Fiesty comments on organs [updated]

Last week I posted a note on Israel moving to give priority to registered organ donors and on Andy Tookey's work here in New Zealand to improve our system. If you didn't follow the thread thereafter, jump back and flip through the comments.

Commenter "Anita" provides what seems the orthodox line from the New Zealand health service: that allowing directed donation through a system like LifeSharers opens the door to a horde of imaginable repugnant donor preferences and that allowing compensation would crowd out charitable donation. Of course, the Iranian experience on the latter has been entirely the opposite.

I note that, even in the worst case of horrible racists wishing only to donate to preferred-race people, that's still better than that those organs rot in the ground. And it's not just crazy economists like me who think this. Here's a nice piece from Bioethics.

Andy Tookey of GiveLifeNZ weighs in, reminding Anita that LifeSharers is open without fee to anyone who'd like to join, that current measures trying to encourage donation through moral suasion have been rather ineffective, and that LifeSharers gives folks a very strong incentive to become organ donors - donation rates ought to increase substantially as more folks join. Dave Undis from LifeSharers US also comes in.

I spend a week on organ markets in my Economics and Current Policy Issues course. Below I've copied in the reading list as well as some other fun sources. I'll particularly recommend Hippen's discussion of how organ markets work in Iran which suggests that worries about crowding out charitable donation are overblown; Becker and Elias's excellent discussion of how proper markets could work; and, the pieces by Kerry Howley, Sally Satel and Virginia Postrel.

The status quo is killing people because some ethicists would feel bad if we allowed incentives to come into the system. Perhaps the ethicists should be working for free if financial incentives are so corrupting. And the surgical teams, and the hospitals, and everybody else involved. Maybe we'd really have a few thousand transplant specialist centres in New Zealand if all the altruistic transplant teams hadn't been crowded out of the market by the ones that get paid to do their jobs. I rather doubt it though.

Required Reading:

• Winter, Harold. 2005. “Do you want to trade?” Chapter 3, pp. 21-31 in Trade-offs.

Recommended Readings:

• Barnett, Andy, Roger Blair and David Kaserman. 2002. “A market for organs.” Chapter 6, pp. 89-106 in Alexander Tabarrok, ed. 2002. Entrepreneurial Economics. Oxford University Press.
• Barnett, William, Michael Saliba and Deborah Walker. 2001. “A free market in kidneys: efficient and equitable.” The Independent Review (Winter), pp. 373-385.
• Hippen, Benjamin. 2008. “Organ sales and moral travails: lessons from the living kidney vendor program in Iran.” Cato Policy Analysis 614.

Supplemental Readings:

• Barney, Dwayne, Jr. and R. Larry Reynolds. 1989. “An economic analysis of transplant organs.” Atlantic Economic Journal 17:3 (September), pp. 12-20.
• Cohen, Lloyd. 2005. “Directions for the disposition of my (and your) vital organs.” Regulation (Fall), pp.32-38.
• Epstein, Richard. 2006. “Kidney Beancounters.” The Wall Street Journal. 15 May. Pg. A15.
• Freedman, B. 1985. “The ethical continuity of transplantation.” Transplantation Proceedings XVII:6 Suppl. 4 (December), pp. 17-23. [Note: this is the standard ethicist's objection to use of incentives]
• Howley, Kerry. 2007. “Who owns your body parts?” Reason (March).
• Kaserman, David and A. H. Barnett. 1991. “An economic analysis of transplant organs: a comment and extension.” Atlantic Economic Journal. 19:2 (June), pp. 57-63.
• Matas, Arthur J. “A gift of life deserves compensation: How to increase living kidney donation with realistic incentives.” Cato Policy Analysis 604.
• Satel, Sally. 2006. “Death’s waiting list.” The New York Times. 15 May.
• Tabarrok, Alexander. 2002. “The organ shortage: a tragedy of the commons?” Chapter 7, pp. 107-114 in Entrepreneurial Economics.
• Tookey, Andy. 2006. “Organ donation – facts, figures and other interesting snippets.” Give Life NZ.
• Wilkinson, T.M. 2007. “Racist organ donors and saving lives.” Bioethics 21:2, pp. 63-74.

And here are a few other fun sources on the economics of transplant.

• Becker, Gary and Julio Elias. 2007. "Introducing incentives in the market for live and cadaveric organ donations." Journal of Economic Perspectives 21:3 (Summer). Working paper version of the same paper.
• Abadie, Alberto and Sebastien Gay. 2004. "The Impact of Presumed Consent Legislation on Cadaveric Organ Donation: A Cross Country Study." Working paper.
• Abecassis, M.M. 2006. "Financial Outcomes in Transplantation -- A provider's perspective." American Journal of Transplantation 6:6 (June). Note that we do not have a subscription so you'll only be able to get the abstract; I was able to get a full copy, but it isn't exactly easy.
• MatchingDonors.com
• Life Sharers
• Life Sharers New Zealand
• Andy Tookey's presentation to my Econ 224 class
• Keltz, Jessica. 2005. "Unorthodox ideas for economics." University at Buffalo Reporter 37:13. An interview with Julio Elias.
• Dubner, Stephen and Steven Levitt. 2006. "Flesh Trade" New York Times Magazine 9 July.
• Virginia Postrel's blog, Dynamist. She has lots of stuff on organ markets, and if you look back through the archives to May, 2006, you'll find her story about donating a kidney. Well worth a read.
• Marginal Revolution has a nice write up on the effect of prohibitions on organ sales on the number of transplant centres in the US.
• Richard Epstein chats on EconTalk with Russ Roberts about The Economics of Organ Donations. They also have a nice reading list of other materials on the subject.

Note: Updated to add links to more of the articles. Enjoy!