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.
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