Out-Innovating Us on Organs: Israel… and Iran

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There’s an important piece by Alex Tabarrok in the WSJ today on tackling the organ shortage. We should be pretty embarrassed when Iran is out-innovating us in medicine and public health:

Only one country, Iran, has eliminated the shortage of transplant organs—and only Iran has a working and legal payment system for organ donation. In this system, organs are not bought and sold at the bazaar. Patients who cannot be assigned a kidney from a deceased donor and who cannot find a related living donor may apply to the nonprofit, volunteer-run Dialysis and Transplant Patients Association (Datpa). Datpa identifies potential donors from a pool of applicants. Those donors are medically evaluated by transplant physicians, who have no connection to Datpa, in just the same way as are uncompensated donors. The government pays donors $1,200 and provides one year of limited health-insurance coverage. In addition, working through Datpa, kidney recipients pay donors between $2,300 and $4,500. Charitable organizations provide remuneration to donors for recipients who cannot afford to pay, thus demonstrating that Iran has something to teach the world about charity as well as about markets.

…

Two countries, Singapore and Israel, have pioneered nonmonetary incentives systems for potential organ donors. In Singapore anyone may opt out of its presumed consent system. However, those who opt out are assigned a lower priority on the transplant waiting list should they one day need an organ, a system I have called “no give, no take.”

Many people find the idea of paying for organs repugnant but they do accept the ethical foundation of no give, no take—that those who are willing to give should be the first to receive. In addition to satisfying ethical constraints, no give, no take increases the incentive to sign one’s organ donor card thereby reducing the shortage. In the U.S., Lifesharers.org, a nonprofit network of potential organ donors (for which I am an adviser), is working to implement a similar system.

In Israel a more flexible version of no give, no take will be phased into place beginning this year. In the Israeli system, people who sign their organ donor cards are given points pushing them up the transplant list should they one day need a transplant. Points will also be given to transplant candidates whose first-degree relatives have signed their organ donor cards or whose first-degree relatives were organ donors. In the case of kidneys, for example, two points (on a 0- to 18-point scale) will be given if the candidate had three or more years previous to being listed signed their organ card. One point will be given if a first-degree relative has signed and 3.5 points if a first-degree relative has previously donated an organ.

Read the whole thing here. We’ll get to see how the Israeli system works out — but we really ought not wait around too long with people dying on waiting lists at a rate of 5,000 a year (for kidneys alone, just in the U.S.). The least we should be doing is making organ donation opt-out.

If you haven’t signed to be a donor, do it today. Or, at the very least, do it when you renew your license. Additionally, this group, LifeSharers, is a private, non-profit network where “members promise to donate upon their death, and they give fellow members first access to their organs.” The Journal previously covered LifeSharers here.

(Routine disclosure: I do some work for the Journal’s Saturday section on a freelance basis.)