Organ Quality as a Complicating Factor in Proposed Systems of Inducements for Organ Donation

All potentially transplantable organs are not created equally. Even among organs currently used for transplantation, there exists a wide spectrum of quality. Donor risk factors can account for as much as a twenty-percent absolute difference in post-transplant survival. Thus, in some cases, actual receipt of a transplant matters less than the quality of organ received. Organ quality might complicate inducements for organ donation in several ways. First, organ quality can diminish the impact of inducements on net increase in organs transplanted, and furthermore, can increase the cost of inducements. Second, whether directed toward organ-procurement organizations or potential living or deceased donors, inducements risk increasing the supply of organs at the expense of quality. Finally, the heterogeneous quality of organs can complicate market systems. These issues are most relevant to deceased-donor organs, and can be less problematic in the setting of living donation. Furthermore, there are a number of potential regulatory mechanisms that could mitigate concerns related to organ quality.