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Let organ donors be first to benefit

The Press | Thursday, 8 March 2007
It may be time to ration organ transplants to those who are willing to donate their own organs, writes ANDY TOOKEY.

Rationing already occurs in our health system, usually in the form of qualification to access the system. For example, publicly funded hospital treatments are restricted to those who qualify by being New Zealand residents and therefore contribute to the tax pool.

Likewise, health-insurance companies will not pay for treatment unless you have paid your premiums up front.

There has been much in the news media recently about drug rationing because of the cost, and having to be sicker before you qualify for an operation.

New Zealand suffers from a chronic shortage of organs for transplant. Should we consider allocating organs first to people who are prepared to be donors themselves, and put those who refuse to be donors lower on the waiting list? Could it benefit both groups?

At present, organ transplants are based on need, not contribution, which discourages the incentive to contribute. Some people will not donate organs, but they will accept them if they need them. They are willing to benefit from a common resource without investing anything to create it.

It appears that it is in everybody's interest that donated organs be available, but it is in no-one's interest to make their own organs available.

In New Zealand, you are more likely to need a transplant than to become a donor.

At the beginning of a week, "John" may be against being an organ donor for whatever reason, but the next day he may be diagnosed with liver failure and he will go on the waiting list for a new liver.

"Julie", who may have expressed a lifelong willingness to donate and have encouraged her family and friends to declare their intentions to donate, will enter the waiting list under the same terms and with the same waiting time as John.

If you feel uncomfortable about giving preference to Julie over John, remember that organ donation relies on the goodwill of donors. If everyone thought the same way as John, there would be no organ donors.

People are motivated more by self-interest than by altruism. To increase organ donation, the incentive needs to be aligned with self-interest.

Agreeing to give the gift of life would no longer be an act of pure altruism. It would be an insurance policy.

Even the most selfish individuals would be willing to become a donor if it gave them greater access to the hearts or livers that might save their lives.

Of course, there would need to be a stand-down period, so that people don't sign up as donors the minute they discover they will need an organ.

Even after registering, it is extremely unlikely that a registrant will donate organs, because it is rare to die with organs medically eligible for transplantation. Potential donors can make the trade-off between the remote possibility of becoming an organ donor and the not-quite-so remote possibility of needing an organ.

Opponents of the scheme may say it is not fair. In fact, it makes the organ-allocation system fairer. What is not fair is giving an organ to someone who won't donate their own when there is a registered organ donor who needs it. It's like awarding the Lotto jackpot to someone who didn't buy a ticket.

Opponents may also claim that it is a slippery slope. They are wrong. Giving organs first to women doesn't produce more women. But giving organs first to organ donors produces more organ donors, and that is something that saves lives.

The goal of our organ-donation system should be to save lives, not to spread deaths equally among groups.

As long as people who refuse to be a donor can jump to the front of the waiting list if they need a transplant, we'll always have an organ shortage.

Maybe a system like this, based on individual responsibility, should replace the current one based on handouts.

* Andy Tookey is a Christchurch organ-donation campaigner. He helped write National MP Jackie Blue's private member's bill to create a binding register of organ donors. For further information, see www. givelife.org.nz or www. organdonor.co.nz

courtesy of STUFF www.stuff.co.nz

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