Tuesday, December 23, 2008

Lifesharers: organ donation as a club good rather than a public good

My earlier post today drew a comment from the executive director of an organization, LifeSharers, with an interesting approach to promoting deceased organ donation. In economist-speak, they want to increase organ donation by changing it from a public good to a club good.

Deceased organ donation is a public good in the sense that everyone is better off in expectation if everyone else is willing to donate their organs when they die, but no one receives any direct benefit from donating his organs after death (and there must be perceived costs to donation, since not everyone is a donor).

Economists often worry about how to provide public goods (which is one reason for the invention of taxes: the fellow who mows the lawn in a public park is likely a city employee, but there's no problem in getting people to maintain their own, private lawns...)

In between public and private goods are "club goods," like a park or country club that is funded by members, and is only open to members and their guests. The idea of LifeSharers is that organ donation can be a club good: members indicate that they are willing to donate their organs, giving first preference to other members.

The LifeSharers site has references to some of the many articles that discuss this or similar ideas favorably in the context of organ donation. (I can't put my finger offhand on an unfavorable reference, but I recall seeing some arguments in the medical ethics literature that question whether you should always be happy giving preference to a club member in favor of a non club member, when there might also be many other features that distinguish them...)

As a practical matter, there are obviously obstacles to making a voluntary club good out of a public good that only benefits a member with very low probability. The LifeSharers FAQ includes the following:
Q. How many LifeSharers members have died and donated organs?
A. We have not yet had a member die in circumstances that would have permitted recovery of his or her organs.

Whatever your views on the market design issues, the holidays are a good time (when families are gathered) to let yours know that you would like to be an organ donor, so that they will be able to act on your wishes if it comes to that.


Unknown said...

It's true that there's a low probability that the average person will benefit from joining LifeSharers. On the other hand, it costs nothing to join (other than your promise to donate your organs after you're dead and can't use them any more). Also, the average person is much more likely to need an organ transplant than to be an organ donor.

LifeSharers currently has just under 12,000 members, meaning that anyone joining will get preferred access to the organs of almost 12,000 people. At our current membership level, there is about a 45% chance that one or more LIfeSharers members will die and become organ donors in the next 12 months.

More than half of the people on the national transplant waiting list will die before they get a transplant. So the opportunity to increase your chances, even by just a little bit, could literally mean the difference between life and death.

Membership in LifeSharers is free at www.lifesharers.org.

Anonymous said...


I'm a member of LifeSharers because I told Dave that I would join - it's just a good idea. And good ideas just aren't that easy to create out of nothing.

Donate-For-Life Organ Donor Program is also a good idea because it is the SOLUTION to the severe shortage of organ donations in America. Our SOLUTION has been thoroughly vetted by a well-known Fortune 100 insurance corporation; they put it through two actuarial science analyses, and it passed with flying colors.

Our SOLUTION is about encouragement-based incentives; potential donors are given redeemable credit. It is a win-win-win scenario with no downside. It saves the taxpayers at least $4,657,860,000 during the first year of startup/operation, and each year thereafter. It'll virtually empty the UNOS waiting-to-die list within 48-months. Transplant operations are free, including first-year follow-up. A life saved is not an optimized success story when they become a candidate for the poor house. The black market in organ sales and operations is brought to an absolute end - worldwide. The blood banks are filled to capacity. The health of participants is markedly improved. And there's so much more!

Congress is considering easing up on the incentives specification by allowing the states to try different approaches to the shortage dilemma. The National Kidney Foundation may change their long-held no incentives policy at the next board meeting. Dr. Satel of AEI is collaborating on a book dealing with possible solutions - due out next month. All of this is almost like being a day late and a dollar short for the people who are dying every day; 7,200 every year or 20 per day!

The SOLUTION is here now and it is workable as soon as it achieves startup. In the meantime money is pouring down the drain and individuals are dying.

There's hope with Senator Daschle being appointed as Secretary of Health and Human Services under the Obama-Biden Administration. I've written to him about Donate-For-Life Organ Donor Program.

Website: http://www.donate-for-life.com/

OneEyedMan said...

I thought a public good was one in which there was both non-rivalry and non-excludability of consumption.

Surely an organ donated to one person cannot be donated to another, and the expensive costs of transplantation make it easy to exclude others.

The language of public goods seems completely wrong here.