How Can Countries Encourage Organ Donation?

By CATHERINE RAMPELL

by Magnus D

Israel will soon become the first country in the world to give people who agree to become organ donors priority treatmentif they should require an organ transplant themselves.

Officials hope the incentive will increase the supply of available organs — of which there is a shortage across the world, but especially in Israel, where only one in 10 adults carries a donor card.

This is sure to be a closely watched change, as most countries have tried different measures to increase willingness to donate organs. Here’s a rundown of some of those efforts, which include (1) creating markets for organs; (2) making all citizens organ donors by default, unless they explicitly exempt themselves; and (3) investing in more health care infrastructure.

Some countries have proposed legalizing the sale of some organs for money, as is the case in Iran. But such policies are controversial, and not just because people have moral qualms about putting a price tag on an item as precious as a healthy kidney. Some scholars have written about the fear of “crowding out” altruistic motives for donating organs.

Offering a newly bereaved family a fat check upon the sudden death of their daughter might seem crass, and discourage the relatives from donating the girl’s liver because it is the “right” thing to do.

Many countries have also put in place “opt-out” organ donation systems, known as “presumed consent” systems.

Under such policies, citizens are considered organ donors upon their death unless they have explicitly stated otherwise (as opposed to an “opt-in” system, where people are organ donors only if they explicitly sign up to do so, as is the case in the United States). The purpose of switching this “default” organ donor status is to expand the pool of organ donors, and to help change social norms about the appropriateness of organ donation.

Spain, which has very high organ donation rates, is perhaps the best-known example.

Proposals to change the organ procurement systems in the United States and Great Britain to “presumed consent” have frequently provoked ethical objections. Critics worry that such a system would effectively coerce people into donating organs, even over the wishes of the next of kin.

Ethics aside, it’s also not clear that such programs actually produce more donations.

Sweden, which has an “opt-out” system, has a relatively low rate of donation in comparison with other developed countries, and the United States has one of the highest rates.

Perhaps this is because — as Kieran Healy, a sociologist at Duke University has found — “opt-out” and “opt-in” systems are really not that different in practice. In both, doctors still typically defer to the wishes of the deceased’s family, whatever the official donor status of the deceased.

In a 2006 article in the DePaul Law Review, Professor Healy argued that presumed consent laws didn’t seem to be the key to improving cadaveric organ donation rates. Rather, infrastructure investments did.

Countries that experienced the biggest donation increases in recent years, like Spain and Italy, were those that hired more transplant coordinators, started public awareness campaigns, installed 24-hour organ retrieval teams at hospitals and improved training for doctors who talk to grieving families.

He concludes:

Arguments about altruism versus self-interest and disputes over presumed and informed consent together constitute a good portion of the public discussion about organ donation. Yet neither debate helps us explain why some countries have many more organ donors than others. As best we can tell, countries with high procurement rates do not owe their success to any distinctive legal conception of consent, nor to any special way of institutionalizing exchange in human goods. Rather, more fine-grained organizational differences– specifically in logistics and process management — are responsible for their success.

As mentioned above, Israel’s new strategy for incentivizing organ donation is as yet untried. Presumably the success of such a program depends on how vulnerable people feel they may be to organ failure themselves, and my hunch would be that most people underestimate the likelihood of such rare catastrophes.