How to Best Incentivize Organ Donations?

(Polka Dot)

Organ donation is a familiar topic around here. Back in December, we discussed whether there should be a legal market for organs in a podcast episode called “You Say Repugnant, I Say… Lets Do it!” A few weeks ago, we blogged about whether the idea of a legal organ market is losing its stigma. So we were immediately intrigued by news that emerged earlier this month from China, about a 17-year-old boy who had sold his kidney for $3,392 to buy a new iPad 2. From the BBC:

The 17-year-old, identified only as Little Zheng, told a local TV station he had arranged the sale of the kidney over the internet. The story only came to light after the teenager’s mother became suspicious. The case highlights China’s black market in organ trafficking. A scarcity of organ donors has led to a flourishing trade.

The story turned out to be perfect fodder for Michele Goodwin, who has embarked on a three-part series on organ transplantation over at the Chronicle of Higher Education. Goodwin argues that the organ transplant market is far too restrictive, and makes the case for creating better incentives for organ donors in order to undercut the black market. From her first installment:

Some might read the take away from Little Zheng’s story as a warning against incentives for organs, but that would be short-sided and incomplete. Don’t get me wrong, black markets in organs are illegal and brokers should be prosecuted to the fullest extent of the law for coercing, exploiting, and otherwise harming organ suppliers. But, keep in mind, organ demand outpaces supply, and the will to live is strong—Darwinian you might say.

Organ supply is a problem in China and the United States. In the United States, there are 111,519 patients waiting for organs. About 7,000 people who could benefit from an organ transplant will die in 2011. Most of those who will die are patients on the transplant wait list. The  patients who will hang on this year might wait six or seven years before a suitable organ becomes available. For an increasing number of patients that length of wait-time is a death sentence. For those patients, the black market is a logical solution.

In her second installment, Goodwin sketches out the restrictions that surround the organ transplant market:

The National Organ Transplant Act (NOTA) has been problematic for some years. Under the Justice Department’s enforcement of NOTA, there was the prohibition of organ swaps, meaning a husband and wife who didn’t match couldn’t swap with neighbors who did match.

Violation of NOTA can result in a felony conviction, with a five-year prison term and $50,000 fine.

She then lays out a few ideas on how to provide better incentives to donors:

Jake Linford, a young professor at Florida State University Law School, advocates for scholarships for kidney donations. According to his plan, give a kidney and get a full scholarship. No loans or owing the banks with that proposal. Other incentive-based proposals include burial benefits for families who donate their deceased relatives’ organs, tax deductions, mortgage forgiveness, and free medical coverage for life. These all have merit and are worth considering by states and the federal government—now, not later.

If we want people to step up to the plate to be organ donors in a healthy, transparent system, let’s give them something.  If police officers, fire fighters, and military men and women receive acknowledgments, including incentives for saving lives, why not show that same kindness to potential organ donors? It’s a much better and safer solution than black markets.


What's the best way to incentivize people to donate their organs?

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  1. hackster42 says:

    offer them an iPad

  2. Tim says:

    Why not take the equity out of an organ? The donor receives payment and the organ is taken when they die. Clearly it would be a lower payment than that given for an organ that would be removed instantly, reflecting the delay in receipt of the organ and risk of damage before/during death.

    • T Wain says:

      So a healthy young person gets small dividend payments for an organ guarantee? An old/dying person gets large windfall payments?
      Then we could repackage and sell those Organ-backed securities! Young organs get a AA rating, old organs sell at junk bond rates. Hooray financial innovation!

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    • Enter your name says:

      If you wait for natural death, the organ almost certainly wouldn’t be useful. I believe that only 5% of Americans who die have usable organs.

      A quarter are on the absolute no-no list when they die: cancer, septicemia, and HIV. In other cases, the donation would be pointless: a person who dies of kidney failure or multiorgan failure (a common immediate cause of death) doesn’t have a kidney worth transplanting.

      As a result, the typical young adult could easily take the “bonus”, and still not result in an organ being donated. Furthermore, advance payment makes it hard to refuse later. If you converted to one of the rare religions that discourages it, would you have to pay back the money? What if you made deliberate choices—like choosing to die at home, surrounded by your loved ones, with no rush to call the hospital after you died—that made the organs unusable?

