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May 31, 2006

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TJ

Prof. Epstein,

You are right, of course, that broadening the list of non-price factors on which donees can compete will increase supply (broadening the list to include money may even make them balance). Economists and libertarians tend to care very little about distributive effects that occur in the process. But here is the extreme example that makes this disregard troubling as a practical matter:

Donor is a committed organ donor who is also a white supremicist. In the enforced, anonymous donee system, donor would donate to the next-in-line without knowing the race of the donee, since the probabilities strongly favor the donee being white. Allowing donor to choose, of course, donor would choose a white donee with 100% certainty. If there are enough white supremicists in the population, the line for blacks becomes much longer.

The Law Fairy

Do you have data on how many strangers volunteer to donate organs to specific persons? I'm inclined to think that it cannot be high enough that this is a Serious Issue. On the one hand, it's obviously correct that if I want to donate my kidney to a dying mother of four, I ought to have the right to do that even if I'm not family or a close friend (I'm also interested in how they determine who is a close enough "friend" such that non-close friends -- or recent strangers -- are forbidden from donating). But I think it's a valid and legitimate worry that this system of donations could be abused. What incentive does a stranger have for donating a kidney? I think you'll agree, Professor Epstein, that in general people act in their own self-interest. The vast majority of people, I would venture, derive no benefit from donating a kidney to a stranger. Thus, they will only "donate" if they are paid. Thus, making it harder to select persons to whom to donate chills the incentive to pay someone for a kidney, as it only moves the payer up one slot on the waiting list.

You note that the prohibition on purchasing organs is "indefensible." Do you mean to make the argument that people ought to be free to buy and sell organs on the market? I'd be interested to hear how any less "indefensible" this position is.

priscieve

Re blacks forming a longer line, if other blacks saw this happening they would start donating more &/or the price blacks would have to pay would go up creating more incentives for whites to donate to blacks thus driving the price right back down.

Tim Lee

TJ: If the white supremacist knows he might be forced to give his organ to a black person, isn't he more likely to simply refuse to donate an organ at all? Black people benefit from having white people in front of them removed from the queue. As long as at least some donors still give to the front of the queue, the white supremacist is benefiting black and white alike.

TJ

At the risk of hijacking this discussion, allow me to respond briefly:

Yes, enforced color non-discrimination may lead to less overall supply (white supremicists are less likely to donate than if they got to choose), but that is precisely my point: Enforced non-discrimination on any basis leads to less overall supply since you are restricting freedom of choice (and thus people's utility), but, sometimes, we might not like the allocative effects of those choices.

Money and race (or, for that matter, any other characteristic) are not that different in this discussion: X prefers to donate to whites because X is a white supremicist. Y prefers to donate to rich guy because rich guy will pay him money. Both X and Y may have donated anyway under a pure-charity anonymous donee regime, but they might not have.

Admittedly, our present enforced queue makes the only "permitted" discriminating characteristic, by default, the length of sickness. As Professor Epstein points out, that characteristic makes little sense since people may not want to donate to the sickest person, but at least no one (except a few hyperrational economists) finds that distasteful in any way. But the more freedom you allow people to choose, the more distasteful personal choices that might come into the equation.

Tim Lee

TJ: It's not clear to me that an anti-discrimination rule would help blacks at all. Rather, it would hurt them because blacks benefit when whites who are ahead of them in the line are taken out of the queue. Given that you're never going to force a white supremacist donor to give to a black person, isn't allowing him to give it to a white person better (for blacks as well as whites) than not allowing the donation at all?

David J. Undis

The generosity of live organ donors like is remarkable. But we wouldn't need many live organ donors if Americans weren't burying or cremating 20,000 transplantable organs every year.

There is a better solution to the organ shortage -- if you don't agree to donate your organs when you die, then you go to the back of the waiting list if you ever need an organ to live.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. About 60% of the organs transplanted in the United States go to people who haven't agreed to donate their own organs when they die.

Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. They do this through a form of directed donation that is legal in all 50 states and under federal law. Anyone can join for free at www.lifesharers.org or by calling 1-888-ORGAN88. LifeSharers has 4,497 members, including over 400 ominor children enrolled by their parents.

Virginia Postrel

In some cases, directed donations might involve racial discrimination, but DePaul law professor Michele Goodwin's research in Black Markets: The Supply ahd Demand of Body Parts suggests that, far from encouraging white supremacy, allowing discrimination would likely increase the donation of organs from blacks to blacks. Although African Americans are about as likely to donate organs as other groups, they make up a hugely disproportionate number of the people who need kidneys, and there is both anecdotal and survey evidence that many black Americans would be more likely to donate organs if they thought they would be used to save other black people. That racial identification may not be admirable, but if you want to save lives and relieve suffering you might want to allow it. It is pretty disingenuous to keep bringing up the KKK--hardly a major threat--when the reality is that black Americans are needlessly dying by the thousands under the current system.

Two Comments

Not to be inflammatory, but it is possible that black recipients might want kidneys that are given to them by a nondiscriminatory selection process, i.e., having a "black-power kidney" might make a black recipient feel as though he is alive because a nonblack person is dead. No one wants a "racial-guilt kidney".

I wonder why white supremacists are presumed to possess murderous intent. A white supremacist might, out of condescension, choose to have his "genetically superior" kidney go to a black person for the purpose of creating racial debt.

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