I promised to talk a bit more about the Organs & Inducements symposium that I mentioned earlier. I’ll refrain from giving much detail about individual papers at this point, as many of the authors will be substantially revising their papers over the summer and I don’t want to misrepresent them. But I will give some detail about how the conference came into being, about how Phil Cook and I conceived of the conference theme, and how we settled on the concept of “inducements.” And I’ll be back later to talk more about specific papers as the authors have a chance to revise and submit their papers to Law & Contemporary Problems for publication.
Phil and I began talking a year or two ago about our overlapping interests – mine in what I frequently refer to as “taboo trades,” and his in what might be referred to as the economics of “vice.” For example, Phil has written extensively on issues of gun control (Gun Violence: The Real Costs, Oxford University Press, 2000), state lotteries (Selling Hope: State Lotteries in America, Harvard University Press, 1989), and alcohol (Paying the Tab: The Costs and Benefits of Alcohol Control, Princeton University Press, 2007).
Anyway, Phil and I began discussing the many recent advances in organ donation, none of which have managed to eliminate the waiting list. We wanted to convene a discussion designed to tackle what we thought of as “next steps” in the long-running debate about methods to increase the supply of transplantable organs. We purposely employed the term “inducements,” rather than “incentives,” believing that the term “incentives” had become too closely tied with organ markets in the traditional sense – compensation for organs with money, vouchers, or some close cousin.
In contrast, we viewed the phrase “inducement” as potentially signifying something much broader and more inclusive. According to Merriam Webster, an inducement is simply “a motive or consideration that leads one to action.” And, as we thought about recent advances in organ donation and organ policy reform that most intrigued us, most did not involve monetary or similar compensation, but rather more subtle means to facilitate organ donation.
Thus, from our perspective, inducements could range from public awareness campaigns exhorting people to donate and informing them of the severity of the organ shortage, at one of the spectrum, to outright organ auction markets at the other end of the spectrum. But we largely expected authors to address the many interesting variations in inducement in between those two extremes, and that is exactly what our participants did. The papers covered, for example, experiments regarding changes in the framing of the donation decision; the analysis of possible changes in the consent regime – for example, opt in versus opt out; priority schemes, such as that in Israel, under which priority for an organ is given to one who has agreed to be a donor; reciprocal-exchange schemes such as swaps and NEAD chains; other barter-based systems that might expand the range of tradable items to include other types of charitable gifts; and markets tightly constrained through government oversight with prices set by regulation, rather than by supply and demand.
In other words, debates about organ policy reform have often been framed in terms of a market versus gift dichotomy, with a focus on the preservation of “altruism” -- a framing that Kieran Healy and I have previously criticized as misleading and unhelpful. As we have argued, and as the contributions of our symposium authors highlight, the real world is far more complex than this, with many shades of gray. And donors act for a variety of motives, only some of which are “altruistic” in the pure sense of that term.
We also encouraged our participants to go a step further, to address regulatory next steps. If inducements are permissible, what kind? Are all inducements created equally? Or are some more acceptable than others? And why?
Do all potential donors receive an equal inducement? Why or why not? Who is entitled to apply the inducement? Government? Private actors? Medical professionals? Transplant recipients?
In other words, in a system with at least some inducements – including our present system – what safeguards are necessary to assure us that the system is safe, fair, efficient, and egalitarian? And do we value each of those things equally or not?
Those are the questions we hoped to engage over the two-day symposium and our participants did not disappoint. Naturally, I’m biased, but I found the conversation both energizing and challenging. I think that others did too. And I’m confident that some excellent papers will emerge from this symposium.
Keynote speaker, Al Roth, discussed his work on organ donation, including recent experiments with fellow Organs and Inducements participant, Judd Kessler. You can read Al’s write-up of the event at his Market Design blog.