Organ markets

The Sunday Star Times (unfortunately, not online) notes that Israel now gives organ donors priority in receiving transplants. There were apparently a few ultra-orthodox folks who figured 'twas better to receive than to give, so the legislation puts folks on a more equal footing. This is of course now a bit old news, but nice to see it being reported here.

The piece nicely notes Andy Tookey's tireless work trying to improve New Zealand's policy framework. Andy heads up the local branch of LifeSharers: a club for potential organ donors and recipients who wish that their organs, should they become available, be offered in the first instance to other members of the club. If no club members are suitable matches, then the organs are released to the general pool. A few ethicists hand-wring endlessly about some more medically desperate folks perhaps being passed over, but absolutely nothing stops those folks from joining the club as well, and I'm enough of a hard case not to be overly worked up if folks who wouldn't be willing to give me an organ if they died and I needed one are passed over for first call on mine.

An economist's first best is a free market in live and cadaveric organs, appropriately regulated to ensure that all parties involved weren't coerced into the transaction. There are lots of options between here and there that would improve outcomes:

• allowing compensation for cadaveric donors to encourage donation;
• allowing compensation for live donors;
• restricting transplants to folks who sign their organ donor cards (and banning any familial veto post-death);
• restricting the set of people who are allowed to veto your expressed choices (right now, in NZ, pretty much anybody can veto your choice about being an organ donor);
• presumed consent for cadaveric donation.

The Maori Party seems likely to veto any potential changes to New Zealand's organ donation regime: while Maori have higher diabetes rates than others, and consequently are more likely to need a transplant, some Maori view the harvesting of organs after death as being tapu and consequently forbidden. If the Maori Party views beliefs about tapu as wholly price insensitive and broadly held across the community, then they'll reckon that changes prioritizing donors over non-donors would disproportionately adversely affect Maori.

I'd tend to expect instead that a change in regime would induce folks to lay aside more costly beliefs; I'd further expect that the increase in donation rates that could be achieved by giving preferential treatment to donors could be sufficient to ensure that even registered non-donors could be made better off by the change. Is it better to be at the bottom of a very short queue or in the middle of a very long one?