Comment on 'The Shortage in Market-Inalienable Human Organs' Faulty Analysis of a Failed Policy

DAVID L. KASERMAN [*] ABSTRACT. In the 1998 article "The Shortage in Market-Inalienable Human Organs: A Consideration of 'Nonmarket' Failures" in this journal, Emanuel D. Thorne advocates increased exhortation and advises against the adoption of markets in cadaveric organ procurement. In support of this view, Thorne offers analysis in which he purports to show that, with more effective exhortation, a donative system is capable of procuring more organs at lower costs than market procurement. We argue that Thorne's analysis is seriously flawed and that his conclusions are suspect, if not entirely illogical. The flaws in his analysis include both logical errors and empirical fallacies. Importantly, the issues we, and Professor Thorne, address are not mere matters of academic quibbling--human lives are at stake. Simply put, we argue that Thorne uses faulty analysis to support a policy that is so ill-conceived that it needlessly allows people to die. In this comment, we discuss some of the errors in Thorne's article and explain why we believe that his policy recommendation is ill-conceived. I Introduction IN A RECENT ISSUE of this journal, Emanual Thorne (1998) presents a discussion of several economic issues surrounding the ongoing debate concerning how best to reform the U.S. cadaveric organ procurement system. As is well known, that system consistently yields a shortage of organs, resulting in ever-increasing waiting lists and a growing number of deaths as patients who require transplants are unable to obtain the needed organs in time. Importantly, the current system proscribes payment to organ donors (generally, the families of recently deceased accident victims), relying instead upon altruistic motives to call forth the requisite supply. In his discussion, Thorne argues that we should eschew proposals that call for the formation of organ markets to resolve the shortage. Instead, he proposes a modification of the current donative system in which potential organ suppliers are exhorted--in other words, coaxed or cajoled--into agreeing to forfeit the organs of the deceased without receiving any financial or other compensation. Incredibly, he argues that such a system, modified along the lines he proposes, could yield a greater supply of organs at a lower cost than a market-based system of procurement in which positive prices are allowed along with exhortation. The analysis presented by Thorne to support this claim, however, is seriously flawed in a number of important respects. As a result, there is simply no reliable support provided for his basic policy recommendations. His arguments contain numerous errors of both a theoretical and a policy nature. In the sections that follow, we shall address each of these sets of errors. II Criticisms of Thorne's Theoretical Arguments THE FIRST PROBLEM ONE ENCOUNTERS in attempting to evaluate the merits of Thorne's proposal is trying to discern exactly what the theoretical arguments are. His presentation is extremely vague and the underlying theoretical bases for his conclusions are unclear. Nonetheless, we have attempted to unravel the logic of the various theoretical propositions, being as generous as possible in our interpretations. In addition, while there are numerous points on which we disagree with Thorne's analysis, we will focus our attention here on only two of the most egregious and pivotal errors contained therein. Donation and the Quantity Supplied Thorne acknowledges that the current procurement system produces a shortage. He argues, however, that it is "under-exhortation" that leads to the organ shortage, not some inherent problem with express donation. The solution for Thome is simple. Increase the efficiency and/or level of exhortation expenditures and an adequate number of organs will be donated. Indeed, he asserts that exhortation is potentially so powerful that it could yield more organs than a market. …