Donating organs could prove a costly decision

Jamie Whyte
NEVER make yourself worth more dead than alive. This was the sage advice my father gave me as a boy and I have stuck to it ever since. That is why my life insurance pays out less if I die than the net present value of my likely future earnings. I trust my wife, but why put temptation in her way?

It also explains why I object to a new proposal from the British Medical Association (BMA). They want to shift organ donation from the current opt-in system, on which you must apply for an organ donor’s card, to an opt-out system. If they have their way, everyone will be deemed to have consented to the harvesting of their organs upon death unless they explicitly say otherwise.

Many will think this a good idea because there is no cost in donating your organs. The dead have no use for their liver, heart, kidneys or for anything else. It is only the time and hassle of applying for a donor’s card that deters people from becoming donors. So why not simply remove this cost by introducing an opt-out system?

Alas, the cost is not only in the application but in the achievement too. Because being an organ donor increases your value when dead, it increases the chance that you will die. Imagine yourself on the operating table following a car accident that has done some nasty damage to your guts but left your other organs pristine. If you die, and you are an organ donor, your heart, kidneys, liver and lungs will be available to save four lives. The doctors working on you therefore have less incentive to save you. If you are a donor, your death produces a net gain of three lives. If you are not, it delivers a net loss of one.

The suggestion that doctors would make such a calculation may seem outrageous. But it need not be official policy or said aloud by the doctors and nurses tending to your broken body for the thought to be there, in the back of their minds, affecting the fervour with which they try to save you. Even if you trust doctors, why put temptation in their way by being an organ donor?

This is not to deny that there is too little organ donation going on. If there were more, the net effect on lives saved would be positive. The question is how to remedy the currently unsatisfactory situation. And the BMA has got this wrong. The problem with the current system is not that opting-in is too bothersome but that it fails to recognise that being a donor is costly, and therefore in need of compensation.

People should be paid to become donors. The payment could be upfront. For example, I am sure many students, even students of statistical finance, would see signing up as a good deal in return for £100. Or the payment could be conditional on harvesting. You might sign a contract that, in the event of your death and donation, £5,000 will be paid to your estate.

Some will find the idea of commercialising organ donation distasteful. But, since the transaction would be entirely voluntary, it is really none of their business.

Jamie Whyte is a senior fellow of the Cobden Centre.