Sally Satel on Incentives, Altruism, and Kidney Transplants

Michael Giberson

Sally Satel writes on “Supply, Demand, and Kidney Transplants” in Policy Review:

Under the 1984 National Organ Transplant Act, anyone who offers or receives something of material value in exchange for an organ can be charged with a felony. The ban ’s rationale was twofold: to prevent lurid scenarios in which desperately poor people auctioned off their spare parts to the wealthy and to ensure that citizens had equal access to the organs collected. “The prisoner in California gets the heart transplant because he needs it and is first on the list. It ’s blind to whether you’re a saint or a sinner or a celebrity. That’s key to maintaining the public trust,” said Mark Fox, former head of the [United Network for Organ Sharing] ethics committee.

But the trust is already damaged because of the death toll over which UNOS presides. The equity that UNOS seeks to preserve is “degenerating into an equal opportunity to die waiting,” nephrologist Benjamin Hippen told the President’s Council on Bioethics last year. The dire shortage of organs today is striking evidence of the fact that altruism is not sufficient to produce enough organs.