How an Organ Mortgage system could solve the donor shortage
Posted on August 8, 2011Organ donation is back in the news, with the creeping advance of so-called “nudge” theory resulting in the introduction of a question in the Driving Licence application process (to which the only answers are “Yes” and “Maybe later”). Would-be organ recipients are understandably keen to see more organs donated while libertarians fear that the state may move towards compulsory harvesting of organs to solve the shortage – both of which are perfectly legitimate points of view.
There is a clear problem, in that there aren’t enough organs for all the people who need them. The question is how best to increase the supply to meet the demand.
Unsurprisingly, I think “compulsory donation”, ie organ harvesting, is unacceptable. My body belongs to me in the most fundamental way possible, not to the state to do with as it wishes.
Nudging, as is being tried with the new Driving Licence question, is insidious in its approach, pushy and – I suspect – will prove to be either ineffective or only effective for a short time.
The ASI’s Sam Bowman has raised what is widely viewed as the only other option – a free market for the sale and trade of human organs. The PR problems around the idea are endless, though – the first mention of it makes people freak out and become hysterical, citing flawed assumptions about the richest getting help rather than the sickest or the idea that the poor could be somehow forced into making sales that would harm them in the long run.
But what if there was a different, less risky and more publicly acceptable way to increase the levels of organ donation?
Let’s call it the Organ Mortgage (or perhaps the Orgage, if you enjoy a portmanteau word).
You’re an ordinary Joe, or Jane. For whatever reason, you want or need some more money – perhaps to go to University, or to send your kids to University, or to go on holiday or whatever.
So you take out an Organ Mortgage, signing up to donate your kidneys, or lungs, or the whole lot at the point of death. What do you get? You get given a wad of cash there and then. What do you give? Well, literally nothing at all until you die, at which point however many of your organs you’ve mortgaged are donated to someone else who needs them to stay alive.
You can increase the amount of money you get if you are willing to enter a contract to live to a particular standard of health – for example, to not smoke or take heroin.
What would the practical results be? Financially, the payouts would be somewhat smaller than in a pure sell-my-live-organ-right-now situation, because the NHS would be taking a gamble that you wouldn’t live until you were an untransplant-worthy 126 years old, or that you might get so badly splattered by a falling piano that nothing could be salvaged.
However, the argument about the poor and needy harming their health in return for money would be irrelevant, because you would keep all of your organs as long as you were alive. For that matter, the incentive to get a higher payout if you agree to avoid particular unhealthy activities would have a knock-on positive health effect for the donor without the need for the compulsion or nannying that our society currently resorts to.
It may well be a slower solution that would take slightly longer to solve our supply problems than the unpalatable idea of allowing the state to pillage people’s bodies might, but it seems to me a far preferable one. It offers the opportunity to treat and heal more people, to provide new assets and opportunities to those who are poor without harming their lives or health, and potential to improve the health of the nation through free will rather than bans, taxes or bullying. So why not?
Tags: Adam Smith Institute, Freedom, Health, Libertarianism, Nanny State, NHS, Nudge, opinion, Organ Donation, Politics, Sam Bowman, Smoking, Westminster
This is an interesting idea. The question would be to what the cost implications would be for the NHS – money spent on mortgages would be money not spent on other types of clinical requirements, and you’d likely have a break-even point where the additional organs thus secured would be outweighed by the cost required to secure them. Depending on whether that break-even point is at or below what you could call the ‘market rate’ for organs would determine this idea’s success.
03.08.2011 13:37
Look at the numbers on the organ register. They have reached 50% of the maximum available number of donors, but the supply is only about 15% of the demand.
Increasing the number of people willing to donate is not sufficient.
They either need to bump a few more people off to harvest the organs. Perhaps capital punishment should include donation, if you have a sick mind.
03.08.2011 14:32
How about a Leaseback system instead. It would work like this with kidneys- You give a kidney and are paid for it(after all you have another perfectly good one). If your remaining kidney fails you are entitled to an immediate replacement kidney from the leasing company.It would be a very unusual requirement to need to meet but would increase the supply at once rather than after years with the mortgage scheme
04.08.2011 11:28
So… what happens if the organ fails before death, after the future donor has already been paid for it? Not only is there one more person on a waiting list, but the NHS is out the money it had paid for the organ.
The risk factors for organ failure are not yet fully quantified to the point of predicting with any accuracy the chance that any one organ will last intact until the person’s death. As deaths are caused by failure of some vital organ or other (or a system-wide failure which would ruin the lot of them anyway), it turns into a game of waiting for a vital and so far irreplaceable organ – the brain, for example – to hopefully fail before the nontransplantable organs have become too damaged or exhausted to reuse. Either that, or a tragic accident at a young age. Because of the uncertainty, the intrinsic value of, say, a teenager’s kidney would be so low as to be negligible, unless their lifestyle would make them prone to a non-drug-related violent fatality.
This is one of those rare problems that could be alleviated by more drunk driving and fatal collisions.
04.08.2011 14:29
How about we all sign up to donate our organs because it’s the right thing to do and because our organs are useless to us when we’re dead?
If we must talk about schemes and systems, how about one very simple rule:
You can only receive an organ if you’re willing to donate one.
04.08.2011 19:32
I really struggle to see why people have such a problem with a free market in organs.
People might make stupid mistakes? That’s their choice.
05.08.2011 16:10