Using Reciprocity to Motivate Organ Donations

More than 6,000 Americans die annually due to a shortage of organs for transplants. This article contends that the supply of donated organs could be increased (and thus many unnecessary deaths avoided) by the adoption of a policy of reciprocity, a kind of organ insurance. Those who committed to donate their organs at their death should be rewarded with a small preference in the event that they later need a transplant. Although this policy is opposed by those who hold that donations should be based solely on altruism, it would represent a form of reciprocal altruism and is consistent with the current United Network for Organ Sharing (UNOS) system of awarding 4 points to any patient seeking a kidney who has previously donated one and allowing paired exchanges. Increasing the supply of organs is already used as one of the justifications for the UNOS local first rule (whereby those located in the same local area as the donor are favored over better matches outside the area) and a reciprocity policy would likely represent a more effective means to that end. Just as time on waiting list is used today to help determine who receives an organ, time on willing donor list should also be a factor.