through the effort of actually becoming a donor (aside from the moral imperative to actually do so, which apparently doesn’t sway Americans). Of course, from a purely selfish standpoint, it kind of makes sense: you are going to be dead when the organs are donated, and they will only help some unknown John Doe, so naturally the country concludes, “Why bother?”

What is clear is that there is a massive political failure. In 2004, British MPs rejected a change from an opt-in to an opt-out system (which would use the free-rider problem to the advantage of all since many would be unwilling to go through the process of opting out). Sadly, that is eons ahead of the U.S., where George Bush chose to focus on more politically “sexy” bioethical issues in his latest State of the Union, where he called on Congress to “pass legislation to prohibit the most egregious abuses of medical research: human cloning in all its forms, creating or implanting embryos for experiments, creating human-animal hybrids, and buying, selling, or patenting human embryos. Human life is a gift from our Creator—and that gift should never be discarded…” I wholeheartedly agree with the President that human life is a gift that should never be discarded, but I hardly see how human-animal hybrids have anything to do with that when thousands could be saved every year with the simplest of policy changes.

But in the face of such failure, a provision in the Uniform Anatomical Gift Act, passed in 1968, has been used to create an incentive structure that is capable of overcoming the free-rider problem associated with the present state of organ donation. The Act allows an individual to direct specified organs to certain individuals post-mortem. An innovative and truly effective organization, LifeSharers, has used this law to create a pool of mutually insured organ donors. If you become a member of LifeSharers, you sign a binding agreement to direct the donation of your organs to other members of LifeSharers. The end result is a rapidly expanding network of donors that encourages the donation of organs and does not reward Americans too lazy to donate their own organs.

The beauty of this organization is that it avoids the political pitfalls of government action and the inevitable argument over religious exceptions that would ensue. It simply allows individuals to donate their organs to those who will do the same. In doing so, it harnesses the power of self-interest that is the cause of the shortage now, but it uses it to encourage people to donate organs and save lives.

I’m not sure what to think about the morality of such an incentive structure or of directed donations, but I do know that I am seriously considering becoming a member of LifeSharers. Perhaps that means that self-interest trumps morality, but when it is being used for such unequivocal good, it is hard to complain.