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  3. Kathleen says:

    Make the decision to allow organ donation a more public event. Maybe a ‘I’m an Organ Donor’ Day? Stickers for everyone who is on the registry to wear to work – encourage organ donors to give other organ donors a high five! Celebrate success stories of children who received life saving transplants. Volunteers could collect organ donor agreements and give out stickers.
    I recently filled out the DMV form to be an organ donor and received a thank you letter from the NY Public Health Commissioner. That was nice.

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  4. Alex says:

    In Iran it’s mandatory to donate if you’re a match, and you are not entitled to compensation. The idea is that everyone benefits from such an altruistic system, and it cannot be corrupted. It’s not palatable in the US due to strongly different sensibilities, but clearly it answers the poll question – there is no better way to incentivize donation.

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  5. Hold on says:

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  6. Mike says:

    Can we start with compensation for blood donations? This would be much less controversial. And then go down the slippery slope towards organ donations.

    BTW, I vote for cold hard cash.

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    • Enter your name says:

      Compensation for blood donors was a significant reason why HIV/AIDS killed so many people with hemophilia, leukemia, and other medical conditions. The people who seek out those payments disproportionately tend to be drug addicts or other high-risk donors. The money proved to be an incentive to tell lies: “If I say that I’ve never, ever used injected street drugs, then I get the $25, right?”

      We have stopped payment for blood products because it saves lives. Right now, it saves a tiny number from AIDS (even the most sensitive test can’t reliably identify an HIV infection acquired hours before the donation), but in the future, it will save many lives, from whatever the next bloodborne “mystery disease” is.

      The restrictions on IVDU and men who have sex with men exist because we realistically believe that HIV is not the last deadly virus that science will ever discover. Anal sex and needle sharing are extremely efficient transmitters of bloodborne diseases, and you can’t test for what you don’t know to exist.

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  7. David says:

    Why make organ donation opt-in – We should all be automatically considered potential donors upon death unless we have opted out. In the United Kingdom, the question of organ donation used to be included on the driving license application form which seems appropraite as road accidents are one of the main sources of young corpses with viable organs.

    • Celine says:

      I agree, everyone should automatically be an organ donor, and they should have to opt out if they object. This is in place in lots of places in Europe.

      I would love to know some of the reasons that people DON’T opt in to the program…personally I have no qualms about donating organs when I die….I’m dead, what other purpose could they possibly serve?

      What stops people from donating? Anyone want to shed some light on reasons I haven’t thought of?


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      • Patrick says:

        The problem with opt-out programs is that it invites challenges and possibly even litigation by the family members of the deceased. It may be argued by detractors that an opt-out system does not provide the requisite intent necessary to reflect an individual’s wishes.

        Last year CA passed an organ donation reform, largely due to Steve Jobs’ support, part of which instituted a yes or no requirement. The previous system didn’t require a “no.” Someone either checked the yes box, or did nothing (which is the system I encountered in NY). It seems relatively harmless, so I’ll be interested to see if this nudge has a noticeable effect. Perhaps the social pressure of actively saying “no” would motivate some to reconsider. At the least, it forces people to think about the issue, if even for a second.

        Possibly repugnant metaphor alert: A stack of brochures by the register for a department store credit card won’t garner nearly as many enrollments as an associate who asks every customer.

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      • Uthor says:

        The most common objection I hear is that medics will not try as hard to save you if you are a donor.

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      • Enter your name says:

        You’re right: this does seem to be a common objection. Education should be able to overcome it in most instances, but there will always be people who believe in conspiracy theories.

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      • Chris says:

        Yes, there is a lot of misinformation like this out there (e.g., that celebrities can get priority). And we can get around litigation from families in an opt-out system. Ohio (and a few other states), for example, amended their donation laws so that if you say you will be an organ donor, the family cannot override your decision. Just make that national along with the opt-out system.

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  8. Peter says:

    Simple: People registered as doners are automatically given higher priority if they need to receive an organ. Highest priority given to people who have been registered doners their whole life, so registering just when you find out you need an organ isn’t going to help much.

  9. Chad says:

    I learned about one interesting solution to the problem of organ donation from a fellow student at Princeton whose senior thesis was solving a network problem of organ exchange. If I remember correctly, for organs that one can donate without dying, often a willing donator is not a match for the donatee. What her model did was match up donations across the country, so that if I wanted to donate to my wife, but didn’t match, and another person was in the same situation, I would essentially donate to his wife, and he to mine (both matches). When this network is much larger than two families (i.e. the whole USA), the number of organs that could be donated is much larger than the current number that are. There are obviously a lot of kinks to work out, but this system could be implemented if the rules disallowing the selling of organs (effectively prohibiting the trading of organs) were altered. Ah Optimization.

