Afternoon roundup

Today's afternoon news roundup.

Item the first: NZ's organ donor rate remains low; the kidney waiting list in particular remains long. Andy Tookey again suggests compensating cadaveric organ donors with subsidised funerals to encourage donation. I agree.

Item the second: if you're a small country, and the US ignores a WTO ruling in your favour, your options are pretty limited. Antigua gets points for creativity. HT: Susan.

Item the third: the National Business Review reprinted a couple of my posts this past weekend; here's cost-benefit analysis and banning cats. Their comment pool is a bit different from the one we have here. I'll be talking with Jim Mora and Radio New Zealand's The Panel on the topic around 4:15 this afternoon. [Update:  embedded below]


Item the fourth: American crime rates seem more sensitive to number of police on the streets rather than number of people in jail; the policy recommendation is to spend less on imprisoning people and spend more instead on community policing. A small portion of this effect is may be due to that crimes committed by police may be less likely to show up in the crime rates. The Bridgeport, Ct. police officers filmed stomping on the head of an immobilized and tazered individual are on desk duty rather than under arrest, at least so far. At least the guy who filmed them is unlikely to be arrested; had it happened in another state results could have been different. But I do agree with the overall policy recommendation - so much the more so if it could be done by diverting police resources away from victimless crimes.

Item the fifth: SciBlogs is running a survey on scientific literacy. I got a perfect score on it, but only because I lied a little bit about one of my answers. One question asks what makes a scientific result most credible: peer review, reputation of the research team, or a couple of other options. I knew the right answer was peer review. But I often put a lot more weight on researcher reputation. Things are so infrequently replicated, and results so often fragile when replicated, that I far more typically weigh a bundle of researcher reputation, publication, and topic. A new working paper from somebody who's credible is just worth more to me than a published piece from somebody who has a bit of a reputation for results that are fragile to specification search.

Item the sixth: +Jeet Sheth rightly wonders whether this is inconsistent with our usual assumptions around transitional gains traps. I'd think of it more in terms of a Peltzman regulatory model. In New Zealand, older used cars must undergo a basic safety inspection every six months while newer ones only need it every year - the Warrant of Fitness. They don't seem to be a profit centre for most garages except inasmuch as they give garages the opportunity to sell other (hopefully needed) services to those getting inspected; some garages specialise in only doing WoF checks on a quick while-you-wait basis. The national government proposed moving to annual inspections for vehicles first registered in 2000 or later. Recall that in the Peltzman model, regulation always balances the public interest with that of the regulated party; that balance changes as technology changes. The mechanics' trade association lobbied against the change, painting it as a road safety issue; the Automobile Association lobbied in favour of it despite also providing WoF checks. While dedicated WoF stations could have been earning some rents from the regulations, free entry into providing WoFs would have meant those rents would not have been huge. It's better viewed in a Peltzman model where deregulation (or a loosening of regulations) can emerge when a technological shock makes the regulation less beneficial to the regulated and to customers. Here, mechanics who weren't WoF specialists would have been seeing less benefit from the regulation as car manufacturing standards improved over time (and so potential gains from on-selling other services were smaller); the regulation's incidence was also pretty obvious to car owners.

Item the seventh: having this particular lotto number selection strategy isn't clever, it's just a way of increasing your winnings if your main numbers happen to come up. It's a bit nuts to purport that any number selection strategy is more clever than any other. It's a random draw guys. Random.

Item the eighth: Andrea Marchesetti points to a nice little story perhaps illustrating Caplan's rational irrationality model. Recall that in Caplan's model, when beliefs are of low cost, you'd indulge your bliss belief; when beliefs contrary to truth become expensive, you scale back demand for them. The Wall Street Journal reports that "haunted" homes in Hong Kong no longer trade at much of a discount; the property boom has pushed prices up. Entrepreneur Ng Goon Lau buys up at discount houses where an unnatural death has occurred, rents them out to expats who don't believe in ghosts, then later sells them - presumably with reports from the renters showing there to be no ghosts. It's unclear from the story whether the Hong Kong boom has brought in sufficient expats that haunted houses were bid up to standard prices without locals changing their beliefs, or whether the absolute increase in housing costs induced locals to put up with spooky ghost problems.

So concludeth the closing of the browser tabs.

Kidney Counsels of Despair

I love the contrast between Steve Landsburg and Virginia Postrel on the Roth Nobel.

They're both completely right.

