Supply and demand

May 31, 1999|By Ellen Goodman

BOSTON -- It would be nice to think of this as a simple problem of supply and demand. A test case for Economics 101. A problem for the marketplace.

Over here we have 66,000 potential customers on a waiting list. Over there we have 5,500 products. How do you satisfy all these customers? Where's the supply to meet the demand?

But we aren't talking about a shortage of Star Wars tickets or Beanie Babies. We are talking about a shortage of human organs. We are talking about people who die waiting for a liver or a heart or a lung. We are talking about thousands who might have left behind a legacy of life.

Until now, we've kept economics out of this group portrait. Although there are reports of kidneys for sale in poor countries, Americans don't put organs on the free market. We not only have a taboo against buying organs, we have a law against it.

Now the state of Pennsylvania is going to try a new experiment -- or perhaps an end run-- around this taboo. The details will be announced soon by an advisory board. But the outline is already clear. The state is beginning a three-year program to pay $300 to help donors' families pay for funeral costs.

State officials insist they are not in the organ-buying business. The money is low, the check goes to the funeral parlor. They prefer to think of this as a reward, a societal thank you note for the gift.

But they also hope that the program will provide an incentive. This is a test -- just a test -- to see whether a financial incentive of a few hundred dollars will increase the number of organ donors.

In short, Pennsylvania is trying to find an ethical line between reward and compensation, between a thank-you note and a paycheck. They are creating that ethical oxymoron, a paid gift.

I understand the motive behind this, even the desperation. Some weeks ago, after writing about the organ legacy of my cousin Keren, I heard from dozens of grateful and needy families. There's been a long and frustrating attempt to increase the number of folks who check off the donor box on their driver's license, and the number of families who give permission at moments of enormous grief.

In Pennsylvania, a center of transplant surgery, there are personal stories that reinforce the thinking behind this $300 difference. And stories that raise doubts.

Consider the death of John White, a 20-year-old whose organs helped a dozen others but whose family was left to pay for a funeral. Surely they deserve the $300.

Consider, on the other hand, the parents of 2-year-old donor Max Kaner: "When we decided to donate it was purely altruistic."

Is one person's reward another person's insult? Is money an incentive or a turnoff?

This is not the first discussion of economics and donors. Some economists have talked of a futures market in organs. Others have suggested that we offer a tax write-off like the one for charity to those who sign on as a donor.

But unease and suspicion already shadow the feelings of some families faced with this choice. A $300 reward inevitably would mean more to poorer families. Does that start us on the business plan that has already made a flourishing market for "donor" eggs?

What happens if the Pennsylvania experiment begins a bidding war. Pennsylvania offers $300 for a funeral. Do I hear another bid? New York offers $600? California offers $1,200? SOLD!

This experiment will be conducted under the eyes of an ethics panel. But when all is said and done, it is by no means clear how it can measure success.

Joseph Moreno, an ethicist at the University of Virginia, says this offers a paradox, "If they do increase the supply of organs one would infer that families were price sensitive. I'm not sure that's a good thing.

"If, on the other hand it doesn't increase the organ procurement rate, well, then families aren't price sensitive, but we also haven't gotten any more organs."

Society should offer collective gratitude to donors and families. But there is something unseemly and ultimately destructive in this $300 solution. In the end it undermines the value that encourages donation, a value that says there is something money can't buy: altruism.

Ellen Goodman is a syndicated columnist.

Pub Date: 5/31/99

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