The Economics of Organ Donation

What percentage of Durham students are on the donor register?

Currently more than 10,000 people in the UK need an organ transplant. Every day three people will die waiting. Economics lies at the heart of this problem; there is an incredible demand for organs, unmatched by supply. There must be a way of solving the economic problem of unmatched demand for organs that does not lead to an ethical nightmare.

An alternative to the UK’s current opt in donor register is to create a free market for organs. Currently there is a grotesque black market in operation for organs. Increasingly, rich westerners go to South Asia or Africa to buy organs in order to prolong their lives. The desire to live a longer life is by no means strange; life is the most valuable commodity on earth. This leads to vast sums of money being handed over for organs that are often diseased or unsuitable. The black market for organs hurts both those who demand and supply organs. A legal free market system for organ donations could ensure only suitable organs are donated and protect those who choose to donate their organs.

Iran is very rarely held up as an example for the West to follow. Yet Iran’s Association of Kidney Patients, the non-governmental organisation responsible for all legal kidney transplants highlights the benefits of a legal free market system for organs. In contrast to America where the average waiting time for a kidney is considerable, Iranians are able, if they wish, to obtain a kidney through a free market.

A free market for organs would certainly differ from just another market for a commodity like potatoes. Yet the basic principles of free market economics would remain. Consumers would demand organs, and people would have the choice to supply them. As the price of say a kidney increased, the market mechanism would respond and more people would be prepared to supply a kidney for donation at that price.

Today, a free market for organs in the UK remains a distant reality. This is due undoubtedly to the vast religious, cultural and ethical issues that are raised by the prospect of paying a fellow human being for a part of their body. There is also the ethical dilemma of a criminal being able to obtain a kidney that lengthens his life and leads to an increase in crime. However, it can be argued in return to this point that the life of a human being is important regardless of personal qualities.

In addition to these issues there is the worry that whilst the rich will be able to afford organs and enjoy longer, healthier lives, the poor will be unable to do so. A solution to this problem has been highlighted by economist Alexander Tabarrok who suggests a ‘no give, no take’ policy to ensure a healthy supply of organs. With people unable to receive an organ unless they agree to donate their organs after they die, a healthy supply of organs could be guaranteed. This would ensure that supply kept pace with demand, so that the cost of organs could not become prohibitive to people from certain backgrounds.

It is clearly apparent that a free market for organs cannot be created overnight. However, there is a policy the government could change quickly and easily that would help ease the problem of a shortage of organ donors. Currently if a resident of the UK wants to donate their organs after they die they have to join the NHS organ donor register. This is an opt in system, and as is the case in many aspects of life people often stick with the default option. Ninety percent of Britons say they support organ donation, yet only thirty percent of the population are on the organ donor register. The government can influence this choice by nudging us towards organ donation. If people had to opt out of donating organs, then the number of organ donors would undoubtedly rise. The opt out system does not change policy on organ donations, it simply nudges people towards donating their organs. This nudge concept was highlighted by Richard Thaler’s excellent book, Nudge: Improving Decisions About Health, Wealth and Happiness.

The constantly growing number of people that die waiting for an organ transplant should act as a rallying call for the need for economic analysis of organ donation. The continuing failure of governments across the world to apply economic principles to the problem of organ donation only fuels a grotesque black market and a mounting death toll. Future generations will probably look at our attitude to organ donation and view it as a pathetic failure of human compassion, a missed opportunity to save lives. As a society we’ve let the fact that organ donation makes us feel a bit uncomfortable dominate public policy for far too long. It’s time to get over our repugnant attitude to organ donation and move towards economically sensible solutions.

Join the NHS Organ Donor Register here.

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