Arnold Kling

Market for Body Organs?

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Alex Tabarrok looks at the issue of how to increase the availability of organs for transplant.

In the minds of many, financial incentives for organ donation means rich people buying up kidneys being hawked on eBay by the desperately poor...Two distinctions are especially important. First, financial compensation for cadaveric donation and for living donation are different ideas and it is quite possible to have one without the other. Indeed, the primary cause of so-called organ tourism—rich people flying to poor countries like India to undergo a transplant from a poor, living donor—is the shortage of organs in the West. By allowing compensation for cadaveric donations we’ll increase the domestic supply and reduce the demand for people to fly to poorer countries for living donation. Financial compensation for cadaveric donation, in other words, is a substitute for both paid and unpaid living donation.

Second, organs are currently allocated according to a point system which is based on factors such as the quality of the match between donor and recipient, the length of time the potential recipient has been on the waiting list, the health of the potential recipient and so forth. It is not necessary to change these criteria in order to make use of financial compensation. Financial incentives can be used to increase the supply of organs without using finance to determine who will receive an organ

For Discussion. Using financial incentives for blood donation and organ donation is controversial. Including other countries, what experiments have been tried and what issues have arisen?

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COMMENTS (12 to date)
Boonton writes:

I believe a major issue with 'selling your blood' was that the donars tended to be addicts looking for a quick $20; the result was a lot of sorry ass blood in the banks. Making blood donation an 'in thing' for fashionable and healthy people had the doubly good effect of improving the quality of donated blood and cutting its price (although the savings might be deceptive since the ad campaigns necessary to give blood donation a good image don't come for free).

I'm not sure organ donation will suffer from this problem. Donating a kidney or an eye is no easy feat. I would imagine that screening requirements and the risk and burden to the donars will limit the risk of 'low class' organs hitting the market. For post death situations, I think paid compensation could overcome many of the knee jerk objections family members may have. If the compensation could take the form of paying for all or part of funeral expenses (which are great if the person died without insurance) then family members won't be made to feel they are taking a bribe but rather providing for a proper goodbye for their loved one.

Shank writes:

No doubt paying for organs and blood would increase the number of people willing to "donate". Who is paying for this, though? The article implies that this would have no impact on the priorities for who receives the organs - from this, it seems that the person receiving the organ would not be the "buyer". Will the state/federal government pay? Will various organ sharing networks or the Red Cross pay? How would the prices be determined? Would taxpayers approve of this?

The proposal in Georgia discussed in the article appeared to be a good idea - giving a discount for drivers license renewal for people who sign up to be organ donors. This provides a real incentive (provided that the discount is substantial enough) and the whole process seems less open to corruption than if we paid cash for organs on the spot.

Boonton writes:

Who pays for donated blood? The people that need transfusions buy it from the Red Cross and the Red Cross sells it to hospitals for a profit. The Red Cross doesn't pay people directly for blood but it does 'buy' the blood when it spends millions on ads promoting blood drives.

I could imagine a scenero where a 25 year old dies in the ER after an accident. The family is told that if they don't object to harvesting his organs, the hospital will waive his bill (if he is uninsured) and/or give them a $5000 credit towards funeral arrangements. The hospital will then sell the organ to a network who will collect $10K from the hospital that uses the organ for transplant (the $10K getting passed onto the patient, insurance, medicare, charity or whoever is paying for the operation to begin with).

Bernard Yomtov writes:

Not quite on-topic, but organ donation is something I feel strongly about. It seems to me that agreeing to donate organs at death is a moral imperative, and that people ought to try very hard to overcome reservations about donation that are simply superstitious.

I very strongly feel that this message should be spread by religious leaders, among others, and that to the degree religious beliefs discourage donation, they are actively immoral.

I'm not claiming this would solve the problems, and I have no objection to an arrangement similar to Boonton's suggestion.

Eric Krieg writes:

Stem cell therapy will make organ donation a non-issue, if we can just get that big meanie George Bush to stop forcing his religion on all of us and allow research into stem cells.

Ronnie Horesh writes:

Some interesting work has been done by a Swiss professor, Bruno Frey. He has written a book entitled 'Not just for the money' [or similar]. He talks about the possibility that payments for such things as blood donation can undermine our intrinsic motivation to give blood, as part of our civic duty. When payments are made, then many will not give blood any more, because it is no longer an altruistic or socially cooperative act. As I recall, his conclusions apply in other areas, such as people considering whether to accept construction of a nuclear power plant nearby.

Donald Lacombe writes:

In response to Bernard Yomtov's not-on-topic post, a solution may be to have the state require individuals to donate at the time of death with a provision to opt out for religious or other reasons. The state can conscript organs with a "buy your way out" clause. Obviously, there are objections that can be made by limited government advocates which are very relevant and possibly correct, but I just wanted to throw this out into the web ether.

Eric Krieg writes:

You know, there are non-altruistic benefits to giving blood. It gets accumulated metals and other toxins out of your bloodstream, especially excess iron, which can be a problem for men (meat eating and non-menstrating as we are).

It's not a huge health kick, but then it isn't the hardest thing to do either. I am needle-phobic, and I still do it on a regular basis.

Lawrance George Lux writes:

Several things need be changed to increase Organ and Blood donations. First, the price of Blood has to be regulated without Government bureaucracy, simply Tax law placing medical product profits in a separate Progressive tax rate based on percentage level of profit. The next step is force Insurance companies to separate medical underwriting--demanding Organ transplants need their own separate insurance policy--saving families the cost of underwriting Organ transplants, and establishing a defined Market price for Organs.

I have listened to the arguments of Organ Donations since the 1960s, and admit seriously to adopting the attitude of Christian Scientists. I will survive or not, with the Organs originally developed. lgl

John writes:

Barnett and Kaserman argue that one reason a market is essential in the case of cadaveric organs is that unless the donor can make an contract before death his/her descendents are likely to ignore his wishes as expressed (e.g. through a universal donor card).

John writes:

An earlier commenter mentioned the barrier of religious objections. Given the times, it's interesting to observe that the Islamic religion apparently does not object to organ transplants.

Bernard Yomtov writes:


Though I'm hardly a libertarian, I would very strongly object to a government requirement that organs be donated at death, even with a buyout provison. Perhaps, come to think of it, I object even more to such a rule with a buyout than without.

The wishes of the individual and family surely must be respected.

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