Says Landsburg:

So Alvin Roth wins the Nobel Prize for, among other things, figuring out the best way to allocate kidneys subject to the constraint that you’re too damned dumb to use the price system.

Next up: A Nobel prize in medicine for figuring out the best way to prolong your life while repeatedly shooting yourself in the head.

Says Postrel:

Imagine a parallel universe in which federal law prohibited Americans from paying anyone to care for their children, whether in cash or in some other “valuable consideration,” and where paid child care was similarly repugnant and illegal throughout most of the world.

In this alternate reality, family bonds would simply be deemed too sacred and children too precious to permit the taint of commercial transactions.Some desperate parents would risk arrest to pay under the table. Parents with a lot of friends and family would help each other out. People with small social networks or loved ones in poor health would be out of luck. A lot of parents would stay home with the kids when they’d prefer to go out, whether to a romantic dinner or a regular job.

The intellectual consequences are equally predictable. Michael Sandel would use child care to demonstrate to his Harvard University classes that there are some things money just shouldn’t buy. The Cato Institute would issue reports showing how the prohibition hurts poor people who would like to be nannies and noting that the law makes an unfair exception for school teachers. Economists would calculate how much higher labor force participation and gross domestic product would be if parents could pay someone else to watch their children. Feminists would debate whether paid child care would liberate women or subject yet another aspect of women’s lives to the brutality of the marketplace.

Meanwhile, Alvin E. Roth, who shared this year’s Nobel Prize in Economic Sciences, would be figuring out how to make it as easy as possible for parents to trade off taking care of each other’s children.

Back in grad school at Mason, the harder core libertarians used to debate these kinds of questions. Roth makes the interventionist world suck less than it otherwise would and has definitely saved lives. In doing so, he has arguably reduced potential pressure for broader changes to the system that would do even more good, although equally convincing cases could be made that he is incrementally helping to make a full market system more palatable to those with strong visceral reactions against any kind of kidney exchanges.

When I attended the Rothbard Graduate Seminar at the Mises Institute, I made the case for free immigration in a session run by Hans Hermann Hoppe. He warned that we couldn't do it while the welfare system remained in place. I reminded him that a big influx of people demanding welfare would be the quickest way to generate real reform moving back to private alternatives, if he really wanted to be rid of welfare anyway. He countered, "But that is a counsel of despair!"

David Henderson criticises Roth for failing to explicitly support full markets in kidneys. If Roth does support them, though, he likely can't say it. If he does, then his system gets tossed out as an incrementalist path towards something some voters find repugnant.

Optimisation constrained by ridiculously harmful voter preferences is a lot harder than unconstrained optimisation. The best we can hope to do is make things suck less. And so Roth has done much good.

Update: Mike Giberson agrees. So does Paul Walker.

Coercion everywhere: organs edition

I had an awfully fun time a few weeks back guest-lecturing in an honours health ethics course in  Canterbury's Health Sciences programme. They wanted to know how an economist approached ethical issues around organ donation. It was pretty clear pretty quickly that the grad students there hadn't been exposed to economic arguments before; they were, on the whole, remarkably receptive. The lecturer, a bit less so. And so it was great fun.

I started by explaining how economists go about estimating the value of a statistical life, the importance of such estimates in drawing the appropriate balance between policies that mitigate risk and those that enhance the quality of life, and the importance of individual risk assessments in deriving those estimate. I moved then to compare the risk of workplace death in various industries with the risk of death from voluntary live kidney donation - live kidney donation is pretty safe. If we're prepared to let people accept cash for risky things like working on a fishing boat, why aren't we prepared to let people accept cash for risky things like donating organs?

The lecturer worried a lot about coercion. I yesterday noted the distinction between voluntary and euvoluntary exchanges as highlighted by Mike Munger. I noted it there too. Sales of organs seem pretty likely to fail the euvoluntary test - income pressures could drive a lot of donation decisions. But that's also true of decisions to work on a fishing boat or to take a lot of other unpleasant and risky jobs. What makes the "coercion of being poor" so much worse for the decision to sell a kidney than for the decision to take a job on a fishing boat if the risks of death or other adverse health consequence from the two decisions are roughly comparable?

The students seemed pretty happy with the notion that if we let poor people trade risk for income on fishing boats, it's a bit odd to ban them from taking roughly the same level of risk for income from selling a kidney, especially as the latter can save lives. The lecturer wasn't as keen on the idea. But I really couldn't pin down just what made the two kinds of decisions different except for that one involved organs, despite rather a bit of pressing. At one point she was backed into the (to me) clearly untenable position that workers on commercial fishing boats take the job not for the income but because they love fishing, then denying people were taking money in exchange for risk. 

