Behavioral economics and compensated live kidney donations

Healthy adults are allowed, and even encouraged, to donate a kidney to patients in dire need of a functional kidney. The encouragement can take various forms, but under US law (and under the laws of most other jurisdictions), a kidney donor cannot receive any “valuable consideration.” The standard contention that informed, rational, voluntary exchange between adults is mutually (and, absent negative externalities) socially beneficial does not carry the day with respect to current public policy towards compensated kidney donations.

Arguments in support of the ban, then, tend to focus on the extent to which a compensated kidney transfer is informed and voluntary and rational, and on the possibility of negative externalities. Those externalities might be of an abstract nature, such as a view that organ sales are repugnant (Roth, 2007). The wide support that uncompensated kidney donation receives, however, suggests that considerations of coercion, poor information, departures from rationality, and negative externalities are perceived as being more potent in the realm of organ transactions when valuable consideration is added into the mix.

Departures from rationality in individual decision making are the central focus of behavioral economics, and hence behavioral economics has direct applicability to the debate on compensated organ donations. In Beard and Leitzel (2013), we briefly discussed some behavioral influences – risk misperceptions, loss aversion, the endowment effect, and present bias – on the decision to donate a kidney. The goal here is to broaden and deepen that analysis, and to go beyond donors to look at behavioral influences on four other sets of actors: patients and potential patients, family members of patients, organ procurement agents, and physicians and other medical personnel. How does the addition of valuable compensation to organ donors influence the rationality of the decisionmaking of all actors involved in transplants? How can a compensated system be designed to address the concerns that are heightened with respect to kidney sales as opposed to uncompensated donations?