Posted by Eugene Volokh:
Medical Self-Defense and the Risk that Compensation for Organs Will Drive Away
Volunteers:
http://volokh.com/archives/archive_2006_11_12-2006_11_18.shtml#1163527295
One of the commenters asks:
Finally, any guess as to how many of those healthy organs donated
benevolently will not be available when the pricing game starts?
Believe it or not, everyone and their descendents is NOT motivated
by money. Look at how many community women stopped volunteering --
the work that truly built American character before the
market-inclined came into the game -- once there was some
expectation people could be paid for such services. Sure you'll
pick up some donors in it for the money; how many of the
"volunteers" -- in it for the end result, not the pay -- will you
lose?
I had a section in an earlier draft addressing this argument, but I
had to cut it for space reasons (though I included a little bit of it
in other places). Here's what I said:
Some have also hypothesized a somewhat different altruism effect:
that offering money for organs might alienate donors who would give
the organs for free, and might therefore decrease (or not
substantially increase) the aggregate donor supply. One can imagine
some such mechanisms: If some people believe (whether rightly or
wrongly) that an organ market is immoral or disgusting, they may
refuse to participate. If some people start thinking of the
transaction in financial terms, they may conclude that $30,000 is
too low a price for parts of their bodies, even if they would have
donated the body parts for free.
Likewise, some people might be turned off from the loss of the
emotional benefit that accompanies a pure selfless act. Or some
people might donate organs under the current system because they
seek the emotional reward that comes from doing something that can
only be done by the charitably minded. Once organ provision becomes
the sort of thing that is routinely done for money, they might no
longer be interested in doing it.
Yet while one can imagine such reactions, my sense is that they�d
be quite rare. To begin with, only about 1.5% of all U.S. living
donor transplants -- in 2005, 89 transplants in total -- are purely
unrelated anonymous donations. Even if all these unrelated
anonymous donors become alienated by the prospect that others are
being compensated for providing organs, and aren�t mollified by the
prospect of refusing compensation or donating the compensation to
their favorite charity, this will be a very small loss to the organ
pool. The remaining 98.5% are either donations to relatives,
targeted donations (presumably mostly to acquaintances), or �paired
exchange� donations in which the recipient�s relative or
acquaintance provides an organ in exchange to the donor�s relative
or acquaintance. These donors, I suspect, will care primarily about
the welfare of the transplant beneficiary, and won�t refuse to
donate just because compensation is offered. The cadaveric organs
do often go to strangers. But how likely is it that a next-of-kin
who would be willing to donate the decedent�s organs under a pure
donation system would instead refuse when offered money (even given
the option of declining the money, or sending it to his favorite
charity)?
On the other hand, the opposite reaction -- a financial incentive
doing what financial incentives usually do, which is stimulated the
rewarded conduct -- should, I suspect, sway quite a few people. We
see some evidence of this in the supply of eggs to infertile
couples: In America, where women routinely get $5000 to $15,000 for
such eggs, the eggs are generally available; in England, where the
compensation is capped at £250, there is a years-long waiting
list; in Australia, where payment for eggs is banned, there is a
five-year-long list. We also see plenty of evidence of this in our
daily experience with the overwhelming majority of other goods and
services, where offering money will get you much better results
than asking for charity.
Moreover, the offer of money may easily be presented in ways that
harness charitable people�s charitable attitudes. Providing your
(or your recently deceased relative�s) kidney for money, after all,
saves a person�s life just as much as donating the kidney would;
and then, if you have strong charitable impulses, you can just take
that money and give it to your church, or your favorite charity.
The recipient is no worse off because you took the money. (Under an
organ market system, the cost of the organ would surely be paid by
private or government insurance, just as the much greater cost of
the other inputs into the transplant -- doctor time, hospital
space, pharmaceuticals and surgical supplies -- is now paid.) And
if you are charitably minded, you can just take the money and give
it to your church, or your favorite charity, or if you prefer some
fund that will support organ transplants for the poor. You get to
feel good about two things, the saving of a life and the donation
of the proceeds, rather than just one.
What�s more, many genuinely altruistic people understandably feel
that their charity should begin at home. A father�s death in an
accident, which makes the organ donation possible, might at the
same time strip away his wife�s and children�s main source of
financial support. Getting money for the organs and using it for
the children�s benefit will likely seem far more appealing -- even
if the mother is generally charitably inclined -- than just giving
the organs away.
This leaves one sort of person who might still be turned off,
despite the option of declining payment or routing the payment to
his favorite cause: someone who is deeply attached to the concept
of doing the sort of thing that cannot be done for compensation.
Note that this person isn�t the hyper-altruist who just wants to
provide an organ to save a stranger�s life; he can still do that if
he gets paid. Nor is it the hyper-altruist who just wants to give
the organ free; he can still do that by forgoing compensation.
Rather, it�s someone who won�t want to save the stranger�s life if
such lifesaving is also done by others for compensation.
Yet how common are such people likely to be, compared to those who
will see an offer of payment as an incentive? Consider a thought
experiment: Imagine a requirement that doctors who do organ
transplants do them for free, or not at all. Do we expect that such
a requirement would on balance increase the number of doctors
willing to perform such operations, since some doctors will be
thrilled to do something that can only be done by the charitably
minded? Would we say, �Sure, some doctors won�t want to invest
their time and effort with no compensation, but think of how many
more doctors would want to perform such a public service�? Or would
we expect that counting on a combination of incentives and
conventional altruism (in which some doctors may contribute their
time and effort while forgoing compensation ) is a much surer bet
than counting on pure altruism alone?
_______________________________________________
Volokh mailing list
[email protected]
http://lists.powerblogs.com/cgi-bin/mailman/listinfo/volokh
