Some politico-economic aspects of organ shortage in transplantation medicine

Transplantation of solid organs has become a widely performed and accepted procedure. This type of high-performance medicine has led to vigorous debates on ethical and economic issues and most of this discussion can be seen as an example of the different opinions about highly individualised and technologised approaches in health care. The paper focuses on the rising gap in the demand for suitable organs for transplantation and the levelling off, or even fall, in the supply of these organs. Despite the rather demanding requirements for organ donation, there appear to be a sufficient number of deaths under suitable circumstances to satisfy the annual demand of transplantable organs—if the collection rates are adequate. It has been shown that there are great differences in the rate of organ procurement efficiency within different regions. The question then how to set appropriate incentives to obtain organs in sufficient quantities from eligible donors to meet the demand. This paper discusses the different medical and societal approaches as well as the economic proposals to overcome the organ shortage. The theory of Public Choice is used to develop a specific policy that can be applied to organ procurement efforts. This is a different approach, whereby political and economic considerations of ethical dilemmas focus on setting appropriate and widely accepted frameworks and rules, in which individuals may then decide about their behaviour. In an appendix, the economic consequences of transplantation medicine are discussed if more organs were to be made available and the impacts of relaxing the simplifying assumptions on effectiveness of organ replacement therapy and on the allocation system are considered. Ultimately, artificial organs or genetically transformed animal organs may be used but it is highly likely that a vigorous debate on the ethics and especially financial implications of these interventions will take place beforehand.