Limits to Altruism: Organ Supply and Educational expenditures

The plural of anecdote is data. --George Stigler I. INTRODUCTION As most people are now aware, there is a severe and growing shortage in this country of cadaveric human organs available for transplantation. Currently, the list of patients waiting for a suitable donor organ to become available stands at almost 85,000. (1) Less than half of these people are expected to live long enough to receive the needed organs because expected waiting times are now beginning to stretch into years. At least 16 lives are lost each day (more than 6000 a year) as a direct consequence of this shortage. To economists, the underlying cause of the organ shortage is patently obvious. Specifically, the National Organ Transplant Act (NOTA) of 1984 proscribes any payment to organ donors or their surviving family members to encourage increased collection rates. (2) Under this law, the legal price of organs is set at zero. It is hardly surprising that shortages have persisted year after year, despite ongoing efforts to increase supply through expanded public and professional educational campaigns. (3) Noneconomists, however--particularly those in the medical and transplant communities--have traditionally opposed proposals to lift the ban on donor payments for cadaveric organs and allow market forces to resolve the shortage. (4) That opposition has typically relied on two separate lines of argument. (5) First, various alleged ethical concerns about allowing money to influence surviving family members' decision to donate have been expressed (see Kaserman and Barnett 2002, chap. 4). These concerns, however, have recently been analyzed and resoundingly rejected in the published literature on this subject. (6) As a consequence, these ethical arguments are now beginning to wane. (7) Second, some defenders of the current (so-called altruistic) organ procurement policy argue that positive prices are not required to solve the shortage. Rather, they insist that increased spending on education is capable of significantly shifting organ supply curves to the right, thereby eliminating (or at least ameliorating) the shortage. (8) Such education consists of public advertisements to increase organ donation awareness among the general population (public education) and training programs for doctors and hospital staff to improve both the identification of potential donors and the way donation requests are presented to surviving families (professional education). Proponents of increased educational efforts are arguing in effect that the quantity intercept of the cadaveric organ supply curve can be increased significantly through such efforts. (9) To support this claim, largely anecdotal evidence is typically offered. (10) To the authors' knowledge, however, no empirical study of the impact of educational spending on cadaveric organ collection rates has been done. The purpose of this article is to conduct such a study to assess the merits of the education proponents' claims. The article is organized as follows. Section II provides a brief background on this subject by describing the structure of the organ procurement industry as it exists under the provisions of NOTA. The authors also describe how the process of cadaveric organ procurement operates and the role of educational expenditures in that process. Section III then presents an empirical model of cadaveric organ collection rates across the various organ procurement organizations (OPOs) and describes the data used to estimate that model. Next, section IV presents the estimation results. Section V concludes. II. THE STRUCTURE AND OPERATION OF THE ORGAN PROCUREMENT INDUSTRY The 1984 NOTA and related federal and state legislation largely dictate the structure and operation of the U.S. organ procurement system. (11) Under that legislation, OPOs carry out the principal task of acquiring cadaveric organs from recently deceased individuals. Once these organs are acquired, they then enter the allocation system administered by UNOS for distribution to patients who are on waiting lists at transplant centers. …