Although most people are unaware of it, the world faces an absolutely critical shortage. There are far too few organ donors. Every hour that ticks by, one American and one European die for want of a transplant donor. In other words, western society faces a huge shortage of organs. Yet in principle there are more than enough natural -- though tragically untimely --deaths to provide sufficient donors for all of our citizens who need them. Our nations just do not bother to match up the demand and the supply.
We must. One day it will be you who needs a transplant. Or me. Paradoxically, economic progress is worsening our difficulties. First, the wearing of seatbelts and improved safety designs have decreased the number of organ donors. Second, medical advance has raised the usefulness of donations, so in a funny way the effective shortage has gone up. Preservation techniques and immune-system suppressants have improved. In the United States, 90% of kidney transplant patients are alive and well at one year from the operation. Even for heart transplant operations, the US figure is 85% after one year. Third, people everywhere in the western world are living longer, so demand for healthy organs is rising.
This is a tricky problem. But we can solve it -- with a bit of economics and a sprinkle of common sense. Britain should use the tax system. A tax-incentive solution would run like this. We would offer a small lump sum reduction on a person's income tax bill if he or she would agree to, be a potential donor in the future. The size of the incentive would not have to be big. A tax break would partly serve -- by offering a box to tick on the person's annual tax form -- to highlight a problem about which nobody speaks. The tax break would itself be good advertising. Human altruism and the tax incentive would do the rest.
Let's talk numbers. Say the tax reduction for a person were 10 pounds (15 dollars) a year. In a country such as the United Kingdom, there are around 20 million taxpayers of working age. This would mean a cost to the Exchequer of 200 million pounds sterling. There is a good chance that the tax incentive and publicity would double the stock of officially registered potential organ donors from its current 8 million people. If so, it would be feasible to increase the number of transplants by around 2000 a year.
The implicit tax cost in a nation like the UK would thus be 100,000 pounds per annum per extra transplant. Although this is a large sum, it is not unacceptably great. There are enormous costs of providing, for example, kidney dialysis treatment to those waiting for a transplant. The lost income from having workers incapacitated is considerable. More important, the value in pain and suffering from major illness could be considered to make efficient any tax scheme that would deliver such an outcome.
Ensuring a supply of organs, though it sounds terribly hard-hearted to put it in that language, really matters. It will become increasingly important in western society. The provision of small tax incentives for altruism seems the natural way to go about this.
Would some people view tax breaks for potential organ donation as morally objectionable? Perhaps.
However, virtually all religious denominations officially support the principle of organ donation. The alternatives, too, are unattractive. Most people feel that to allow the buying and selling of organs would be wrong. The main alternative, so-called compulsory opt-in, is unappealing. This is the idea that all citizens should be presumed, unless they have signed a waiver, to have agreed to allow their organs to be used in the event of, for example, their death in a car crash. Yet 'automatic opt-in' is unreasonable and undemocratic. It is best opposed in a free society.
Yet remember the need. In the United Kingdom, approximately 6000 people are waiting at any one time for transplants of major organs - especially kidney, pancreas, heart, lung, liver. Only 3000 transplants are done each year in the UK. Thousands die needlessly. In the United States, at any time 70,000 men and women are waiting for a transplant of a major body organ. But the annual number of transplants in the US is only about 20,000. The National Kidney Foundation of the USA estimates that 50 Americans die every week for want of a kidney donor alone.
It is against the law, in our nations, to trade in human organs (for good reason). And voluntary sign-up donation mechanisms are not as successful as required - probably because people prefer not to think about death. Hence there is a missing market, an economist would say. So here we have an area where governments must step in. In this sphere of life, things cannot be left to market forces. And life here really means it.
For further information please contact:
Professor Andrew Oswald, Professor of Economics
University of Warwick Tel: 024 76 523510 (Office),
01367 860005 (Home)
email Andrew.Oswald@warwick.ac.uk (office)
Originally Published 5 February 2001