Market Design for Living-Donor Organ Exchanges: An Economic Policy Perspective

Within the last decade kidney exchanges emerged as a modality of transplantation to better utilize living donation possibilities as a cross disciplinary success of medical doctors and ethicists, market design economists, and computer scientists. This paper summarizes at which fronts these efforts have been successful and what needs to be done further to increase their impact. Also this paradigm is partially being applied to liver exchanges. There are other organs for which living donation is possible and gains from exchange can be much bigger than kidneys. Recent academic work on single-graft liver and dual-donor organ exchanges for lobar lung, dual-graft liver, and simultaneous liver-kidney transplantation are also discussed. 1 Transplantation, Organ Donation, and Exchanges 1.1 Ethical Constraints and Donation In most of the world, buying and selling a body organ is illegal. Exchanges of human organs for valuable consideration have long been debated in philosophy, anthropology, theology, economics, and medicine. Since organ shortage is severe in most countries, for most economists a legal and regulated organ market would seem a natural solution. Most important objections against an organ market focus on ethical issues. For living human organs, projections predict the sellers to be ∗Department of Economics, Boston College and Distinguished Research Fellow, Koç University; E-mail: [email protected]; URL: http://www.tayfunsonmez.net †Department of Economics, Boston College and Distinguished Research Fellow, Koç University; E-mail: [email protected]; URL: http://www2.bc.edu/utku-unver For example, The National Organ Transplant Act (NOTA) of 1984 makes it an illegal activity in the US to exchange a body part for “valuable consideration.” A notable exception is Iran, where a legal organ market is in place.