The Global Organ Shortage: Economic Causes, Human Consequences, Policy Responses.

• Author: Tabarrok, Alexander
• Position: Book review

* The Global Organ Shortage: Economic Causes, Human Consequences, Policy Responses

By T. Randolph Beard, David L. Kaserman, and Rigmar Osterkamp

Stanford, CA: Stanford University Press, 2013.

Pp. xvi, 242. $55 hardcover.

The shortage of human organs for transplant is by now well known. Throughout the world, for example, some 2.8 million patients are undergoing dialysis, but only seventy-three thousand kidney transplants are performed annually. Not every dialysis patient is a good candidate for transplant, but under any definition the demand for transplants far exceeds the supply. Moreover, because demand is increasing faster than supply, the shortage is growing worse every year. Compared to dialysis, transplants offer patients a longer and better life (higher-quality-adjusted life years in the technical parlance), and transplants are also remarkably less expensive than dialysis on a discounted lifetime basis. The great shame (in all senses of that word) is that even in the face of such a debilitating shortage we continue to bury and burn organs that could save lives. In the case of kidneys, there is also a potential supply of billions of kidneys because each living person has two kidneys even though one is typically adequate. Unfortunately, it is currently illegal in most of the world to incentivize the supply of kidneys.

In The Global Organ Shortage, T. Randolph Beard, David Kaserman, and Rigmar Osterkamp have performed the useful task of surveying and evaluating almost the entire extant literature on the organ shortage and potential solutions. They conclude that compensating organ donors, both living and cadaveric, is by far the best way of increasing supply. They do not, however, restrict their analysis to compensation; they also look at changes in default donor rules (shifting to presumed consent, for example), improved collection procedures (the Spanish model), organ chains and swaps, and demand management (avoiding obesity and dialysis in the case of kidney disease), among other topics.

The Global Organ Shortage is an academic book written in academic style, but the authors do offer a few arresting sentences, such as "[I]t is quite difficult to think of any other system where begging is the sole legal means of obtaining a supply of goods" (p. 3). They later make a point I had not previously considered. It is often thought that compensation would add to the costs of a transplant. (Even if true, this is no objection to compensation...