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Lifesharers on ABC
If you had to sign your organ donor card to be eligible to receive an organ transplant the shortage of human organs for transplant would disappear. I am on the board of advisors of LifeSharers an organ donation club which has begun to implement such a system. LifeSharers and its tireless president, Dave Undis, were featured recently on ABC News Tonight. Here's the video.
Posted by Alex Tabarrok on December 11, 2006 at 01:25 PM | Permalink
Comments
Wouldn't there be a tendency for people who would expect to need organ transplants to overwhelmingly become members while the most desirable organ donor population segments (healthy young people who ride motorcycles without adequate protective gear) would have no incentive to join?
Posted by: don Hosek at Dec 11, 2006 2:11:54 PM
Mr. Hosek:
Certainly someone who knows they need a transplant has a greater motivation to join LifeSharers than a healthy person. But everyone has an incentive to join as long as there is a shortage of transplantable organs. Joining LifeSharers increases your chances of getting a transplant should you ever need one. More than half of the people on the national transplant waiting list will die waiting, so the chance to improve your odds can literally mean the difference between life and death.
As it happens, only about 1/2 of 1 percent of current LifeSharers members need transplants.
Posted by: Dave Undis at Dec 11, 2006 2:30:03 PM
Well, I joined LifeSharers three years ago when I had no expectation of having anything at all wrong with me. But a month ago, I had my left kidney removed because of damage that kind of went downhill from a stone I had several years ago. I might have died in those three years and donated my organs, and been happy (in advance) to do so; I think I have a right to expect now that there might be a bit of a place for me on the list. I could still die and donate a fine heart or eye or what have you. Most people with organ failure don't have all their organs crash at once, right?
Posted by: speedwell at Dec 11, 2006 2:41:06 PM
It is wrong, wrong, wrong to say that "If you had to sign your organ donor card to be eligible to receive an organ transplant the shortage of human organs for transplant would disappear." LifeSharers does a tremendous disservice to the cause of increasing the number of donors by constantly suggesting that cadaver organs can significantly decrease the shortage. STOP SAYING THIS. IT IS FACTUALLY INCORRECT.
Around 72,000 of the 90,000 people waiting for organs are waiting for kidneys. Last year there were seven times as many people on the kidney waiting list as there were potential cadaver kidneys--that is, kidneys that could have been donated if every person who died in the right circumstances had signed a donor card. The list is also growing much faster than the number of potential cadaver donors. The bottom line: There are nowhere near enough transplantable cadaver kidneys to meet the demand, and kidneys account for most of the waiting list. LifeSharers is great at getting publicity and making a case for in-kind incentives, but it isn't doing much at all to solve the problem.
Posted by: Virginia Postrel at Dec 11, 2006 2:43:34 PM
From Mr Undis: "As it happens, only about 1/2 of 1 percent of current LifeSharers members need transplants."
While this statistic may be true, I am willing to bet that the elderly and ill are sgreatly overpresented in membership vis a vis the general population. They may not need a transplant now, but the likelihood of needing one in the near future is much higher than the rest of the population.
Posted by: awp at Dec 11, 2006 2:54:28 PM
Seen on their site:
"Once you've joined, you can sign up your children as well."
Okay, I hate them.
Posted by: Francois Tremblay at Dec 11, 2006 3:01:50 PM
Ms. Postrel:
Cadaver donors CAN significantly decrease the organ shortage. About 10,000 to 15,000 transplantable kidneys are buried or cremated every year. The transplant waiting list is growing by about 4,000 people every year. So a significant increase in cadaveric donors would save lots of lives, reduce the size of the waiting list, and shorten waiting times for people still on the list.
Posted by: Dave Undis at Dec 11, 2006 3:10:02 PM
awg said: "I am willing to bet that the elderly and ill are sgreatly overpresented in membership vis a vis the general population."
In fact, the age distribution of LifeSharers members is not significantly different than the age distribution of transplant recipients or deceased organ donors.
I can't speak the the health demographics of LifeSharers members, except to repeat that only about 0.5% of them transplants.
Posted by: Dave Undis at Dec 11, 2006 3:33:24 PM
Alex did not say that cadaver organs, or the LifeSharer approach, "can signficantly reduce" the organ shortage. He said, as I quoted, "If you had to sign your organ donor card to be eligible to receive an organ transplant the shortage of human organs for transplant would disappear." That is the misleading impression that LifeSharers gives the public, no matter how much you want to split hairs. I am all for encouraging cadaver donors, but let's be clear about the numbers.
