By David E. Harrington and Edward A. Sayre
Special to washingtonpost.com's Think Tank Town
Monday, November 27, 2006 12:00 AM
Medical schools in the United States are awash in cadavers. Yet, at the same time, there is a chronic shortage of organs for transplant patients, resulting in the deaths of thousands of people each year. Understanding why so many people donate bodies to medical schools holds lessons for how we should reform the laws governing organ donations.
Currently, U.S. medicine tries to procure transplant organs by urging people to register as organ donors. A recent report by the Institute of Medicine (IOM) on the severe shortage of transplant organs proposes more of the same medicine but at a higher dose: In essence, it counsels that we should ask more fervently. But continuing this policy, no matter how fervently we solicit would-be donors, will only fail to prevent more unnecessary deaths and more reports on the chronic organ shortage.
An alternative proposal, currently under consideration in Canada, the UK and by the U.S. Department of Health and Human Services, is to legally entitle medical officials to "presume consent" -- have authority to harvest organs from the recently deceased unless there is clear evidence that the donor would have objected. But some potential donors would have objected if asked prior to death, making this policy akin to stealing in some cases.
There is another effective way to increase the supply of transplant organs without the indignity and questionable ethics of presumed consent: offer would-be donors and their families some sort of compensation for agreeing to post-mortem donations.
Many public intellectuals, including the members of the IOM's organ donation panel, have raised all sorts of objections to this idea, and they argue that no compensation should be allowed unless there is clear empirical evidence that it would increase the supply of transplant organs. At the same time, compensation opponents decry the idea of creating a pilot program to obtain the empirical information they require. Despite those constraints, we have found clear empirical evidence that even modest compensation can dramatically affect donation decisions.
Medical schools routinely pay for the cremation or burial (often with elaborate memorial ceremonies) of the people whose bodies were donated to them for medical research and student training. In contrast, it is against federal law to offer any compensation for transplant organ procurement, including paying for organ donors' funeral expenses. This creates a bizarre asymmetry in the treatments of organ and whole body donations.
Given the current cost of funerals, the savings from donating bodies to medical schools can be substantial. This is especially true in states with funeral industry--protective regulations that are intended to keep out low-cost competitors. Those states provide us an opportunity to test empirically the effects of compensation on whole-body donation and, in turn, to extrapolate whether there is any merit to the criticisms of organ donation compensation.
If potential whole body donors respond to financial incentives, then we ought to see more body donations in stringently regulated states where funeral prices are higher. That is, in fact, what the data show. The number of body donations in stringently regulated states is 7.6 bodies per thousand deaths and only 3.2 bodies per thousand in unregulated states. This is powerful evidence that people react to financial incentives in making whole body donation decisions. We estimate that high funeral prices in the 38 states with stringent funeral regulations increase the number of donations by 8,400 bodies per year. It stands to reason that financial incentives would also raise the donation of transplant organs.
The IOM's rejection of such proposals rests on the argument that offering modest compensation would be perceived by organ donors as sullying their gift. But the empirical data on whole body donation discredit the IOM's argument; the families of whole-body donors often proudly highlight their gifts in obituaries, despite their receiving the financial benefit of not having to pay for a funeral.
The empirical data also discredit the IOM's argument that financial incentives would not increase the supply of transplantable organs. Surely if funeral service payments increase the donation rate of whole bodies, similar compensation would increase the donation rate of transplant organs.
It is time the IOM and other public intellectuals accept the empirical data and set aside their dubious arguments against donor compensation. To continue the status quo or to adopt a presumed consent policy are both morally unacceptable. Allowing donor compensation would protect the dignity of donors and would reduce the suffering and death of the many people waiting for transplant organs.
David E. Harrington is the Himmelright Professor of Economics at Kenyon College in Ohio. Edward A. Sayre is assistant professor of economics at Agnes Scott College in Georgia. The results of their research will appear in the winter issue of the Cato Institute's Regulation Magazine.