Whatever the problem, inequality's to blame

Man, the snake-oil salesmen of the 1800s had nothing on today's inequality campaigners. Turns out that inequality's to blame for New Zealand's low organ donation rates. Really?

Here's Eileen Goodwin at the ODT.

An "individualist new-right'' attitude that holds sway in New Zealand is holding back organ donation rates, a University of Otago biomedical ethics authority says.

Prof Grant Gillett was contacted for comment on a Ministry of Health consultation process that seeks to increase New Zealand's low rate of organ donation.

Prof Gillett supports a shift to an opt-off organ donation system that would involve families in the decision-making process.

He said the political ideology of the Ministry of Health and the Government hindered efforts to foster a different view of organ donation.

"The ministry's got quite an individualist new-right sort of agenda.

"I think it's shared by the Government at large; I think that's the reason why we are encouraged to tolerate the inequalities [in society].''

"It's fundamental to neoliberalism that every individual should be able to be accountable for their own stuff, wrapped up in their own life, and not have dues to others.''

... Asked if countries with high economic inequality had lower organ donation rates, Prof Gillett said he did not know.

"To do that you would need to look carefully at Scandinavia.''

That second-last line's a kicker. Any evidence that MoH is actually a den of neoliberalism? No. Any evidence that inequality affects organ donation rates? No. Gillett knew inequality was to blame before he even opened up the data tables. Great stuff, but he's a biomedical ethics authority.

I'm grateful that Eileen Goodwin got in touch for a response. She quotes me below:

Contacted for a response, Dr Eric Crampton, head of research at right-wing think-tank The New Zealand Initiative, said the link between income equality and organ donation seemed "tenuous''.

"America's organ donation rate far exceeds Sweden's and New Zealand's, but Spain beats both. Inequality does not seem to enter into it. If we want more organ donation, we need better incentives around organ donation,'' Dr Crampton said.

Dr Crampton said New Zealand could follow Israel's lead and put willing donors at the front of the queue when they needed an organ themselves.

I ran some very very rough correlations using Wikipedia tables on deceased donation rates and World Fact Book tables on Gini: neither are great, but it was what I could grab in 15 minutes yesterday afternoon.

The very rough correlation coefficient between inequality and donation rates in a cross-section of European countries plus the US was about 0.07: slightly positive, but nothing that you could conclude anything from. I put zero stock in it, because doing it properly would require at least a panel study to pull out country-level fixed effects that could simultaneously drive inequality and organ donation, but at least on the face of it, there is no there there on inequality and organ donation.

Doing it even more properly would start with data on individualistic attitudes from the World Values Survey.

I should have pulled the Irodat data. Here's the table for deceased donation rates. If you can see any inequality pattern in there, your eyes are better than mine. France and the US have ballpark identical deceased donation rates. So do Ireland and Finland. And New Zealand's rate beats Greece's. Estonia is a poster-child for market-oriented reforms; its donation rates are higher than lefty Italy.

And here are the rates for live donors.

Amazing that the socialist transformation of man away from individualism in Venezuela still has their live organ donation rates lower than those in that every-man-for-himself dog-eat-dog Hong Kong, never mind the US. And Sweden is also lower there than the US.

Israel really shines in live donor rates with its combination of proper compensation for live donors and a guaranteed front-of-the-queue position if you're a live donor who later needs a transplant; effects on deceased donation haven't been as great as we'd have hoped. That's in part, it seems, due to perceived easy cheating on deceased priority where you get the priority card while you're alive, but somebody raises a religious objection and gets you out of it when you've died. That kind of cheating breaks reciprocity norms and erodes confidence in the system.

Eileen quoted me accurately. My full comments were below, but she took the right excerpt.

“If New Zealand wants to increase its organ donation rate, it needs to improve the compensation paid to live organ donors. Chris Bishop’s member’s bill will make progress on that front. Donors bear real costs when they take time out of work to help save a life and should not be out of pocket for having done so.”

“To increase donations from deceased donors, New Zealand should look to Israel’s example. In Israel, those who are willing to be donors have priority over those of similar medical need who are not willing to be donors. Family members affirming a loved one’s wish to be a donor should the time come also have priority. And live organ donors have priority so that they should never find themselves at the back of the queue that they already helped to shorten.”

“Countries with opt-out systems for organ donations have slightly organ donation rates than opt-in countries, but the benefits of switching can be overstated. Whether the New Zealand system were opt-in or opt-out, doctors believe themselves required to seek the family’s consent to any donation. So the real barrier then is in ensuring that people agree to be donors and that they inform their families about their wishes. Ensuring priority for donors can encourage people to be donors, and encourage families to respect the donor’s wish.”

“Links between income inequality and donation rates seem tenuous. America’s organ donation rate far exceeds Sweden’s and New Zealand’s, but Spain beats both. Sweden beats the UK, but the UK beats Denmark. Inequality does not seem to enter into it. If we want more organ donation, we need better incentives around organ donation.”

I've no particular problem with opt-out instead of opt-in but I have a hard time seeing big gains from it where the doctors would, regardless of opt-in or opt-out, go and ask the family for authorisation. Either way, final say is with any family member who might veto.

FWIW, I've signed my organ donor card. I'm also a member of LifeSharers and hope that my organs could be directed to another LifeSharers member should one be a suitable tissue match.

Elizabeth Prasad's report for the Initiative on the economics of organ donation is here.

My prior posts at Offsetting on the topic are indexed here.