Wednesday, September 30, 2009

Wanna Buy a Liver?

There has been quit a bit of talk around the interwebs about Richard Thaler's piece in this weekend's New York Times. Quite frankly I am a bit surprised that some people are so troubled by changing the way people select their organ donor status.

My own thinking on the issue has evolved over time. I can recall quite vigorously arguing for an open market for organs, in my property class in law school. I still find the idea somewhat appealing on its face, but realize the very real negative risks to such a system. Obviously, a market for the sale of organs would result in the wealthiest members of society receiving most, if not all, of the available organs.

Perhaps some way around this would be a lottery. People who were in need of a liver could enter into the lottery for an available liver that matched. The total proceeds of the lottery, less some administrative cost, would be given to the seller. But you'd have to find some mechanism to prevent wealthier individuals from purchasing so many tickets as to tilt the odds into their favor. Also, without some very strict form of limited ticketing, there would be an obvious arbitrage opportunity. In other words, devising a system that ensured equity in the distribution of available organs would be complex at best, impossible at worst.

Thaler seems to express at least some trepidation about moving to an opt out system, which is why he pushes instead for mandated choice. I do not have any particular moral/ethical reservations about an opt out system. But I do feel it might be difficult to figure out a way to phase it in. I'm not so sure that it's as easy as making the person's next license renewal include the opt out default setting. There are older people who might not be aware of the change, even if it is well publicized.

Of course, the larger issue we have to confront under any change is the way in which Americans cling to life. We can be sure that the usual suspects (pro-lifers and other religious conservatives) will find plenty not to like about a system that makes it easier to harvest organs. Death panels will be replaced with liver panels. I'm sure Betsy McCaughey is working on it already.

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