The markets for organ transplants

As a general rule around here we think markets work. We’re also entirely cool with the idea that sometimes restrictions must be placed upon markets to make them work better. There are, for example, those varied problems with externalities, things not accounted for in market prices. We’re even happy with the idea that we should have a market in market restrictions. How else are we to find out what actually works if we don’t go try it?

We do though insist that we then learn our lessons from those market outcomes. Something that isn’t being done with organ transplants. The government here has nationalised our corpses - moved from an opt-in process for the use of cadaver organs for transplant to an opt-out. Instead of us registering that we would like to help those in need after our death it is now assumed that unless we have distinctly stated otherwise our bits and pieces may be so used.

This doesn’t actually work:

Studies comparing opt-out and opt-in approaches to organ donation have generally suggested higher donation and transplantation rates in countries with an opt-out strategy. We compared organ donation and transplantation rates between countries with opt-out versus opt-in systems to investigate possible differences in the contemporary era. Data were analysed for 35 countries registered with the Organisation for Economic Co-operation and Development (17 countries classified as opt-out, 18 classified as opt-in) and obtained organ donation and transplantation rates for 2016 from the Global Observatory for Donation and Transplantation. Compared to opt-in countries, opt-out countries had fewer living donors per million population (4.8 versus 15.7, respectively) with no significant difference in deceased donors (20.3 versus 15.4, respectively). Overall, no significant difference was observed in rates of kidney (35.2 versus 42.3 respectively), non-renal (28.7 versus 20.9, respectively), or total solid organ transplantation (63.6 versus 61.7, respectively).

It’s worth noting that this is being reported by Al Roth - reported, not the original paper - whose Nobel was for the design of markets and matching systems at least in part concerning organ transplants.

Which brings us to our view - probably not supported by Roth - concerning organ donation. Nice though it would be to think that they are enough it turns out that charity and empathy aren’t. This accords with the Welsh experience recently, where the move to opt-out didn’t move the dial on that rate of organ transplant. We’ve done the experiment, seen the outcome, and variations on uncompensated donation don’t solve the problem. Thus, if we want to solve the problem we need to move to a system of compensated donation.

As we’ve said many times over the years. Closely managed compensation of live donors of those organs which can be gained from live donors does in fact work in the one place it is generally allowed - Iran. Market experimentation in its true sense, using different arrangements to see what works, has shown us the answer. If we want to solve the problem this is therefore what we should be doing.