How an Organ Mortgage system could solve the donor shortagePosted on August 8, 2011
Organ 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?