Arguments for an Opt-Out Organ Donation System
I have been following the Becker-Posner Blog since September in an effort to see the economic side to controversial issues. The authors are economists who evaluate dilemmas facing our country (ie, the death penalty and whether to punish parents for children’s crimes were two recent hot topics) while attempting to achieve a balance between moral and economic interests. Currently, the discussion revolves around the shortage of organs available for transplantation as the waiting list grows ever longer, a debate that arose from the question of whether or not one should be allowed to sell an organ.
France was used as an example of a nation with an opt-out system. That is to say, everyone is an organ donor unless they specify that they choose not to donate. The only data available are from a study indicating that an opt-out system would only increase the availability of organs by 25 to 30%. Richard Posner, in reference to one perspective, writes: “…an increase in cadaver donations would presumably reduce the number of donations from living people, so the net effect on donations is uncertain.” I suppose my argument here is that, even assuming the net difference is zero (although I don’t think it would be), it would reduce morbidity if not mortality if organs are not having to come from living donors. Thus, even if the increase in the number of cadaver organs was only slight, I still think the system would be justified.
One of the comments on the blog, left by David Undis, is: “A better way to reduce the organ shortage is to change the organ allocation system — allocate organs first to registered organ donors. This would create an incentive to donate.” In theory I agree with this. As it stands currently, organs go to those who need them the most – ie, the sickest patients (for livers, this is calculated based on various factors into a raw number known as the MELD score – the higher the number the more likely one is to get a liver). The reason Undis’ proposition will not work is illustrated in this example – the number one reason for liver transplantation in the United States is cirrhosis secondary to hepatitis C infection, and anyone infected with a communicable viral illness such as hep C is disqualified from donating. Who would determine which of the thousands of hep C patients get to go to the operating room first? The leading cause in the U.S. of acute liver failure is acetaminophen toxicity. Just because a person is a registered organ donor, are they then entitled to a liver following a suicide attempt (ie, self-inflicted injury)? It seems need is a good way to go, although then we are forcing many patients to wait until they become quite ill before performing an operation with a relatively high mortality on them. I have heard the argument that those who have waited the longest have the right to the next organ that is a match. Again, this should not be an issue if there was an adequate supply of organs.
Anyway, something to ponder.