28.3.17

OVERCOMING REPUGNANCE.

Harvard's Alvin Roth, who has given a lot of thought to allocating resources by methods other than price, uses the term "repugnant markets" to describe situations in which allocation by price makes people squeamish.  Market allocation of organs for transplantation is one such situation.

And yet, organs for transplantation are scarce resources that have competing uses, and as such, present a rationing problem.  In the absence of price incentives to donate, the supply is likely smaller, and recipients, who do not get to bid for their transplants, have to provide some other case for their worthiness.

That works against people dealing with various disabilities.
Transplant decisions can be hard. How long should a drinker be in recovery before he is eligible to receive a new liver to replace the old one destroyed by alcohol? Should a homeless person with no safe place to keep his anti-rejection medications receive a kidney?

Doctors feel the tug of “lifeboat ethics”: With only so many organs to go around, some must die so others may live. Still, we rarely deny stents to patients with coronary-artery blockage even if their diets are poor and they do not exercise. That’s because stents are not rationed. But with organs, the bar is high: Wise stewardship dictates that scarce resources go to those who can maximize the health benefits.

It doesn’t have to be this way. To reduce or even possibly eliminate the organ shortage, we should reward people who are willing to give an organ to save a life.
"Altruism is not enough," note authors Sally Satel (herself a two-time transplant patient, once with a little help from Virginia Postrel) and Kurt Schuler.

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