The Kidney Opt-Out Revolution


Economist Richard H. Thaler and law professor Cass R. Sunstein have a book out called Nudge: Improving Decisions About Health, Wealth, and Happiness in which they promote their theory of "libertarian paternalism." At the book's new blog, they mention Drew Carey's bit about organ sales, and they seem to have come to some strange conclusions:

Reason, the libertarian magazine, has put together a video (hosted by comedian and libertarian advocate Drew Carey) on the virtues of organ donation.

The organ shortage in the U.S. is primarily due to default rules that require organ donors to formally register their wish to be a donor, known as explicit consent. In surveys, most Americans express a strong willingness to donate their organs upon death, but very few take the costly step of formally registering to become a donor. We tend to take people at their word that they do want to be an organ donor, and advocate switching the default rule from explicit to implicit consent, in which the minority of Americans (15-25 percent depending on polls) who do not want to be donors would fill out a form expressing those wishes.

As Virginia Postrel explains here, even if every one of us signs on as a potential donor, Americans will continue to die waiting. The circumstances under which deceased donor organs are usable remain quite limited, so abolishing the list entails incentivizing live donation. Only Iran has managed to find kidneys for everyone in need, and Iran has an imperfect, highly regulated system of organ sales.

Pointing out that presumed consent will not solve the problem is not exactly an argument against it, but the consent policy Thaler and Sunstein advocate is more complex than they seem to understand. It's an extremely delicate issue among minorities who are (with good reason) wary of the medical establishment, and it may be politically impossible in a society as heterogeneous as ours.