Priority Rule for Living Organ Donors Should Include Post-Pledge Waiting Period To Ensure Quality of Supply Isn’t Compromised, Johns Hopkins Researcher Says

It sounds like a reasonable, well-meaning policy: To help boost the persistently low supply of human organs for transplant, a few countries allow individuals who pledge their organs for donation to receive priority status if they should ever need a transplant themselves.

Yet, as a Johns Hopkins University researcher argues in a new study, the “donor-priority rule” might create unintended consequences because it provides a stronger incentive to individuals who are more likely to seek a transplant in the future. The supply might increase, but at the risk of potentially reducing the quality of organs.

Also, a psychological burden might befall high-risk individuals who feel compelled to pledge donations they otherwise might not have made.

A simple operational remedy could correct these flaws, says Assistant Professor Tinglong Dai of the Johns Hopkins Carey Business School. He proposes that each pledge be followed by a “freeze period” of a specified length of time. Anyone who promises a donated organ would not be given priority for a transplant until the freeze has expired.

As a result, Dai explains, the quality of donated organs would face less of a threat of becoming compromised, and individuals with a high likelihood of needing transplants might not feel pressured to pledge their organs just for a chance to move toward the front of the transplant queue.

“When used in conjunction with the donor-priority rule, this remedy can ensure social-welfare improvement by expanding the size of the donor registry without reducing the average quality of donated organs or inducing unnecessarily high [psychological] costs of donating,” the paper states.

The psychological costs of the priority rule are a factor even in a scenario in which all donated organs would come from healthy individuals. According to the paper’s findings ― attained through a queueing theoretic model that Dai developed with two co-authors ― the rule might induce healthy people to pledge to donate their organs, not because they wish to but because they feel they must do so to gain special consideration in case they would ever need a transplant.

All these factors, Dai says, cast doubt on the donor-priority rule’s intended benefit to the greater society.

But, he adds, the rule needn’t be discarded, as long as it can be combined…

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