Organ donation is a complex personal decision?

A story in the Dayton Daily News about some of the reasons people don't sign up to be organ donors reports this:

Psychologists and pollsters who have studied the issue say choosing whether to be an organ donor is a complex personal decision.

Is choosing whether to be an organ recipient a complex personal decision? No, it isn't. Just about every single person who is unwilling to be an organ donor would be happy to be the recipient of a donated organ if they needed a transplant to live.

About 50% of the organs transplanted in the United States go to people who haven't agreed to donate their own organs when they die. That's not fair, and it's one of the biggest reasons there is such a large shortage of transplantable organs in the United States.

As a nation, we bury or cremate 20,000 transplantable organs every year. As long as we keep giving organs to non-donors this terrible waste will continue.

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Woman gets Army hero's heart through directed donation

Another case of directed donation is in the news. Directed donation is the process that LifeSharers members use to offer their organs to other LifeSharers members. Famous singer Natalie Cole got a kidney transplant through directed donation several weeks ago.

Corporal Benjamin Kopp, an Army Ranger, died recently at Walter Reed Hospital in Washington as the result of wounds sustained in Afghanistan. Corporal Kopp's mother, Jill Stephenson, donated his heart to a family friend. A story in the Washington Post provides more information:

The doctors at Walter Reed raised the possibility of organ donation with Stephenson, but she said there was never much question that it would happen. Kopp had talked about it and indicated his preference both on his driver's license and in his living will with the Rangers. And organ donation wasn't something new for the family.

"I lost a brother 27 years ago. He was only 11, and our family donated his organs," Stephenson said. "And I had that sitting in my heart all these years."

On July 18, Stephenson posted an online journal entry telling family and friends about Kopp's passing and said that they were going to donate his organs.

Maria Burud, Stephenson's first cousin in Chicago, had been following Kopp's condition on the Web site. What occurred next was happenstance.

Burud and Meikle are friends who had worked together in the 1980s. Burud knew that Meikle needed a heart transplant, and Stephenson happened to see her cousin's message in time.

Stephenson had been told that the family could designate an organ recipient if the person was eligible for a transplant. At the time, Stephenson didn't think she knew anyone on the eligibility list.

"It's a pretty unusual coincidence that somebody knows somebody who needs a heart," said Dr. Michael Shapiro, chair of the Organ Transplantation Network/United Network for Organ Sharing ethics committee.

Meikle knew it might not work out, that Kopp's heart might not be a match. "It's a million-to-one shot," she said. It had taken her seven months to get on the eligibility list because she needed to build up a tolerance for heparin, a drug used to prevent blood clots during heart surgery. But she got a call later that day from Northwestern Memorial Hospital in Chicago.

In the early hours of July 20 -- two days after Kopp died -- Meikle had her transplant surgery at Northwestern. She is resting at home in Winnetka, a Chicago suburb.

Directed donation is a wonderful thing. As practiced by LifeSharers members, it is legal under federal law and under the laws of all 50 states.

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The economics of LifeSharers

Professor Alex Tabarrok explains the economic theory behind LifeSharers in article in the Library of Economics and Liberty:

"The economics of common resources provides another perspective on the shortage of organs. Resources owned in common tend to be under-supplied and over-utilized. No one wants to pay to restock a lake, for example, when the benefits of restocking flow to everyone regardless of whether or not they helped to pay for the restocking. As a result, open fisheries are almost always driven to depletion. The solution is to close the fishery to those who do not help to restock the lake.

UNOS considers organs to be a "national resource," owned in common. The result, as in other areas, is a tragedy of the commons. Everyone wants to fish in the organ pool but no one has a direct incentive to "restock the lake" by signing their organ donor card. As with fishing lakes, a solution to this problem is to close the organ pool to non-donors.

Consider a no-give, no-take policy for organs. Under this system in order to receive an organ you must have previously signed your organ donor card. Under no-give, no-take, signing your organ donor card can be thought of as joining a club, the club of people who have agreed to share their organs. Or one can think of signing the organ donor card as the price that you pay for organ insurance.

An advantage of the no-give, no take policy is that it satisfies most people's moral intuitions. Many people find the idea of paying for organs distasteful but nevertheless are comfortable with the morality of reciprocity, those who are willing to give should be the first to receive.

A variant of no-give, no-take can be implemented quite easily within the current system by giving those who have previously signed their organ donor cards extra points that would advance them on the queue. In fact, a similar program is already in place. People who have previously been live organ-donors are given extra-points should their one remaining kidney fail them. No-give, no-take simply extends this idea from actual donors to potential donors.

Something like no-give, no-take is currently being implemented privately. LifeSharers.com is an "organ club." Anyone can join. Members agree that if their organs should become available they will go first to a fellow LifeSharers member. (If everyone joins LifeSharers, it becomes equivalent to no-give, no-take.)

Although reciprocity proposals like no-give, no-take have moral advantages it is important to remember that their primary purpose is to increase the incentive to donate and therefore to increase the total number of organs available."

Alexander Tabarrok is the Bartley J. Madden Chair in Economics at the Mercatus Center, George Mason University, and Director of Research, The Independent Institute. He writes regularly at www.MarginalRevolution.com.

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