I'm still puzzled about why it's obvious to many people that transactions around organs are inherently coercive but those involving very comparable levels of risk or unpleasantness that don't involve organs aren't. Bans on trade based around inarticulable squeemishness concerns do have effects. The National Business Review reports that New Zealand has imported human tissues from RTI Biologics' subsidiary Tutogen [paid link - get a subscription!]; Tutogen has gotten into a bit of trouble about how it sources its parts. Caleb Allison at NBR points to the ICIJ report that shows how pretty much everybody in the system, and especially the companies trading in tissues, are able to profit from individuals' uncompensated donation decisions. Banning trade in such things here, where we could be pretty confident that harvested tissues could be registered and traced back to source, just pushes the problem to places where the regulatory regime may well be less sound. We would have fewer problems in sourcing organs and tissues domestically were we able to compensate donors. 

I'd love to hear a comprehensible reason why we ban compensation in this area but allow it for taking risky jobs in mining, logging, and fishing.

Update: do read EuvoluntaryExchange - the pdf above-linked has the in-one-place version, but the blog is where the argument lives. 

NBER roundup [updated]

The late-night NZ-time twitter feed occasionally brings American morning delights. Tonight, it's the new NBER working papers. In the queue for when I'm back on campus and can read the NBER subscription papers:*

• Callison and Kaestner find tobacco consumption less price sensitive than previously thought; they reckon it would take a 100% tax increase to get a 5% drop in consumption. This would be estimated around American tax levels, which are rather below NZ ones; I'd need to back that out into price elasticity estimates to translate it into effects of NZ tax increases. From the abstract:
  

  ...we focus on recent, large tax changes, which provide the best opportunity to empirically observe a response in cigarette consumption, and employ a novel paired difference-in-differences technique to estimate the association between tax increases and cigarette consumption. Estimates indicate that, for adults, the association between cigarette taxes and either smoking participation or smoking intensity is negative, small and not usually statistically significant. Our evidence suggests that increases in cigarette taxes are associated with small decreases in cigarette consumption and that it will take sizable tax increases, on the order of 100%, to decrease adult smoking by as much as 5%.

  If that's right, Turia's tax increases are more regressive than we'd expected.
  
  Update: Oh wow. Read this bit from the full paper:

  Using this method, we found that for adult smokers ages 18 to 74, a 10% tax increase is associated with between a 0.3% to a 0.6% decrease in smoking participation and a 0.3% to a 0.4% decrease in smoking intensity. More surprisingly, given past research suggesting that youth smoking is more sensitive to taxes and prices, we find very little difference by age in the association between cigarette taxes and cigarette consumption. A 10% increase in state cigarette tax is associated with: between a 0.3% to a 0.7% decrease in smoking participation for those ages 18 to 34; between a 0.2% to a 0.4% decrease in smoking participation for those ages 35 to 54; and between a 0.3% to a 0.6% decrease in smoking participation for those ages 55 to 74. Similarly a 10% increase in state cigarette tax is associated with: between a 0.3% and a 0.5% decrease in smoking intensity for those ages 18 to 34; a 0.3% decrease in smoking intensity for those ages 35 to 54; and between a 0.3% and a 0.4% decrease in smoking intensity for those ages 55 to 74. Finally, standard errors of estimates are of a magnitude that rule out cigarette tax elasticities with respect to smoking participation (intensity) among adults greater (more negative) than -0.12 (-0.13).
  ...
  It is notable that estimates in Table 3 provide no evidence to support the hypothesis that smoking behavior is more responsive to taxes (prices) among younger persons than older persons.

  There may be effects in encouraging kids younger than 18 to avoid starting smoking; the analysis here is restricted to adults. But if this is right, it means that whatever benefits come from Turia's Tax will be over a very long time horizon while the costs on low decile households through reduced net-of-smoking disposable income will be very large for a rather long time. I probably ought to pull this up to being its own post. There are rather a few careful controls in here that need more discussion.


• Reyes gives more evidence that banning leaded gasoline, and other restrictions on environmental lead, was a very good idea. From the abstract:

  The paper finds that elevated levels of blood lead in early childhood adversely impact standardized test performance, even when controlling for community and school characteristics. The results imply that public health policy that reduced childhood lead levels in the 1990s was responsible for modest but statistically significant improvements in test performance in the 2000s, lowering the share of children scoring unsatisfactory on standardized tests by 1 to 2 percentage points. Public health policy targeting lead thus has clear potential to improve academic performance, with particular promise for children in low income communities.

