The problem: There are 8,096 people on the active transplant waiting list.¹

The solution: There were 568,613 deaths, who were potential donors, in Britain in 2024.²

Discussion

There is a tragic mis-match between people needing transplants and supply. Transplants are the difference between gruelling treatment and an active life. This is ‘market failure’. The current system is failing and should be changed. The difficulty is that many people feel revulsion at the idea of their body being used for strangers. Economists pivot towards incentives.

The current British strategy is altruism, which is the, willingness to do things that bring  advantages to others, even if it results in disadvantage for yourself.³ British organ donation is voluntary and motivated by a desire to do good even after death. The system is creaking. Desperately ill people are waiting a long time for donations to become available and some die whilst waiting. A modification of the altruistic system is necessary to overcome the problem of revulsion. Incentives, however, must be calibrated to add to and not replace altruism to improve the supply of organs.

A cash incentive is the normal route. It should be remembered that funeral expenses are considerable.⁴ An incentive could link organ donation and funeral costs. Obviously this is a lottery because only some people would be called upon to donate their organs. There is a massive excess of deaths annually compared to ‘only’ eight thousand on the active transplant list. Being a potential donor wouldn’t guarantee your funeral expenses being met. Perhaps a further incentive is needed like paying an access fee for being willing?

The fact of lengthening active waiting lists is indicative of market failure. Incentives that are attractive could induce the sale of organs. Many people might find this unacceptable as it involves monetising the organs of the body during life.

Those who are poorer may be more inclined to put their kidneys up for sale.⁵ 

So what?

Why is there a difference in acceptability between organ donation post-mortem and pre-mortem? A poor person monetising their body is funding a present need with an opportunity?⁶ It does , however, feel wrong for rich people using poverty to enhance their life. It feels ghoulish. The disparity of economic power might be coercion.

Waiting for an organ transplant is gruelling and destructive of life’s pleasures. Kidney dialysis sessions are unpleasant.

Each session takes around 4 hours. Most people need 3 sessions a week.⁷  There are about 30,000 UK citizens on dialysis machines.⁸

The cost of dialysis transplant and machine treatment for the NHS is about £660m pa. The NHS is clear about the cost-benefit advantages of transplants versus dialysis,

When the transplant is stable it costs about £2000 per person per year vs about £20,000 for dialysis – i.e. about 10% of the cost. The quality of life with a transplant is a lot better as well. So, if you are suitable, try very hard to have one.⁹

Using the concept ‘market failure’ for life-and-deathillnesses is brutal. Unfortunately, evading the decision-making process by being squeamish is delusional. Something must be done to alleviate suffering and use NHS’s resources in the best possible way for the maximum number of people.

Notes

1 Organ transplant waiting list hits record high as donor and transplant numbers fall – NHS Organ Donation

2 Death registration summary statistics, England and Wales: 2024 – GOV.UK

3 ALTRUISM | English meaning – Cambridge Dictionary see also NHS Organ Donor Register – NHS Organ Donation

4 Pre-paid Funeral Plans – Pre-arranged funerals – Co-op Funeralcare Medals could be used as a public acknowledgement of altruistic behaviour.

5 Susskind, Richard; Susskind, Daniel. The Future of the Professions: How Technology Will Transform the Work of Human Experts (pp. 241-242).

6 Suicide Act 1961 – Wikipedia This act decriminalised the act of suicide but it also but extension gave the citizen the right of their actions towards their body. By extension the monetisation of the body by selling body parts is legal even if distasteful.

7 How dialysis is done – NHS

8 Dialysis for kidney failure: evidence to improve care

9 loc.cit