voluntary reciprocal altruism for transplanted organs

There are shortages almost everywhere of organs for transplantation. Too many people die waiting for an organ donation. This tragedy could be alleviated with a simple and feasible policy: voluntary reciprocal altruism. Five Canadian researchers explain how the system might work.

In Canada, as in many other jurisdictions, the demand for transplantable organs far exceeds supply. ….

Overall, Canadians are five to six times more likely to need an organ transplant than to become a deceased organ donor. …. The consent regime in Canada remains an opt-in system focused on the theme of gift giving. This … system is based on the principle … [that] access to the transplant waiting list … is a right without any responsibility to contribute to the supply of transplantable organs. ….

[One strategy] … to increase deceased organ donation … [is] voluntary reciprocal altruism. With this approach, individuals who agree to donate their organs upon death are promised priority on the waiting list should they require a transplant in the future. The basis of this approach is that if their self-interest is engaged, a prospective donor is more likely to overcome the natural reluctance to donate their organs.

S. D. Shemie, L. Hornby, J. Chandler, P. Nickerson, and J. Burkell, “Lifetime Probabilities of Needing an Organ Transplant Versus Donating an Organ After Death“, American Journal of Transplantation 11:10 (October 2011), pp. 2085–2092.

The paper is not gated, so can be accessed at the link above, or directly from the publisher.

HT Christopher Willmore

Despite its promise, there are few examples of voluntary reciprocal altruism; at least the authors cite very few.

Opt-in and opt-out systems are both voluntary so voluntary reciprocal altruism could describe either. I would emphasize, more than the authors do, the usefulness of moving from opt-in (express consent) to opt-out (presumed consent) along with a move to reciprocity. Singapore’s voluntary reciprocal altruism system works with presumed consent since, according to Shemie et al (p. 2088), “those individuals who opt out of the system are assigned a lower priority on the transplant waiting list should they ever need an organ”.

Canada has an opt-in system for organ donation, which might explain in part the reason it has one of the lowest donation rates among high-income countries, even though Canadians express high support for organ donation. Many just don’t get around to opting in, or even know how to do it. In British Columbia, where I live, it is necessary to opt-in online. In the past, it was possible to sign your driver’s license or provincial health insurance card. The opt-in method now varies from province to province in Canada.

I have given my consent for organ donation in British Columbia, even though it earns me no points should I need a transplant. Who knows, perhaps if I earned a preference for access to donated organs, I may have been more eager to place my name on the donor list. That is the reasoning, at least, that underpins the strategy of voluntary reciprocal altruism

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