The Agenda

NRO’s domestic-policy blog, by Reihan Salam.

The Organ Donor Registry Matters Less Than You Think


Having recently discussed why I think we should allow compensation of some kind for organ donations, I’ve had a number of conversations about alternative strategies, including shifting to presumed consent. Alexander Berger makes an informed guess that merely getting people to sign up as organ donors is unlikely to make much of a dent in the organ shortage. 

My vague impression is that the organ donation community spends a huge amount of its time, money, and effort trying to get more people to sign up as organ donors. My analysis here has been tentative and exploratory, but I think the lack of stronger empirical evidence for an actual impact of those registries is startling, and that it would be worth a fuller exploration by people with more subject-matter expertise than I have. Given that there are a lot of other strategies for improving organ donation, continuing to focus on donor registration outreach seems like it may be leaving a lot on the table.

I think Berger makes a convincing case.

UPDATE: Berger later wrote a follow-up post in which he suggested that while donor registration outreach was likely to have a modest impact, the resources devoted to it are also quite modest. And earlier still, in December of 2011, he wrote a New York Times op-ed in which he described his decision to donate a kidney and why he believed that compensation for organ donations was appropriate. I found this passage particularly illuminating:

It has been illegal to compensate kidney donors in any way since 1984. The fear behind the law — that a rich tycoon could take advantage of someone desperately poor and persuade that person to sell an organ for a pittance — is understandable. But the truth is that the victims of the current ban are disproportionately African-American and poor. When wealthy white people find their way onto the kidney waiting list, they are much more likely to get off it early by finding a donor among their friends and family (or, as Steve Jobs did for a liver transplant in 2009, by traveling to a region with a shorter list). Worst of all, the ban encourages an international black market, where desperate people do end up selling their organs, without protection, fair compensation or proper medical care.

The case against the ban on compensation ban seems impressively weak. Back in 1984, one could make the case that we ought to give altruism a try and see if it yielded a sufficiently large supply of kidneys and other organs. The intervening decades have demonstrated that this experiment has been a failure.



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