Many years ago, shortly after joining the Marine Corps, I applied to register as a bone marrow donor. As the years went by, I almost forgot I had done so until one day in June 2020, I received a call from my father. He got a call from the Register. (When I first registered, I didn’t have a cell phone, so I just used my old home phone number as my contact information.) It turns out that the person suffers from leukemia and needs a bone marrow transplant. My father passed on the information he had gathered to me and I contacted the registry.
My only concept of how a bone marrow transplant worked came from something I remembered from a medical show. It typically involved sticking a huge needle into the bone to extract the bone marrow. It turns out that this requires a different method. In the days leading up to donation, a nurse came to my house every day to administer filgrastim injections. This in turn causes my body to overproduce bone marrow stem cells and flow into my bloodstream. I was also advised that common side effects of filgrastim injections are severe muscle, joint and bone pain along with headache, weakness and nausea. After a week of injections, I spent hours hooked up to a dialysis machine that filters these cells from the bloodstream and gives them to those in need.
It all sounded like something worth going through. What made things even more complicated was that this was June 2020. It was still early days of the COVID-19 pandemic. I was already cautious about this disease due to concerns that my past heavy smoking could make me more susceptible to respiratory diseases. Taking additional risks seemed risky. The bigger problem was that my wife and I had just welcomed our first child into the world just a few weeks earlier, in mid-May 2020. As any parent can attest, we haven’t had more than two hours of sleep in a row since then. Experiencing the side effects of the injections for a week while continuing to work and care for a newborn seemed like a very daunting task.
In the end, I decided to go ahead and do it. I was already feeling pretty ragged and ended up having a hard time donating and the unpleasantness that came with the process. But I wasn’t like that. dying – And there was someone else, and I could have helped save them. I’m glad I did that. But I was right about my decision at the time. If I had been a little more careful about Corona and its possible complications, if I had been a little more exhausted in the neonatal stage, if I had been a little more worried about the painful side effects of the injections, I probably could have ended up on the other side of the line. .
This step, right at the tipping point of moving from one option to an alternative, is what economists have in mind when they talk about “margin.” I was a marginal donor when I made that decision. He was someone who was willing to make that decision. The cost was all the complications described above and the benefit was the fulfillment of a common desire to help those in need. For me, at the time, the benefits slightly outweighed the costs. But let’s assume that wasn’t the case. Let’s say my general desire to help people was a little lower, or I weighed some or all of those costs a little more heavily at the time. If that were the case, I would hardly have been there. different side of the line. I’m almost willing to donate, but not yet. In that case, do you know what made the difference and led you to donate the balance? Expect to receive salary.
If there was little willingness to donate, the small payment offered might have been enough to get them over the line. If my reservation had been stronger I would have required a larger payment. etc.
In the United States, it is illegal to receive compensation for organ donation. For example, everyone else involved in the procedure, including the hospital and medical staff, may be able to get paid for something like a kidney transplant. actually lost a kidney A crime has been committed if you are rewarded for your part in the process. As a result, kidneys can only be given for free by donors willing to donate. The number of such people is not zero – Scott Alexander One such person – But that number is much lower than the number of kidneys needed for sick people. This is why there is a huge backlog of people waiting for a donor kidney, and thousands of people die every year before a donor can be found.
There are not enough people with Scott-Alexander levels of altruism. But what about those on the edge of that line? These are people who are selfless enough to donate their kidneys for free. For these people, all it takes is a small payment to go from having no intention to donate to being willing to donate. And when those people cross the line, there will be a new group of people who will hardly ever be on the side of this new line. People who combine small payments and altruism almost but not quite Enough that I am willing to donate. If, after paying a small amount, there are still more people who need a kidney than are willing to donate, the price may rise, pushing the next group of people over the limit. This process can continue until the price becomes high enough that the last person who needs it crosses the line from “not very willing” to “little willing.” This means that the final price of a donated kidney is ultimately set by margin. .
According to this As of September 2024, there were approximately 90,000 people waiting for a kidney transplant in the United States, according to the website. About a dozen of them will wait and die one day. A total of 27,000 kidney transplants were performed the previous year. That’s a shortage of more than 60,000 kidneys. The question is, how high must the price be to take 60,000 people from having little intention to donate to being willing to donate? It may be lower than you think. Even though most people wouldn’t consider donating a kidney if it cost less than $1 million, the price isn’t what most people want. The price is fixed in the margin. Because of this, the payout only needs to be high enough to motivate the 60,000 people most willing to donate. barely barely I have no intention of donating for free. I wouldn’t be surprised if the amount you have to pay to make up the gap is significantly less.
Many people dislike paid organ donation. Debra Satz has raised several objections to the ideas contained in her book. Why You Shouldn’t Sell Something: The Moral Limits of the Market. It’s a really good book. But none of those arguments have enough force to overcome the simple fact that more than a dozen people will die today while waiting for a kidney transplant. Twelve more tomorrow, the day after that, Christmas, and Every other day Until more kidneys are available. In contrast, all worries about Satsu’s ‘unpleasant deal’ are nothing more than a storm in a teacup.
