The shortage in market-inalienable human organs: a consideration of 'nonmarket' failures

American Journal of Economics and Sociology, The,  July, 1998  by Emanuel D. Thorne

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In short, an essential feature of market bans is that they make the good or service of interest into common property, and nonmarket efforts to exhort suppliers to donate organs are fundamentally analogous to "fishing" in a commons.

The conventional analysis of the commons shows that it is overexploited, leading to Hardin's famous "tragedy of the commons." For at least some market-inalienable goods and services, however, the overexploitation of the commons could, in theory, lead to a supply even greater than market supply. And unlike the over-fishing of the ocean commons, an oversupply of a market-inalienable good like human organs would not reduce future supplies. Rather, organs otherwise fated to be discarded would be procured. This unforeseen blessing of the market-inalienable commons directly challenges one of the principal objections to market bans - that they necessarily cause shortages.

III

Why the Organ Shortage?

In the absence of a market we cannot know what the market price would have been. However, the cost of procuring organs under the donative system seems not prohibitive, perhaps even cheap. How, then, are we to understand the apparent shortages in organs if exhortation is a cheap means of procuring organs? In other words, why is there "underexhortation"? What are the obstacles to increased and more effective effort that might yield greater supply and more fully exploit the donative system's efficiency?

Some of the obstacles may lie in the reliance on exhortation to secure organs and with difficulties associated with the organization of organ procurement by nonprofits. The government may also be inadvertently retarding the supply of organs.

Relying on Exhortation

Perhaps the most significant obstacles consist in the difficulties associated with relying on exhortation as a means of procurement. First, exhorting donations shares with advertising the difficulty of relating the level of effort to outcome. This is captured by the anecdote of the advertiser who says, "I waste half my advertising budget. I just don't know which half." The difficulty in measuring the effectiveness of effort could mistakenly lead to less effort than warranted.

Second, a procurement agency that exhorts people to donate market-inalienable goods may view its efforts as increasing total procurement rather than its particular share of the total. The inability to exclude free riders - an attribute of a public good - would tend to reduce exhortation from its efficient level.

Furthermore, it is unclear whether an organ procurement organization's (OPO's) efforts directed at physicians and hospital personnel to refer patients to them is an effective means for garnering referrals. With regard to the difficulty of getting physicians to inform the OPO of a donor, Shumway (1993) says that "the doctors attending the brain-dead individuals don't want to bother. When the patient is finally brain-dead, the last thing they want to do is call an organ donation center and do more work to give away organs of the person they were trying to save."