Incentivizing_Donor_Registration_SSIR

(Cartoon by Donald Reilly/The New Yorker Collection/www.cartoonbank.com) 

Sometimes one person’s tragedy can mean another’s salvation. If you consent to be an organ donor, your death could save someone’s life—amazing, considering that donor registration can be as simple as checking a box on a driver’s license form. Yet only about 40 percent of US adults choose to register, limiting the potential pool of life-saving organs.

Economists Judd Kessler of the Wharton School at the University of Pennsylvania and Alvin Roth of Stanford University decided to test the effect of a policy intended to boost the rate of people willing to donate. In March 2008, Israel’s parliament passed legislation that grants organ allocation priority to people who have previously signed a donor card or have consented to organ donation from a deceased next of kin. Israel has had the lowest donation rate among Western countries, and the law was an effort to remedy that.

Roth shared the 2012 Nobel Memorial Prize in Economic Sciences for his work on designing matching markets—systems that come into play when pairing students with schools of their choice, medical residents with hospitals, and kidney donors with patients. He and Kessler conducted a series of controlled experiments to find out whether granting people priority for organ allocation affected their willingness to become organ donors in the first place.

The experiment asked participants to play a game that simulated organ donation. The players possessed “units,” representing a heart or kidneys, needed to stay healthy and alive. They could decide to donate their units to other players, and other players could decide to donate units to them. The players also had small amounts of cash that they paid to represent the cost of donating. In reality, US law prohibits compensation for organ donors, but experiments such as these can help researchers measure how much people are willing to sacrifice to get a certain benefit.

Under the normal rules of the game, people do decide to donate, “but not everyone, by any means, donates, so there’s a shortage of units in our experiment,” Roth says. But after the rules were changed to grant players priority in receiving a unit if they agreed to be donors, the rate of donation more than doubled.

Dr. Jacob Lavee, head of the heart transplant unit at Chaim Sheba Medical Center at Tel Hashomer, was the motivating force behind Israel’s new policy. “I wish I had had these reassuring lab results available to me when I first suggested the prioritization plan in Israel six years ago,” he says. His colleagues were skeptical at first that such a policy would make a difference. But now, Israel has seen a marked increase in the consent rate for donation and the number of organ transplants from deceased donors. The total number of people waiting for a transplant also has dropped, for the first time in a decade.

Roth is cautious about interpreting abstract experiments in the larger context. “But in our experiment, we see the big effect, and it looks like it’s largely due to the direct benefit you get back rather than to social solidarity issues, which in some contexts could be a big deal,” he says. Roth and Kessler will be working with Lavee and his colleagues to analyze the real-life Israeli data as they continue to come in.

Judd B. Kessler and Alvin B. Roth, “Organ Allocation Policy and the Decision to Donate,” American Economic Review, 102, 2012.

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