Last week England decided against switching from informed consent to presumed consent for organ donations because a committee of experts felt it would not significantly raise donations. In informed consent countries, agents are only donors when deceased if they registered to do so while alive. Conversely, in presumed consent countries, everybody is a potential donor once deceased. Therefore people need to register if they do (respectively do not) want to donate their body in informed (respectively presumed) consent countries.
While some studies found that there is a positive effect of presumed consent on organ donations, it is difficult to actually make the leap of faith that a change of legislation would increase donations. The problem of presumed consent countries, such as France and Portugal, is that they rely on the fact that a deceased person is a donor by default. Hence, in case people die and did not express any preference over organ donation, the next of kin that survives her has the choice between giving the organs and preventing the organs from being harvested. Given that the family ends up making the final choice, the informed consent system might lead to more organ donations. Spain is often regarded as an example of successful presumed consent country. But their success is driven by the presence of organ coordinators that are trained to identify potential transplant organs and to talk to the families about the process of donation.
For England, the solution to the problem of organ donations requires a more dynamic approach involving more than new legislation, such as harnessing market forces and involving members of the community. For starters, markets could potentially eliminate organ shortages and significantly reduce health care costs (see Becker and Elias, 2006, Introducing Incentives in the Market for Live and Cadaveric Organ Donations). A market for buying and selling organs would result in the existence of an equilibrium price for living and cadaveric donors. It would also decrease medical costs: Today, the cost of kidney dialysis is about $44,000 per year. The cost of kidney transplant and medical care for the first year is about $90,000. After the first year, medical treatments, mostly for immunosuppressant drugs to prevent rejection are $16,000. That means after about two and a half years transplants save the medical system $27,000 per year as opposed to patients remaining on long term dialysis.
Secondly, the success of organ donation programs in England depend primarily on people understanding what the complete set of benefits: England is now making the right first step by starting a $9 million public awareness campaign to raise donations. But in order to stay on the right track, the English government should favor the creation of organ coordinators to produce a steady and permanent increase in organ donations. Responsibility of people and the existence of a registry that collects people’s preferences on organ donations (yes or no) and not only one side of the question (for example, saying non donor if you are in a presumed consent country) would lead to a much needed donation spike.
Tags: cadaveric, dialysis, England, legislation, market, organ donations, public awareness, shortage
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December 1, 2008 at 9:54 am
Dave Undis
Over half of the 100,000 Americans on the national transplant waiting list will die before they get a transplant. Most of these deaths are needless. Americans bury or cremate about 20,000 transplantable organs every year. Over 6,000 of our neighbors suffer and die needlessly every year as a result.
There is a simple way to put a big dent in the organ shortage — give organs first to people who have agreed to donate their own organs when they die.
Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren’t willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.
Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at http://www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.
December 1, 2008 at 4:13 pm
Abhinav Goel
The benefits are no doubt enormous. But its important to understand the downside. Organ donation could (although arguably) make organ trade more popular, increasing vulnerability of the poorest of the poor in developing countries to forced and illegal organ trade and exploitation. A World Health Assembly resolution adopted urges countries to “take measures to protect the poorest and vulnerable groups from ‘transplant tourism’ and the sale of tissues and organs”.
If practiced in poor developing countries, presumed consent could increase organ trade, which on one hand might be beneficial to poor families to help them sustain once a relative dies, but on the other hand, poverty will incentivize poor farmers to commit suicides to help their families financially after their death.
December 1, 2008 at 5:18 pm
realitycheck
UNOS controls the flow of organs in the U.S., and not a “pledge” made to a non-profit group, Lifesharers or anyone else. Carrying their little card has no legal standing whatsoever, so folks who are sucked into their propaganda are just fooling themselves.
Quite frankly, as a living donor, I find this “if you won’t play with me, I’ll take my toys and go home” attitude so repugnant that if I could sign a card forbidding my deceased organs to go to a member of their organization, I would.
If you’d a glimpse into what occurs when we start ‘paying’ for organs, read this article, titled “Donor, Recipient No Longer Speak”:
http://www.tradingmarkets.com/.site/news/Stock%20News/2055936/
(odd url, I realize, but a syndication of a news article)
Economics are one thing; human behavior is quite another.
December 3, 2008 at 1:19 am
Leo Paul Smith
Realitycheck - the article you posted has nothing to do with a market for organs. The article is about donations to recovering transplant patients, and it is not about buying and selling organs on an open or even a regulated market. If you want to take a jab at economics (i.e. “Economics are one thing; human behavior is quite another.”), then you might want to get your terminology straight.
A market for organs would effectively allow people legally to trade/buy/sell organs. This market would give people monetary incentive to “donate” their organs and thereby increase the supply of organs. An increase in supply would decrease prices, and a decrease in prices would help struggling families such as those mentioned in the article you posted. That’s what happens when we start “paying” for organs.
Obviously, this market presents dangers: people might begin to kill for organs, etc. Regardless, it doesn’t take an economist to see that your analysis is blatantly wrong. It also wouldn’t take more than just one economics class to begin to understand why you are wrong.
December 3, 2008 at 9:11 am
Melissa Rooney
Dear Mr. Leo Paul Smith,
Your hostility toward Dr. Gay is a poor mask for your ignorance and incoherence. As much as you might like to imagine that there exists a black and white line between donations and markets, situations in real life are not always so straightforward. For example, a market-donation hybrid has been developed in some states such that the government subsidizes the funeral costs of organ donors. I would advise you to read Dr. Gay’s seminal piece on organ donations to better educate you on the subtleties of the relevant issues, but I would first recommend that you take additional economics courses to fully understand them. Complexities in economics are generally uncomfortable for people, such as yourself, who are not fully equipped with the necessary skills and intelligence to comprehend them. In the meantime, please do not take your confusion and weak intellect out on people, such a Dr. Gay, who are intelligent and brave enough to explore the gray areas in this world.
December 3, 2008 at 11:17 am
Leo Paul Smith
Dear Melissa,
I was not attacking Sebastien Gay. I was criticizing ‘realitycheck,’ the person who posted before I did.
I thought my criticism was clear. ‘realitycheck’ seemed to criticize Sebastien’s article when he said “Economics are one thing; human behavior is quite another.” i.e. ‘realitycheck’ does not believe Sebastien’s claims because ‘realitycheck’ thinks that econ is not a good measure of human behavior. Well, obviously, I beg to differ.
The market that I spelled out in my previous post was clearly a simplification. Based on the article ‘realitycheck’ posted, he does not seem to understand the idea of a market. The article was a human-interest story (not an economic study), and the financial dispute in question was not caused by a market for organs. It was not even caused by a market-donation hybrid. Whether or not the hybrid market exists/works/etc., the point is that ‘realitycheck’ clearly misunderstands the idea of a market, and I thought I would simply and clearly spell it out.
I apologize for any confusion, and for my hostility. I cannot stand people who take jabs at econ because they are uncomfortable with the idea that econ can actually predict human behavior. I would also like to note that I attacked realitycheck’s argument, not his person (although my last sentence appears to border on the latter, my implication is one of capability: if realitycheck takes an econ class, then realitycheck will learn about markets).
Melissa, I thank you for your criticism, and I am disgusted by your blatant attack on my intellectual capabilities.
Sebastien, I apologize for any confusion. I did not attack you, I attacked someone else’s argument.
Good day.