Tuesday, August 07, 2007

Who shall be saved?

Dr. Sally Satel has a very thoughtful piece in the August-September 2007 issue of the Hoover Institution's Policy Review.

Dr. Satel attended a forum on proposed revisions to UNOS kidney allocation rules. The proposed new rules are an attempt to maximize "Life Years from Transplant", which would mean older patients would get fewer kidneys. This prompted one attendee to say "That’s playing God and people aren’t going to like it.”

Dr. Satel writes: "That is not playing God; that is playing man — the all-too-human affair of people deliberating strenuously and in good faith to determine what is right." She goes on to describe the dilemma caused by the shortage of transplantable organs: "It is the eternal tradeoff that comes with medical rationing: individual versus societal benefit. Who will be saved?"

If there was no shortage of organs, everyone would be saved. There would be no need to decide who to save. Until then, we should decide to save registered organ donors first. Why? Because that will cause more people to register as organ donors, which will increase the supply of organs and save more lives. It will also mean we will face fewer decisions about who to save.

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Ending the black market for human organs

Jeff Stier of the American Council on Science and Health has an excellent piece in the New York Post on August 6th. He points out that the shortage of human organs for transplant operations has led to a macabre black market, and argues that a regulated system of incentives for donors would save lives and reduce the shortage that promotes the black market.

One of the incentives he mentions is Alex Tabarrok's "no give, no take" rule. LifeSharers is a variation of this idea. Alex Tabarrok is an Associate Professor of Economics at George Mason University, Research Director at The Independent Institute, co-author of the Marginal Revolution blog, and an advisor to LifeSharers.

Mr. Stier also writes: "Unless you're lucky enough to have a relative or some other highly motivated and altruistic donor, there is no legal way to improve your chances in the painfully slow race against death." This was true before LifeSharers came along, but it isn't any more. By joining LifeSharers you get preferred access to the organs of other members, so you improve your chances of getting a transplant should you ever need one.

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