January 13, 2019
In a Washington Post column, Megan McArdle suggests that we pay people to donate their kidneys as a way on increasing the number of donors and reducing the number of people who must rely on dialysis. Needless to say, to many folks, it is attractive to get market relationships into ever more aspects of our lives. However, if we are interested in getting more kidneys, rather than just getting more money for the health care industry, this is likely a bad way to go.
There was a great study done a few years back with child care centers in Israel. As it was, the vast majority of parents picked up their children on time because they knew that being late meant a teacher had to stay late. The study examined what happened if centers charged a small fee to parents for being late to pick up their kids. It turned out that the fee significantly increased the frequency with which parents picked up their kids late.
The explanation offered is that when there was no fee, parents felt an obligation not to make teachers stay late. When they paid a fee, they felt that they were compensating with the fee, therefore they didn’t feel guilty about being late.
Would it be the same story with kidneys? It’s hard to say, but people donate now with the idea of providing help to someone in need, often a family member or friend. These donations may well fall off if they know kidneys are readily available for the right price.
For my part, I no longer check off the spot on my drivers’ license to be an organ donor. While I would be very happy if one of my organs could extend the life of a person in need, I remember how Mickey Mantle was pushed to the front of the line to get a liver transplant. The great baseball player had destroyed his liver with a life of hard drinking. Nonetheless, he was pushed to the front of the line to get a transplant at the age of 64. He died shortly after the transplant.
I have spent my life trying to combat this sort of sleaze. If some doctors want to get rich providing transplants for the rich and famous, I don’t intend to help them with my death.
Addendum
Robert Salzberg assures me that rules on organ transplants have gotten stricter since the Mickey Mantle days and are carefully regulated by the Organ Procurement and Transplantation Network. If anyone wants to weigh in on the status of the process today, I would be interested in hearing their assessment.
As far as my point on Mickey Mantle, my concern was not so much this specific case, as what it showed about the process. We heard about Mickey Mantle’s transplant because he was a famous baseball player, but the odds are that he was not the only one to jump to the front of the line based on his fame and wealth.
Robert also suggested as an alternative to cash payments to kidney donors that we might offer free medical care for life. This seems like a reasonable benefit that does not pose the same risk of having a market for kidneys where payments could soar into the stratosphere. It also preserves an idea of it being a gift of sorts, reciprocated with another gift.
Here’s another piece on the organ donor system.
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