Organ donors

Economists seem to enjoy tweeking conventional wisdom of certain subjects. I personally am happy to talk about the downside of “anti-price-gouging” laws following natural disasters and the inherent imbalance in regulations against insider trading. I will also, just to be cantankerous, argue that there were unrecognized public health benefits to Prohibition. However, even the most libertarian minded economists shy away from market solutions to some topics. One of those is the issue of organ transplants.

Nevertheless, regardless of how morally repulsive open markets for transplantable organs seem to me, we as a society stare at a massive imbalance between the demand and supply for healthy organs, which is a classic economic problem of scarcity. The scarcity is so great that direct “compensation schemes” to donors (few dare call them markets) are being actively debated (see the article by Wellington and Whitmire in the most recent Contemporary Economic Problems).

But I don’t want to get into the organ markets debate here (so please, no comments on organ markets). Instead, I would like to highlight two programs that can address some of the gains from alleviating that scarcity without being markets in the traditional sense. One of these was developed with the explicit and active participation of some excellent economists. The other is an illustration of new forms of community springing from the internet. While I believe that each of these institutions ought to pass most Christians moral evaluation, the biggest contributions that Christians can make is to make sure that their organs are available for transplant.

The first program is the New England Program for Kidney Exchange. Kidney exchange addresses situations in which a kidney patient has a willing live donor, but they are not appropriate biological matches. The kidney exchange program uses algorithms to search for another donor/recipient pair with the opposite incompatibility. The NEPKE operates within the favor of the medical community, and their webpage can be viewed here. An interesting feature is the intensive role that economists at Harvard University have played in developing the exchange processes. Scroll down Al Roth’s webpage to find an extensive discussion of how economics played a major role in this project.

Another program has been more controversial. Sally Satel, a national columnist, has herself been through major kidney disease, and has publicized the efforts of a grass root community called matchingdonors.com (one of her articles in National Review is here). An interesting difference is that matching donors has elicited objections from within the medical community.

I find it hard to see how a Christian could have problems either with NEPKE or with matchingdonors.com . In fact, the medical professionals’ objections to matchingdonors.com trouble me a lot. In our book, Doug and I talk about how one of the results of modernity has been to migrate acts of compassion from face to face relationships to more centralized institutions such as the government, insurance companies, and large organizations. We argue that this makes face to face compassion in all areas less culturally plausible. This would certainly seem to be a perfect example. If person X voluntarily, as an act of great compassion, agrees to donate a kidney to person Y, Sally Satel offers a list of arguments as to why that gift is moral and fair. I would go further and say that would seem to me to be an ultimate gift of love that our society should be encouraging. If a particular surgeon is offended, then refusing to participate in the surgery is his private prerogative.

I should also point out that I have seen, without having saved the links, churches using their web pages to seek organ donors for members of their congregation.

To some extent, I can see the side of the story objecting to these communities. If we, as Christians, are willing to donate a kidney to an unknown person on a webpage, why shouldn’t we be willing to donate it to the anonymous person highest on the established kidney donor list? That’s an important question that I’d like to see some comments on from readers. But, if Satel’s account is correct and there have been attempts to actively dissuade others from cooperating with the community lists, then this is a perfect example of the “Big Government/ Big Institutions Know Best” attitude about compassion that is typical of modernity. And it is another example in which the decentralization and dissemination of information on the internet is a threat to monolithic modern institutions.

This is a springboard to another discussion, which is the following: if a cultural neophyte came to American, could he determine whether universities or hospitals or retirement homes with the words Presbyterian or Methodist or Saint or Luther, etc. in the names could be in any way distinguished from their fully government-funded counterparts? I hope to explore this question, especially with regards to universities, in a future post. In the meantime, I just double checked to make sure that I am listed as an organ donor on my driver’s license.