  Reyes previously estimated that reductions in environmental lead can account for a 56% reduction in violent crime in the 1990s.
  
  Update: The paper gives some nice benchmarking of the effects of lead reduction: the improvement in test scores that came of the reduction in the proportion of low income kids with high blood lead concentrations would be comparable to the improvement in test scores you'd expect if per capita incomes improved by 15% in low income communities - a rather substantial effect.


• Hastings et al provide more evidence that kids winning lotteries allowing them to attend the school of their choice enjoy better outcomes. 


• Fergusson, Robinson, Torvik and Vargas set up a model testing an Orwellian idea: that leaders whose power is augmented by warmaking have little incentive to let the war end. They test against Colombian data. From the abstract:

  We find that after the three largest victories against the FARC rebel group, the government reduced its efforts to eliminate the group and did so differentially in politically salient municipalities. Our results therefore support the notion that such politicians need enemies to maintain their political advantage and act so as to keep the enemy alive.

  War is the health of the state...


• And, finally, Lacetera et al on compensation for marrow and organ donation. The abstract:

  In an attempt to alleviate the shortfall in organs and bone marrow available for transplants, many U.S. states passed legislation providing leave to organ and bone marrow donors and/or tax benefits for live and deceased organ and bone marrow donations and to employers of donors. We exploit cross-state variation in the timing and passage of such legislation to analyze its impact on organ donations by living and deceased persons, on measures of the quality of the organs transplanted, and on the number of bone marrow donations. We find that these provisions did not have a significant impact on the quantity of organs donated. The leave legislation, however, did have a positive impact on bone marrow donations. We also find some evidence of a positive impact on the quality of organ transplants, measured by post-transplant survival rates. Our results suggest that these types of legislation work for moderately invasive procedures such as bone marrow donation, but may be too low for organ donation, which is riskier and more burdensome to the donor.

  Becker and Elias reckoned it would take about $15k in compensation to encourage kidney donation. If the tax benefits added up to less than that, it would have been surprising if there had been large effects on live donation rates. The data appendices (free access; the article is gated) shows no state provided more than $10k as tax deduction. Note that a $10k tax deduction isn't $10k in hand: it's $10k that you get to remove from your taxable income total. So it's only worth $10k times your marginal tax rate - in other words, very unlikely to motivate donation from the cohorts more likely otherwise there to be price sensitive.
  
  Update: A few neat bits on seeing the paper rather than just the abstract:
  • Where some worry that paying for organs worsens quality, the authors found instead weak evidence of quality improvement.
  • The authors seem to have reached the same conclusion: the payment levels via tax deductions are likely below the reservation price for live kidney donation.

* I've only caught the abstracts of these thus far; if there are grievous errors in method that aren't obvious from the abstracts, my apologies.

Price of marrow

If there weren't already enough reason to encourage payment for blood donation (counterarguments to which are ably rebutted by Alex Tabarrok), we might have another.

Bone marrow donors, who donate through peripheral blood stem cell transplantation, can now be compensated in the US under the same provisions that let blood donors be compensated. PBSCT seems  more intrusive than blood donation, but somewhat less intrusive than standard marrow donation [see here for one discussion].

Demand for marrow seems likely to increase: bone marrow transplant may be effective as treatment for HIV. If these kinds of results hold up, expect some very effective political campaigners to start helping to change legislation to encourage marrow donation in places where compensation isn't yet legal.

I donated blood a half dozen times as an undergraduate; as I've yet to make any withdrawals from the system, I'm refraining from any further donations on principle until policies around compensation are changed.

Organ supply

TVNZ's CloseUp made the case for compensating live organ donors for lost earnings. I can't embed the video, but I show up in it. I argue that moving the deceased organ donation decision from the time of death to the time of estate planning, by allowing compensation for funeral expenses, could help take the heat out of those decisions and overcome a reflexive tendency where families uselessly want to protect the newly deceased.

Their interviewed transplant surgeon thinks paying people for organs is abhorrent but compensating them for forgone earnings isn't bad. I have a hard time seeing the ethical distinction, but whatever framing works is fine by me.

