Recently, the Seattle Times reported what is the nightmare reality of the 79,000 people on hospital transplant lists around the country: Over 15,000 will die waiting for donated organs. Each year, only 25% of those waiting are fortunate enough to receive transplants, their plight made more poignant by their knowledge that thousands of potential transplant organs are buried or cremated. Sadly, despite the public service announcements, the information campaigns, and the enlistment of drivers’ license bureaus in the recruitment effort, too few Americans sign their donor cards or make their donation wishes known to families and health care providers.
In 1984, federal law created UNOS, the United Network for Organ Sharing to oversee the transplant process. UNOS establishes criteria for donation and for listing of potential recipients and maintains a database to track the numbers.
Go to the UNOS website at http://www.unos.org to get a numerical picture of the transplant situation, including the areas of greatest and least shortage.
As is the case many other arenas of health care, the transplant shortage is where medical science meets economics. Even as doctors and medical researchers improve transplant techniques and success, they are frustrated and puzzled by the persistent inability to convince more of us to become donors. Economists, on the other hand, find it relatively easy to explain the shortage of organs. Certain that people’s behavior is influenced by incentives, economists understand the organ donation shortfall to be evidence that the incentives for donation are ineffective and must be changed. However, while there is general agreement that the current incentives are wrong, there is much disagreement over what changes should be made.
While mainstream efforts to increase donation concentrate on changing the non-monetary incentives, proposals incorporating monetary incentives such as partial payment of funeral expenses or tax credits for donation surface from time to time. In fact, the state of Pennsylvania enacted such a proposal into statute, only to have its implementation blocked by federal law prohibiting any payment for organs. The seriousness with which the medical profession regards the organ shortage can be gauged by the fact that in a recent national meeting, the American Medical Association, a long-time opponent of donations-for-pay, included in its agenda for debate a recommendation that financial incentives be offered for human organs.
Read the following article about the AMA debate:
As you might expect, the range of opinions about both the effectiveness and the ethics of using financial incentives to increase the supply of transplant organs is wide, and the divisions among proponents and opponents are deep and emotional.
In a December 5, 2001, editorial response to the AMA proposal, the Sacramento Bee voiced the concerns of many made nervous by the prospect of paying for organs.
“This is a slippery slope that those who want to promote organ transplants shouldn’t go down.”
“Money certainly can be a powerful motivator. But in this situation, money seems the wrong way to change a no into a yes.”
“…the proposal to pay donors raises an … uncomfortable prospect: the specter of desperately poor people selling off organs for cash. That grisly possibility inevitably hangs over any sort of proposal for compensating organ donors.”
What if it were up to you?
In small groups or pairs discuss the following questions:
- Are payments of some sort likely to increase the supply of donated organs? Give reasons to support your answer.
- List the factors that you believe keep the numbers on the donor lists relatively low.
- Economists have established that people respond to incentives. Do you think that financial incentives will be strong enough to overcome the incentives that keep people from donating? Explain.
- If financial incentives are used for organ donations do you think that the larger the financial incentive is the greater the number of organs that are likely to be donated?
- The editors of the Sacramento Bee believe that offering financial incentives for organ donation is a “slippery slope.” That phrase is used to describe choosing a direction and then being unable to stop moving. Why, do you suppose, the Bee editors think those supporting organ donation will be sorry they supported financial incentives? (What might they fear we’ll find at the bottom of the “slope”?)
- What is the opportunity cost of not allowing financial incentives for organ donations?
- Why do you think that, when the AMA members actually met, they tabled the recommendation?
Teacher notes/answers
Following are answers to the student discussion questions. The questions can be used in either a small group or class discussion format. In addition to the article on the AMA deliberations you may want to refer students to a New York Times article about the transplanting of organs from Chinese prisoners into foreigners—it seems a market for human organs has already developed.
- Are payments of some sort likely to increase the supply of
donated organs? Give reasons to support your answer.
One of the basic understandings of economics is that incentives matter. Economics tells us that a positive incentive like money will increase the number of donations, just as the incentive of higher price will increase the supply of any good or service. How much the supply of organs will increase is unpredictable because there is no data to suggest how responsive the donation of organs will be to a financial incentive.
- List the factors that you believe keep the numbers on the
donor lists relatively low.
This list might include religious beliefs, the fact that there is no personnel gain in donating organs, not knowing the exact wishes of the deceased family member etc.
- Economists have established that people respond to incentives.
Do you think that financial incentives will be strong enough
to overcome the incentives that keep people from donating?
Explain.
It will depend on how large the incentive to donate is. This answer will call for opinion of the students, but it should be tempered by the economic fact that the higher the incentives the more willing suppliers are to overcome other costs or disincentives.
- If financial incentives are used for organ donations do you
think that the larger the financial incentive is the greater
the number of organs that are likely to be donated?
The law of supply states that as price increases the quantity supplied will increase. This means that as the incentive goes up the supply of organs will go up. This should be an interesting discussion for you students.
- The editors of the Sacramento Bee believe that offering
financial incentives for organ donation is a “slippery slope.”
That phrase is used to describe choosing a direction and then
being unable to stop moving. Why, do you suppose, the Bee
editors think those supporting organ donation will be sorry
they supported financial incentives? (What might they fear
we’ll find at the bottom of the “slope”?)
The student responses here will include things like the poor selling their organs, the harvesting of human organs and the backlash that people will not be willing to sell their organs. If you want to extend the lesson this would be a good time to have students read the article noted in the teacher notes about the use of organs from Chinese prisoners. Ask students if not allowing financial incentives will help or hurt the situation that has already developed with prisoners’ organs.
- What is the opportunity cost of not allowing financial
incentives for organ donations?
The opportunity cost, or forgone alternative, is clearly the number of additional transplant organs that would be donated if financial incentives were allowed. Also to be considered are the outcomes of the development of alternative sources of supply, like the Chinese prisoners that are the subject of the New York Times article mentioned in the teacher notes.
- Why do you think that, when the AMA members actually met,
they tabled the recommendation?
Answers here will focus on the ethical concerns and that Medical doctors do not want to be seen as the ones advocating financial solutions to this problem