A grave problem of supply and demand

Grave sites, once sold and occupied, are intended to be occupied for a very long time, and their sale can't easily be negotiated if more valuable uses turn up. So there is less turnouver than in other kinds of real estate, with predictable consequences, as this Globe article attests: Supply limited, demand eternal, graveyards fill up.


"Provincetown’s shortage, while unusually acute, underscores a broad and burgeoning problem in the crowded Northeast. With land expensive and limited acreage available in large swaths of Eastern Massachusetts, budget-crunched communities are struggling to buy sites for new burial grounds as their existing cemeteries fill up."
...
"In Provincetown, many who have reserved burial plots are relative newcomers to the town, and in response, town officials this week passed a rule restricting burial plots to those who have maintained a principal residence for at least two years. Still, that was a short sojourn, some said, for a chance to spend eternity in a slice of heaven.
Said Lemme, the cemetery supervisor: “We might have to make that a little stricter.’’ "

Does a decrease in the number of traffic fatalities increase live kidney donation?

Over at Economic Logic, the Economic Logician reviews an article, The Effect of Traffic Safety Laws and Obesity Rates on Living Organ Donations by Jose Fernandez and Lisa Stohr. It finds that a decrease in availability of deceased donor organs (through an increase in helmet and seatbelt laws) elicits some increase in live donor kidney donation.

Here's the abstract, followed by EL's summary.

Abstract: This paper uses variation in traffic safety laws and obesity rates to identify substitution patterns between living and cadaveric kidney donors. Using panel data from 1988-2008, we find that a 1% decrease in the supply of cadaveric donors per 100,000 increases the supply of living donors per 100,000 by .7%. With respect to traffic safety laws, a national adoption of partial helmet laws is estimated to decrease cadaveric donors by 6%, but leads to a 4.2% increase in the number of living donors, or a net effect of 1.8% decrease in the supply of kidney donations. The recent rise in obesity rates is estimated to increase living donor rates by roughly 18%. Lastly, we find evidence that increases in disposable income per capita is associated with an increase in the number of non-biological living donors within a state, but is not found to have an effect on biological donor rates.

And here is EL's summary:

"There are times where you really wonder why authors would even think that some variables could be correlated and how they then come up with a story that can explain this statistical relationship coming from seemingly nowhere. The paper by Jose Fernandez and Lisa Stohr is one of these.To quote their abstract, "this paper uses variation in traffic safety laws and obesity rates to identify substitution patterns between living and cadaveric kidney donors." Despite reading this sentence ten times, I could not make any theoretical sense of it. But reading through the paper, a good story can be made. Tightening traffic safety laws reduces the number of fatalities, and thus the number of cadaveric organ donors. An increase in obesity increases the demand for organs, in particular kidneys. Thus one can instrument for supply and demand using these measures. With this in mond, one can then study how variations in the supply of supply of cadaveric organs (which are of poor value) and demand can motivate living donors to come forward, as they trade off the usefulness of their donation with the personal harm it will inflict upon them. Fernandez and Stohr fiand that donors respond indeed to cadaveric supply and to the increase in demand due to obesity."

Cadavers for dissection by medical students

I've written before about how the purchase of cadavers (even) by medical schools for anatomy classes was for many years a repugnant and largely an illegal transaction in Europe and the U.S., but no longer. A recent review of a book of photographs of medical students posed with cadavers reveals something about the changing cultural attitudes that have accompanied this shift. Shifts of these kinds are potentially interesting to economists because of what they might tell us about changes in which transactions are regarded as repugnant more generally.

Recent news stories have covered the practice in Asia of having students treat the cadavers as honored teachers, sometimes at ceremonies attended by the families of the deceased: Taiwanese Med Students Honor Cadaver Donors.
"A Taiwanese medical school is responding to the island nation’s shortage of cadavers for study by bringing the family of the deceased fully into the program, the Wall Street Journal reports. At Tzu Chi University, medical students meet with donors' families and even compose poems to their “silent mentors” to express their gratitude. And before they wield their scalpels, they participate in a farewell ceremony."

It turns out such ceremonies have a reasonably long history. From the English language abstract of an article in a Chinese medical journal, Anatomy cadaver ceremonies in Taiwan:
"The practice of holding annual ceremonies in honor of cadaver donors in Taiwan's medical schools has a history of nearly a hundred years. It originated in Japan, where such ceremonies have been widely held in medical schools since the practice was founded by Toyo Yamawaki, who was the first medical scholar in Japan to engage in dissection of the human body and was the author of the first anatomy book to appear in Japan, the Zoshi. The practice of holding donor ceremonies was introduced into Taiwan after the Jaiwu Sino - Japanese war, when the island became a Japanese colony. The tradition was upheld in the Viceroy's Medical School, the Viceroy's College of Medicine, and Taihoku (Taipei) Imperial University College of Medicine, and continued since the restoration of Chinese power to the present. The practice of holding cadaver donor ceremonies in institutions of medical education is intended to express respect for the donor as well as to encourage the practice of cadaver donation to the benefit of medical education."