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    • Bree says:

      Donations like that have happened in MN. I think I read that the most “complex” multi-donation was eight different organs?

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  10. nitin d says:

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  11. Mark M says:

    The problem with any opt-in system is that organ donation isn’t as straightforward as one imagines it might be. The process isn’t simply saying yes and it is done.

    I was recently widowed and donated my late wife’s organs. This meant that in the middle of the worst day of my life I had to sit there and answer an hour’s worth of fairly personal questions about her life. They also kept her on life-support for about 36 hours after she was pronounced dead, prolonging that agony. She was then wheeled off to surgery at an hour that was convenient for them denying me any control of a crushing moment.

    The local organization made efforts to honor her donation, but that really just means reliving that horror again. A name on a wall is no substitute for my wife.

    I am not sure that I would do it again if I was in the same situation again. I can’t possibly imagine that there is some amount of money that would change this opinion.

  12. Tim Nelligan says:

    Hey, how about treating them like human-being, instead of tins-o-beans, or batteries, and ALLOWING the human beings to HELP each-other? No? Ok. @tnteacherTim

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  13. mannyv says:

    Who pays? Everyone makes money off the organ donation process except the donor. That’s patently unfair. Take Tim’s idea and go further: donors (or the estate) of the organ in question receive a percentage of the donor’s income stream. That sort of financial uncertainty would torpedo the idea.

    Really, the problem is that the only stakeholder that isn’t represented in the process is the deceased/donor. Everyone else wants to keep the system as-is: recipients get free organs (via insurance) and the various entities (doctors, storage/transport companies, harvesters) in the supply chain benefit from free raw materials (ie: organs).

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    • ThatMattGuy says:

      Great point! If it’s unethical for me to gain even “a cup of orange juice” from giving up a kidney to someone, why is it ethical for everyone on the surgical team to gain financially from it?

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  14. Dave Undis says:

    The best way currently-legal way to incentivize people to donate their organs is to allocated organs first to registered organ donors. Few people would refuse to donate their organs if they knew it meant going to the back of the transplant waiting list should they ever be unlucky enough to need a transplant.

    Anyone who wants to donate their organs to other organ donors can join LifeSharers. Membership is free at http://www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, and no one is excluded to to any pre-existing medical condition. Anyone who joins LifeSharers will get preferred access to the organs of other members, currently numbering almost 15,000.

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  15. Carolina says:

    I think the idea of the incentives would work best if there were several ones that people could choose from (ie. a scholarship OR help with mortgage).. Although a scholarship would be appealing to many, it wouldn’t be very effective as it doesn’t apply to everyone (whereas tax breaks and health care subsidies does).

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    • Enter your name says:

      Tax breaks don’t appeal to low-income people. A lot of blue-collar families pay almost nothing in federal income taxes.

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  16. SC doc says:

    As a health care professional, I take offense to the fact that you would suggest this.

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  17. K says:

    I’m with those couple others who mentioned it: make it a system that, if you don’t register to be an organ donor, you are not allowed to receive an organ should you need one. Problem solved.

    Educational subsidies, on the other hand, has to be the worst idea I’ve ever heard. Why should the reward be something that is essentially exclusively for young people, the people least capable of making such a life-altering decision and most likely to regret the decision?

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  18. Ludmilla says:

    Whether the poll is asking for a single selection, or multiple selections to the poll question is unclear – are you seeking “what are the best ways to . . . ” or “what is the best way . . . ”

    I chose multiple options; but a literal interpretation of the question could lead others to interpret the question differently, especially anyone not that familiar with the significance of squares vs circles ?

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  19. anonymous says:

    For a blog purportedly focused on economics with a sizable behavioral component, this article and poll misses the most obvious solution, which is to change the default option on driver’s licenses in the US to being an organ donor. This is why Scandinavian countries have higher rates of organ donation than the US — because their policy is to opt-in to donation rather than to opt-out.

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  20. Jared Kaufman says:

    I think that would be like putting a price on the organs, like making it into a market for organs. This would be a negative effect on the society.

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