Posted by: Virginia Postrel at Dec 11, 2006 3:37:52 PM
Virginia,
You are not distinguishing between stocks and flows. It is true that the stock of people currently needing a kidney is too large to be alleviated immediately by cadaveric donation but cadaveric donation can substantially alleviate and even eliminate additions to the stock with the long run consequence of eliminating the shortage altogether. In other words, bad policies have left us with a big debt. Good policies can reduce the deficit with the long run consequence of eliminating the debt.
Thus, I am correct cadaveric donation can eliminate the shortage but *obviously not overnight*. I don't think anyone would be confused about this but I shall try to be more clear in the future.
Alex
Posted by: Alex Tabarrok at Dec 11, 2006 3:51:22 PM
What fraction of organ recipients who are not already registered donors register? What fraction of people on the waiting list for organs register as donors? Just curious because if the people most acutely aware of the problem of organ shortages don't register (or even a sizable fraction, maybe 20%?), what hope is there for people who never think about organ shortages/donation?
Posted by: RSaunders at Dec 11, 2006 3:53:25 PM
Of course, cadaver organs are the primary source as long as free markets in organs are outlawed.
Posted by: Mr. Econotarian at Dec 11, 2006 4:32:53 PM
Distinguishing between stocks and flows is fine, but the flow is not at a constant rate. The list is growing faster every year, as kidney disease becomes more and more common (in large measure because of the increase in diabetes). Some projections put it at more than 100,000 by the end of the decade. The number of potential cadaver organs is not growing.
Posted by: Virginia Postrel at Dec 11, 2006 5:49:41 PM
Alex-
Was LifeSharers started based on ideas from your book?
Posted by: Nathan Whitehead at Dec 11, 2006 6:02:13 PM
The doctors and other medical professionals along with their various hospitals and institutions are to be applauded for their pro bono participation in the trafficing of human organs. It is illegal to profit from this practice right? You don't mean... They get paid to traffic in human organs!?!
What does Dave Undis do for a living when not vollunteering his time as President of the pro bono LifeSavers?
Posted by: Robert Coté at Dec 11, 2006 7:00:02 PM
"Some projections put it at more than 100,000 by the end of the decade"--and I 'm sure some projections put it at less. And I'm sure some projections predict further increases in motorcycle popularity and by extension fatalities, following the trend of the past 9 years or so. I guess what I'm saying is that you seem awfully upset that they offered an entirely reasonable prediction that will, hopefully, result in more donated donors.
And, assuming the numbers Undis provides are correct (10k-15k potential organs wasted every year compared to a 4k deficit) then using the conservative estimate and assuming all those organs were captured, we would see a 6k kidney surplus. Assuming those numbers hold, would take 12-15 years to clear the kidney debt. Actually less since I'm sure quite a few of the people would die, although I don't suppose that really supports either side of the argument.
Posted by: Van at Dec 11, 2006 7:04:41 PM
There is a nice book review by Ian Hacking of a recent book about organ donation on the London Review of Books homepage - it'll probably be accessible for at least a couple more weeks.
Posted by: Surabaya Johnny at Dec 11, 2006 8:35:50 PM
Virgina and Alex,
What do you think a program like LifeSharers does to the probability of adopting pro-market policy in organs? In other words, suppose LifeSharers is relatively successful – does this diminish the argument for permitting the sale of organs?
I consider this to be why Virgina’s point is particularly important. If most of the people waiting are in need of kidneys, and the rate of kidney failure is increasing while the number of people dying is constant, the solution must include incentives for healthy, living people to donate.
In-kind transfers by way of members only clubs constitutes an improvement over the status quo. However, I hesitate to come out in favor of these arrangements because they funnel the discussion away from the best solution. The efficacy and ethical basis for markets in organs must come to the forefront of the discussion if we can expect significant improvements, much less elimination, of the shortage. In my opinion, suggesting that an organization such as LifeSharers can eliminate the shortage takes precious attention away from a better solution. LifeSharers would do better marketing their club as a temporary solution until government recognizes the right to voluntarily trade cash for a kidney in the market.