But going further back in time, it sounds as if the Asian experience may have been quite similar to the European history regarding cadavers. Here is the English abstract of an article published in Japanese on the History of collecting cadavers in Japan
"This study investigated how and from where medical students had acquired cadavers for research throughout Japanese history. At the beginning of dissection in the mid Edo era, they cut up executed prisoners granted by the Tokugawa Shyogunate to study internal body parts. After the Meiji Restoration, the social mechanism of delivering cadavers underwent a complete transformation and they began to utilize 1) dead bodies of inpatients who had received free medical treatment and 2) unclaimed bodies mainly from homes for the aged and prisons. It was quite recently that "kentai", voluntary body donation, became common practice of collecting cadavers. Consequently the history of cadavers submitted to dissection faithfully reflects the relation between medical science and society."

I can't help being reminded of the current cautious attempts in the U.S. to encourage organ donation for transplantation, about which I blogged yesterday: Tax credits for organ donors, and medals.

Markets for (viewing) bodies

Among the oldest repugnant transactions are those that involve dealing with the dead. In the early 1800's, British medical schools illegally purchased cadavers for anatomy classes from grave robbers called "resurrection men," because the only cadavers legally available for dissection were the bodies of executed murderers. (The Harvard Medical School is in Boston rather than Cambridge, I understand, because of an arrangement offered by the city of Boston to supply unclaimed cadavers.) But those constraints have been relaxed over time, and in my 2007 paper Repugnance as a Constraint on Markets, I used as an example the "Bodyworlds" museum shows that tour the world, allowing museum goers to see cadavers (posed as if engaged in lifetime activities) in detail previously available only to medical students (and here is an essay on the value of that experience to medical students: Dead Body of Knowledge).

But while the laws governing the trade in corpses have been relaxed, there remain considerable feelings of repugnance about desecrating corpses, and these museum shows have also aroused opposition. The latest news is that such a show is planned as a travelling exhibit in Israel. Judaism has strong norms about respect for the dead, and it seems likely that there will be considerable controversy: Controversial 'Body Worlds' exhibit based on preserved human bodies scheduled to arrive in Israel next month. Various religious body gearing up for battle against show, arguing it violates the dignity of the dead .

(Meanwhile, elsewhere in the Middle East, the tensions between secular and religious, ancient and modern, is of a very different sort:
Hardline Saudi Clerics Urge TV Ban on Women, Music.
" ''No Saudi women should appear on TV, no matter what the reason,'' the statement said. ''No images of women should appear in Saudi newspapers and magazines.'' ")

British organ donation: opt in versus opt out

The Telegraph reports that A report into organ donation ordered by Gordon Brown will not recommend a system of presumed consent.

"The group ordered to look into the system as a possible solution to a shortage of donors is due to report at the start of next week. It will recommend that ministers work to increase the number of donors but is expected to favour a situation where donors still register to donate organs after their death.
The group is understood to have come under pressure from Muslim organisations to keep the opt-in system.
But senior government figures, including the Prime Minister and Liam Donaldson, the Chief Medical Officer, are understood to believe that presumed consent is the only way to solve the problem. "

The London Times also covers the story, with a different emphasis: Brown’s organ donor plan is rejected by scientists

"Mr Brown has argued previously that presumed consent, already used in Spain and other countries, could help to “close the aching gap between the potential benefits of transplant surgery in the UK and the limits imposed by our current system of consent”. ...
But the taskforce, an expert working group of healthcare professionals, lawyers and ethicists set up to look at ways to increase the number of organ donations, is understood to believe that an opt-out system would do little to boost the number of life-saving transplants. It is expected to say such a move would create practical problems for the NHS and risk a potential backlash among the public.
Last night a senior Whitehall source told The Times: “It’s fair to say this report is not helpful to the case for a change in the law to presumed consent.” "

Thaler and Sunstein will be disappointed too.

Update: Thaler emails me as follows
"Thaler and Sunstein will NOT be disappointed. We favor mandated choice for two reasons. First, presumed consent raises hackles. Second, it leads to more overrides by family since the donor's intentions may be only implicit.
Illinois has adopted this with zero fanfare. When you renew your license they just ask you "donor or not donor". Perfect."