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Monday, May 16, 2005


In response to some of my blogging about Organ Donation, a representative from an organization called "Lifesharers" plugged his organization in the comment section.  He wrote:

If you're going to donate your organs when you die, please donate them to registered organ donors.  By doing so, you'll create an incentive for others to do the same.  This incentive can put a big dent in the organ shortage, which kills over 6,000 Americans every year.

If you want your organs to go to other registered organ donors, please join LifeSharers at http://www.lifesharers.com.  Membership is free and open to all.

This is an intriguing idea but should give us pause.  Although--all things being equal--it seems reasonable to give preference to donors, plenty of people don't sign donor cards because they just don't know that they can.  Moreover, as I've explained, the decision ultimately rests with the family rather than the brain dead potential donor, so signing a donor card doesn't ensure that your organs can be harvested when/if they become available.  Finally, it seems arbitrary whether someone has thought to register with this particular organization.  In short, I suspect this group's heart is in the right place.  But the execution seems to prejudice people that may need the organs more--and people who may not be blameworthy in any way so as to justify withholding organs from them.  Even worse, people who are blameworthy (by destroying their own organs) can get themselves preferential treatment by signing up. 

The organization has thought through some of these issues here and on its blog, but I remain skeptical.  No doubt there are problems with how organs get allocated, but this doesn't seem like the solution.  Thoughts?

Posted by Ethan Leib on May 16, 2005 at 05:46 PM in Current Affairs | Permalink


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Tracked on May 16, 2005 9:49:49 PM


OK, first of all, as a heart recipient, I take offense to this group's message. It would make me sick and angry to find out that my heart had come from someone who's only reason for becoming Donor was the the incentive of cutting the line when and if they needed a transplant.
As for the death row inmate-donor issue, this is done in other countries but it is not done here for a number of reasons. First among them is that you can not be truly altruistic if you don't have 100% control of your destiny. The issue of creating an elite group of "me first" donors actually dilutes the pool of available organs and wastes valuable time at critical points along the transplant path, not a good idea! Then there are those of us who are Donors but won't ever be a part of this fringe group but using their system, we would be Donors but not donated to. There are also huge numbers of people who, believe it or not, that Know Nothing About Organ and Tissue Donation! They have never been asked, Don't know where to register, and most certainly won't search for it online...unknowing then translates to unworthy! That is unacceptable. Now lets talk about the process. For this group's system to work for a member, to receive a bump up the list, they would have to be a donor/member, then someone would have to die, they would also have to be a donor/member, then the family calls and gets a list of members who are on the waiting list and specifies you as the recipient...regardless of the sound medical reasons that UNOS uses to select organ recipients...thus the line cutting. It doesn't work! by this groups own stats, with only 2500 newly registered or previously registered donors, 65 members in need of transplants yet No transplants have taken place among members yet. Why? The system and the promises that this group are promoting don't work! What they promise is undeliverable! what they are promoting is Selfish, fear-based favoritism and it is a fraud. Oh, Yeah, I haven't even started in on the racism, sexism, ageism issues! Dave Undis' answer to that question follows: "There's nothing in the law that says you can restrict your donation to a member of a particular religion or ethnic group. You have to specify an individual as donee". And if a donor wishes to restrict which individuals their organs go to, who's to stop them? If this guy and his group want to increase registered Donors, then I challenge them to put their money behind a good strong widespread Public Education program! I conduct public education about Organ and Tissue donation and my statistics show that when the system, as it is, is explained to people who are not aware of the donation system, they sign up seven out of ten times. So lets teach the public that this is a good idea and not blow smoke up their collective skirt and try to buy their organs with an unrealistic promise!

Posted by: Tom Morrissey | Feb 9, 2009 9:50:13 AM

To amosanon1:

Your question (how would you incentive people?) is a good one. The organ shortage can be fixed from the top down by government (by legalizing financial incentives or by imposing presumed consent, for example) or from the bottom up by individuals (LifeSharers members giving registered organ donors an allocation preference, for example).

I am skeptical of the top-down political approach. It requires a broad-based political consensus that does not exist and will probably not exist in the forseeable future. No progress can be made with the top-down approach until that consensus does exist.

The bottoms-up grass-roots approach, on the other hand, creates progress as consensus builds. LifeSharers hasn't saved any lives yet, but we're signing up organ donors. Sooner or later one of our members will get an organ from another member. The resulting publicity will attract huge amounts of new members. I predict LifeSharers will put a big dent in the organ shortage long before Congress takes any meaningful action to address it.

To Ethan Leib:

You wondered if LifeSharers members were otherwise unwilling to donate. We don't track this information, but based on anecdotal evidence (emails from members, etc.) I don't have any reason to think our members are significantly different from the general population. Only about 30% of Americans are registered organ donors, by the way.

Posted by: David J. Undis | May 17, 2005 11:07:49 AM

I certainly don't agree with mandatory donation, and anyway, it would clearly violate the Free Exercise clause, inasmuch as some religions prohibit it.

But even if you do lobby for mandatory donation or presumed consent (which is still going to run into practical problems, because doctors are not going to go against surviving family members who oppose), we can still come up with a way to incentivize. Shaming is a start in the sense that it punishes those who don't donate; but I think we should reward those who do.

Finally, regardless of what the 3100 LifeSharers would have done, the goal is obviously to create a closed market that will make people want to opt in. And if they get a critical mass, they may succeed.

I don't support LifeShare; I think you are right about that. But I understand the sentiment: why should you get an organ if you wouldn't donate one? It is a moral hazard in itself. And I think their idea of creating incentives is a good one.

Posted by: amosanon1 | May 17, 2005 10:55:19 AM

I'd rather spend my time lobbying for presumed consent or mandatory donation to increase the pool of organs. Or shame the people who refuse. I've never supported an organ market, by the way. I'm still thinking that idea through.

Do you really think the 3,100 members of Lifesharers were otherwise unwilling to donate? I'd be curious.

By the way, check out the string of comments on this post on dissemination.org. Ruchira Paul draws attention to a prisoner on death row who is trying to donate his organs. See http://www.iopo.org/news_detail.asp?ID=756

Posted by: Ethan Leib | May 17, 2005 10:13:44 AM


I think I agree with you, but the economist in me insists that you have to incentivize people to do things they wouldn't otherwise do. If we aren't going to allow monetary incentives (through the purchase and sale of organs), then how would you suggest incentivizing people to sign up? Note also that even if you support an organ market, the fact is that we don't currently have one, and your support of one isn't going to make that change. LifeSharers is intriguing because it is a voluntary group that deals with the situation at hand--rather than an advocacy group tilting at windmills.
So how would you incentivize people to do something that you obviously feel strongly about, but that they apparently don't really want to do?

Posted by: amosanon1 | May 17, 2005 8:30:10 AM

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