ABSTRACT
Over the past decade there have been numerous proposals to use market system incentives to attenuate the persistent shortage of transplantable human organs. While shortages have grown, opposition to market-based solutions has remained adamant. Much of the opposition has focused on monetary incentives. This article explores an alternative--a mutual insurance pool to increase the supply of organs. In the process, criticisms of earlier proposals (specifically the future delivery scheme) are addressed, the operation of an insurance pool is described, and problems associated with insurance markets are identified and addressed. The article concludes that an insurance pool could overcome public and political resistance to more explicit market-based solutions.
Subject(s)
Human Body , Insurance Pools/organization & administration , Motivation , Tissue Donors/psychology , Tissue and Organ Procurement/economics , Attitude to Health , Health Care Sector , Health Services Accessibility/economics , Health Services Needs and Demand/economics , Humans , Patient Selection , Resource Allocation , Risk Assessment , Social Responsibility , Tissue Donors/supply & distribution , Tissue and Organ Procurement/organization & administration , Tissue and Organ Procurement/standards , Trust , United States , Voluntary ProgramsABSTRACT
Improvements in surgical procedures and immunosuppressive practices have greatly increased the range and success rate of organ transplants. Unfortunately, supply does not meet demand, and demand is increasing. This paper documents the current level of unsatisfied demand for several transplantable organs, and argues that the extant system of altruistic organ donation is unlikely ever to provide adequate supply because of lack of incentives to donate and the ambiguity surrounding property rights over transplantable organs. A greater reliance on markets would help attenuate these problems. However, unorganized private spot markets for human organs are likely to be both inefficient and inequitable, and are perceived as morally offensive. A feasible alternative is an organized, publicly operated future delivery market, wherein an individual can contract, for valuable consideration, with a government agency for delivery of a specific organ upon death. The implementation of such a market would encounter difficult (but not intractable) problems such as price determination, the selection of a medium of exchange, and contractual issues, particularly the role of minors in such a system. Finally, it is argued that such a market is superior to the much-discussed compulsory expropriation alternative.
Subject(s)
Human Body , Tissue and Organ Procurement/methods , Altruism , Commerce , Contracts , Costs and Cost Analysis , Family , Federal Government , Humans , Minors , Motivation , Patient Selection , Resource Allocation , Tissue Donors/psychology , Tissue and Organ Procurement/economics , United States , Voluntary ProgramsABSTRACT
In order to study the cardiac catheterization experience in hospitals without cardiovascular surgery programs, data was collected from all 8 Washington "satellite" laboratories over a 5-year period. There were 5 deaths (0.13%) during the 3878 coronary arteriography procedures. Of the 5, 4 had severe left main coronary artery lesions. Of these patients, 2 died during the 24-hour follow-up period after an uncomplicated study. This mortality rate is remarkably good considering that the 5-year period includes the early experience of 7 laboratories. There were 7 myocardial infarctions (0.18%) and 6 strokes (0.15%). The average number of coronary arteriograms done per angiographer during 1976 was 65. The experience of the Washington State "satellite" cardiac catheterization laboratories proves that the immediate availability of cardiovascular surgery and large case loads per angiographer are not necessary in order to safely perform cardiac catheterization and coronary arteriographic studies. Additional studies should be undertaken to determine the appropriate distribution of cardiac diagnostic facilities.
