From the WSJ Opinion Archives
REVIEW & OUTLOOK
An Incentive to Give
Short of selling kidneys, there's a way to use markets to encourage organ donation.
The right to die was in the news this week after the Supreme Court upheld Oregon's assisted-suicide law. Yet we can't help thinking also about the issue of what might be called "assisted life." Some 90,000 Americans are on the waiting list for organ transplants, and many of them will die waiting.
Despite years of publicity about the virtues of organ donation, the number of people who need transplants has been growing about five times faster than the rate of donations. Most new suggestions for closing this gap are controversial, particularly among professionals who administer or advise the national listing and matching program of the United Network for Organ Sharing, or UNOS. But nobody denies that there is a tragic shortage of organs.
In a way, the imbalance between supply and demand reflects a positive development. Before medical advances made more transplants of all kinds an option, many of those on a waiting list today would have died without hope.
So far, however, scientists have not found a way around the basic imperative that organs be taken undamaged, and quickly, from their donors. And only about 15,000 people a year die in circumstances--such as brain death after a car crash--that make them suitable donors for life-saving transplants.
Yet that number is not as small as it looks, because each of those people may have organs of use to several recipients--including two separate kidneys. In any given year, there might even be enough organs to prevent the 6,700 or so waiting-list deaths that occur annually now.
The real problem, experts say, is that many of the 15,000 do not become organ donors. No matter how often Americans tell pollsters that donating an organ is a wonderful thing, less than half the population has signed up--say, on a driver's license--to actually do so. When it falls to a family to decide after a loved one's death, only about 50% give permission. By some estimates, 20,000 transplantable organs are buried or cremated each year.
It's statistics like those that have led more than 3,500 people to join a nonprofit organization called LifeSharers. Each has signed a legal document authorizing the donation of his organs and--this is the significant part--requesting that they be offered first to another member of LifeSharers if a suitable recipient is on the UNOS waiting list. Kindness aside, each member's goal here is to increase his chances of receiving a transplant, should he ever need one, by giving other people an incentive to sign up in the hope of increasing their chances.
This is called a directed donation, and directed donations are not popular at UNOS, where the watchword is "fairness." Somebody's willingness to donate is not supposed to count when scarce organs are rationed out.
The principle of equality among sick people is morally attractive. An even greater good would be saving more lives with more transplants. Dave Undis, who heads LifeSharers, may sound harsh when he says that the current system "seems to be more interested in the equal distribution of death than in preventing deaths." Yet his incentive-based organization is at least offering a strategy for boosting the organ-donation rate--at a time when appeals to disinterested altruism are no longer enough.
