Give up your organs for good

Innovation and striving to create new forms of wealth outside of the typical conventions has… Innovation and striving to create new forms of wealth outside of the typical conventions has continually proven to be the mark of success in business — such creativity is what is sorely lacking in most public policy circles. Rather than focusing exclusively upon how to allocate the resources we have, we should take heart to continually delve for new arenas from which to draw resources. Whatever one may think about the moral implications of states sponsoring so-called “vices,” Pennsylvania’s implementation of slots as a means of property tax relief is an example of the sort of creative experimentation I would like to see more of.

An example of a creative means of attempting to “enlarge the pie” of resources available is at the epicenter of a heated debate about the principles of individual liberty versus need. The debate is over the practice of organ donation.

In 2002, a study found that 6,187 Americans died waiting for an organ donation. Those who do receive organ donations typically must undergo excruciatingly long waiting periods while the search for a suitable donor is underway — one study cites the average wait for a heart donation to be 205 days, 882 days for a lung and 911 days for a liver. With the scarcity of organs available, the costs conversely rise to prohibitive levels, memorably immortalized in the movie “John Q,” in which Denzel Washington’s character takes the staff in a hospital hostage after the soaring cost of a heart transplant threatens the life of his young son.

So why don’t more people volunteer to be organ donors? For some, a stigma is still prevalent that may involve religious beliefs or a fear in urban myths that doctors will not attempt to save their lives if they are in critical condition and listed as a donor. Steps like asking people during their driver’s license renewals if they wish to become a donor help increase the pool that doctors have to draw from. However, the vast majority of people are uninformed or skeptical of what being a donor is about, so they choose not to participate. The vast majority of people simply never have it occur to them how vast the shortage of organs is and have no incentive to learn more about the process and sign up. I believe the vast majority of Americans would rather have their bodies be of use to saving the lives of others after they have died rather than allow precious resources to be buried along with them.

This is why many argue that instead of an “opt in” system, the United States should adopt an “opt out” approach, also called “presumed consent.” This system is used in Spain, Belgium, France, Italy and a slew of other developed European nations. Basically, this system assumes automatically that all citizens have consented to be organ donors unless they explicitly choose to not be listed as donors by entering their name on the national registry of their country’s organ procurement organization. The results have been stunning, each country seeing their supply of suitable organs rise by the millions. The benefits have been economic as well — Spain estimates that its transplants have saved $207 million in medical fees through the increased supply available. This is a prime case of enlarging the pie to increase the social benefits for everyone.

These are obviously murky waters in the era of Schiavo and Abu Ghraib. With distrust of the government at Watergate levels, it is likely that libertarians would lead a movement to “protect our bodies and civil liberties from Washington.” This is indeed a debate of bioethics worth having — should giving to the greater good be a responsibility or a choice? This is a question that we can apply to many other levels of public life. Australia’s compulsory voting system has an increased turnout in voting, but does it result in a reduction of intelligent voting and an increase in seeing democracy as a chore? Those who argue that the government can’t tell us what to do with our organs can make similar arguments about taxes, but it’s clear that our society on the whole would be infinitely worse off if not for the resources provided by tax payers.

“Presumed consent” may sound Orwellian in what it implies, but isn’t our consent for following other laws we don’t agree with implied by our living within the United States? In an era in which civil liberties and security continue to appear to be a choice to many, it is important that we consider that being a part of society, on occasion, means sacrifice for the good of everyone. Compared to Israeli compulsory military service, I don’t think a perfectly good heart is much to ask. What do you think?

Daron’s favorite game is “Operation.” E-mail him at djc14@pitt.edu.