The Everyday Economist

Under current law, in both the U.S. and Britain, organ donations are voluntary. Unfortunately, under this system it is estimated that 16 people die each day waiting for a transplant. Many have suggestions about how to solve this problem. For, example, I have written about organ sales here. However, British Prime Minister Gordon Brown has gotten behind a proposal to eliminate explicit consent. The Daily Telegraph reports:

The proposals would mean consent for organ donation after death would be automatically presumed, unless individuals had opted out of the national register or family members objected.

From the standpoint of behavioral economics, it is reasonable to assume that this will increase organ donation. For example, this change is quite in line with the idea of libertarian paternalism (see here, here, here). However, the fundamental question at the center of this proposal is a question of property rights. Is your body a public good or a private good?

Under the current organ donation system, individuals are assumed to have the right to their organs and thus the organs can only be removed after explicit permission from the individual or their family. Under the proposed system, organs are assumed to be a public good where those awaiting donation are assumed to have the right to your organs unless explicitly stated otherwise.

While the plan has the potential to save lives, it comes at a high price. Individuals essentially lose their autonomy as they necessarily become of function of the state. Similarly, this policy is akin to some faulty logic. For example, it is obvious that Brown believes that if the organ donation were the default option, then organ donation would increase. Therefore, when the number of donors increases, this is thought to be a benefit to the individual and to society. However, simply relying on the default option does not imply that this is the better choice any more than the current decision to rely on the default choice.

As a property rights issue, the default choice should allow the individual the right to their body and its contents. This allows the individual to be autonomous while at the same time the ability the provide the gift of life if they so choose.

Al Roth has written a provocative article in the Journal of Economic Perspectives on markets and moral repugnance, particularly as it relates to organ sales. Here is a sample:

Apparently, some kinds of transactions are repugnant in some times and places and not in others. This essay examines repugnance and its consequences for what transactions and markets we see. When my colleagues and I have helped design markets and allocation procedures, we have often found that distaste for certain kinds of transactions can be a real constraint on markets and how they are designed, every bit as real as the constraints imposed by technology or by the requirements of incentives and efficiency.

[...]

The persistence of repugnance in many markets doesn’t mean that economists should give up on the important educational role of pointing to inefficiencies and tradeoffs, and costs and benefits. But neither should economists expect such arguments to win every debate immediately.

The article outlines the role repugnance has played in markets over time and how, in some cases, public opinion has changed and allowed markets to prosper. Roth does a great job thoroughly discussing both arguments for and against organ markets. In addition, and quite importantly, Roth points out that organ markets will not be a panacea to solve organ shortages. Overall, I found this article to be very thought-provoking.

Here is a non-gated version of the paper.

Also, for those interested, here is an article I wrote on organ sales.