Posted by: echo at Dec 11, 2006 8:38:14 PM
Virginia - excuse the previous spelling error.
Posted by: echo at Dec 11, 2006 8:40:05 PM
Robert Coté asked: "What does Dave Undis do for a living when not vollunteering his time as President of the pro bono LifeSavers?"
Dave Undis answers: "I don't derive any income, directly or indirectly, from LifeSharers or from the organ transplant industry however broadly anyone would like to define it. I am an unpaid volunteer. I think the LifeSharers approach will some day save thousands of lives every year."
Posted by: Dave Undis at Dec 11, 2006 8:44:51 PM
echo--
Assuming LifeSharer or a similar program can eliminate organ shortages, is there any longer even a point in campaigning for an organ market? Especially considering an organ market is a much harder political sell.
Posted by: Van at Dec 11, 2006 9:08:28 PM
Yes, there is still a point to markets even if LifeSharer can eliminate the shortage. In that state of the world the question becomes - at what cost?
Under the LifeSharer arrangement those in need of kidneys still must accept whomever they are matched with on the list. Markets would allow consumers of kidneys to distinguish along quality margins as well. For example, I would pay more for a kidney from a person in their 20s than I would from a person in their 60s, all else equal.
The point of addressing Virginia's evidence of the increasing rate of kidney failure, I think, lends significant weight to the argument that LifeSharers arrangement can't solve the shortage.
Posted by: echo at Dec 11, 2006 9:27:41 PM
echo asks: "What do you think a program like LifeSharers does to the probability of adopting pro-market policy in organs? In other words, suppose LifeSharers is relatively successful – does this diminish the argument for permitting the sale of organs?"
If LifeSharers is "relatively successful" it will save lives. That's the whole point of LifeSharers. LifeSharers is an attempt to save lives, not an attempt to impact the argument for permitting the sale of organs. But the success of LifeSharers will also enhance, not diminish, that argument -- it will prove that incentives can increase the supply of transplantable organs. If the small incentive that LifeSharers offers works, then just imagine how effective a monetary incentive would be.
I believe that a free market in human organs is the best solution to the organ shortage. I also believe that a free market in human organs is a pipe dream -- no one reading this will live to see the day that Congress legalizes buying and selling human organs for transplants. That's one of the reasons I started LifeSharers.
LifeSharers doesn't take "precious attention away from a better solution". It focuses attention on the organ shortage -- and on a practical and legal way to save thousands of lives every year.
By joining LifeSharers, you'll increae your chances of getting a transplant if you ever need one. It's a pretty good trade. Membership is free and open to all at www.lifesharers.org.
Posted by: Dave Undis at Dec 11, 2006 9:40:28 PM
Assume that even widespread adoption of LifeSharers won't adequately address organ shortages. Assume that free markets would. Even given that, I see the first as a slippery but happy slope leading to the second, rather than a counterproductive distraction as echo fears.
You see, LifeSharers is absolutely wrong about one thing: their membership agreement says "I have received no valuable consideration for joining the LifeSharers network." Getting access to organs ahead of others is as valuable a consideration as it gets. Even if you don't need them yet, by joining you are buying an insurance policy while selling options. Yes, yes, I know "valuable consideration" is a legal term of art, here being used to 1) show that you haven't entered into a contract and 2) avoid very specific terminology in the laws and policies controlling organ donation. But still. The reason to join LifeSharers is to get something in return.
And that's good.
It's a step on the path towards acceptance of markets. The gut reaction against them is "why should you be able to benefit from donating an organ?" The answer has to become "why should you not?" Widespread support for LifeSharers, where you do get a benefit - one that is harder to dispute and that has less stigma attached to it - will help persuade people that it's okay to take the next logical step.
Posted by: eddie at Dec 11, 2006 9:41:35 PM
I should note that there's actually two reasons to join LifeSharers. If you weren't otherwise going to donate (for whatever reason), the prospect of getting preferential treatment if you ever need it might be incentive enough to join. But if you were going to donate anyway out of altruism, then joining LifeSharers is a way to make your donation have the best possible results - not only saving someone's life, but acting as an incentive to get others to do the same thing.
LifeSharers: it's for saints and greedy bastard capitalist pigs!
Posted by: eddie at Dec 11, 2006 9:48:34 PM