Previously:

• Compensate cadaveric organ donors with free funerals. It's odd that Otago can cover a cremation subsidy for those leaving their bodies to science, but we can't compensate organ donors for similar donations.
• Encourage LifeSharers as a way of boosting donation rates rather than try to stomp on it [see also here]. 
• Consider the other steps taken by Israel: priority access to donated organs for those signing on as organ donors. See here and here.
• Small steps towards a better world

Hit the "Organ Markets" tab for all the prior posts on the topic.

Adoption incentives

Bethman and Kvasnicka put the adoption decision into a standard rational choice framework and, unsurprisingly, find that those with higher opportunity costs of time and altruism are more likely to adopt rather than have their own children. They argue this helps explain celebrity decisions to adopt rather than to have their own children.

Unfortunately, they leave as something "for further research" the potential use of surrogates.

I'm not going to do any modelling here, but I really would have expected that celebrities would disproportionately use surrogates. Surrogates aren't cheap; celebrities have lots of money. Surrogates might make unobservable decisions about nutrition, substance consumption, or activities that underweight the fetus's interests; a celebrity can afford to have the surrogate live in their house for the period from IVF through to birth. And, while celebrities might have greater incentive to demonstrate altruism than do us normal folks, they're also more narcissistic - which should push towards stronger preference for their own genes.

I really don't follow celebrity gossip. Maybe there's lots of celebrity use of surrogacy options that I've just not caught. But the only case that comes to mind is Patri Friedman, if he counts as a celebrity. On celebrity adoption, it's so common that Sarah Silverman was able to lampoon it in her TED talk.

The only answer that makes sense to me is that surrogacy (alas!) remains subject to disapprobation while adoption draws kudos. And, Bethman and Kvasnicka hint at that answer:

For a celebrity, the adoption of a child generates headlines and adds to popularity, which benefits the career and ultimately income.

A celebrity expecting "rent-a-womb shocker!" headlines in response to a rational decision to avoid personally incurring the physical costs of pregnancy might well be tempted to choose adoption over surrogacy.

HT: @CJFDillow

Organ incentives

Were I a Facebook person, I'd be hitting the "Organ donor" button, now apparently active in New Zealand.

Last week New Zealand became the latest to approve a Facebook initiative that allows people to state that they want to be organ donors.

The global scheme works to promote organ donation, by allowing people to create a "life event" on their timeline saying they wish to become a donor.

Family members are still requested to give permission when the time comes, but the Facebook initiative is helpful in promoting discussion of the issue, Facebook's Australia and New Zealand communications and policy manager Mia Garlick said.

I'd want a slightly stronger button indicating LifeSharers membership.

Michelle Robinson's article makes the case for compensating live donors, drawing on a few bits from me. She uses some of the best quotes I'd sent; the full text I'd provided is below.

"There are a few reasons for New Zealand's relatively low organ donation rate. To start with, we don't have great awareness campaigns around organ donation. So when people renew their driver's licence, they've not really put much thought into the donation decision, and nothing around the driver's licence scheme really helps to encourage an informed decision. Next, to be eligible to be an organ donor, you have to be in an ICU bed when you die; doctors here seem reluctant to assign a terminal patient to a scarce ICU bed in hopes that the patient's family will consent to donation. Finally, because the driver's licence scheme does not constitute informed consent, doctors feel the need to seek explicit family permission for organ donation at what is the worst possible time for families to be making that kind of decision. So it's no surprise that half of families asked decline that the deceased's organs be made available for transplant." 

"Other countries have tried a variety of approaches to increase both live and cadaveric donation rates. Even if everyone signed their organ donor card, we just couldn't meet demand for kidneys; live organ transplants help to fill that gap. Israel has had great recent success with a combination of two policies. First, they have increased compensation for live organ donors. Donating a kidney or a liver lobe is pretty safe - fishermen have a higher on the job fatality rate than do live donors of liver lobes. But, the donation means time away from work both before the transplant and in post-operative care. Israel compensates donors with up to 40 days' lost wages and expenses. Given the costs of dialysis for public health systems, this kind of compensation isn't nearly as expensive as you might think. M.P. Michael Woodhouse has a Private Member's Bill in the New Zealand Parliamentary ballot that would enhance compensation to live donors here. Second, Israel introduced the "Priority System". If you agree that your organs should be available for others if you die, you're given priority should you ever need an organ donation. While medical ethicists worry that it might not be fair that people who are unwilling to share with others might have a lower position in the queue, we have to remember that measures like this don't just change peoples' positions on the list, they also increase the number of organs available for transplant. Israel saw a sixteen percent increase in the number of registered donors with the Priority Law; we have to weigh any of these fairness worries against that these policies save more lives." 

"There are other measures New Zealand could reasonably consider. One policy that should neither be terribly controversial nor terribly expensive would be payment towards the funeral costs of organ donors. This simple policy could help push the organ donation decision from being an afterthought at the drivers' licence office to being something that families talk about together when planning their estates. That takes the emotional heat out of the decision and helps a grieving family to know and respect their loved one's wishes when a nurse or doctor asks about organ donation. And, as the University of Otago Medical School is already covering cremation costs for those donating their bodies for medical research, a subsidy worth about $1500, extending partial payment of funeral costs to organ donors would only really be an extension of something that's currently allowed. WINZ helps defray funeral costs for the poor; why can't we also defray the funeral costs of those helping to save others' lives and reducing the burden on the public health system through their donation decision?" 

"One option I particularly like is LifeSharers. LifeSharers is a club that's free to join. All you have to do is agree to be an organ donor - there are no fees and nobody is excluded, even if medical problems mean your organs might never be used. Being willing to share is all that's required. If you're a LifeSharers member, you agree not only to be an organ donor, but also that first call on your organs should go to a LifeSharers member on the organ waiting list who is a suitable tissue match. If nobody on the LifeSharers list is a good match, your organs go into the general pool. The beautiful thing about LifeSharers is that every person who joins it increases the benefits to anybody else considering signing up as an organ donor with LifeSharers; it's the private equivalent of Israel's Priority Law. If I sign only my driver's licence, I don't do much to encourage anybody else to be an organ donor. But if I join LifeSharers, I help to make it be in your interest to become a donor member. The transplant ethicists here in New Zealand don't particularly like it because they worry that somebody who refuses to share, for whatever reason, might be disadvantaged; I worry more about all the people who are disadvantaged when too few people sign up as organ donors." 

"It's also good that New Zealand is starting to explore running something like America's Kidney Exchange system; National's proposed changes include a feasibility study. Suppose that I wished to donate a kidney to my wife, but I'm not a good tissue match for her, and you're a poor tissue match for your partner, but I'm a match for your partner while you're a match for mine. The Kidney Exchange looks for situations like this and builds chains of living donors. This February, The Kidney Exchange built a chain of thirty kidney transplants involving sixty people. With a smaller population, New Zealand wouldn't be as likely to build these long chains of living donors, but it would still be a great way of helping to increase live donation rates. I hope we move quickly to implementation."

Talkin' 'bout organs

I spent a bit of time talking with Kathryn Ryan on Radio New Zealand's Nine to Noon Monday morning about proposed changes to New Zealand's organ donation regime. The interview is here.


I hit the same topic earlier in the morning with Spanky at RDU's breakfast programme; the audio should be up eventually.

This weekend's Sunday Star Times should have a piece on organ donation and LifeSharers; I've sent through a few quotes for use and will look forward to seeing what the final piece looks like.

Small steps towards a better world

It looks like New Zealand will implement a local version of MatchingDonors The Kidney Exchange as part of a push to improve organ donation and transplant figures. They'll also invest in training specialised ICU nurses to talk with families about donation options.

All of this is for the good. Live kidney transplants are pretty safe; living donors sharing a liver lobe also have pretty good outcomes [discussed here]. But few people would be willing to give a kidney or a liver lobe even to a friend given the reasonably large time commitment involved: frequent flights to Auckland for consultations, recovery time post-op. Compensation to living donors is pretty limited. So Matching Donors, which helps route around donor compatibility issues and increase the potential for altruistic donations, can make a big difference.

Israel experienced a big increase in transplant rates when they paired a Matching Donors system with compensation to living donors - expenses plus up to 40 days' lost wages. New Zealand could improve outcomes further here by making it less costly for donors to give organs.

We could do even better by considering things like Israel's priority law, which complements a binding organ donor registry with priority access to organs for those willing to be organ donors. Or, by requiring that transplant surgeons respect the wishes of members of LifeSharers: organ donors who prefer that first call on their organs goes to other organ donors.

We don't have to go all the way to complete markets in organs to improve outcomes. I'm glad New Zealand's taking a step in the right direction. Other useful steps:

• Compensate cadaveric organ donors with free funerals. It's odd that Otago can cover a cremation subsidy for those leaving their bodies to science, but we can't compensate organ donors for similar donations.
• Encourage LifeSharers as a way of boosting donation rates rather than try to stomp on it [see also here]. 
• Consider the other steps taken by Israel: priority access to donated organs for those signing on as organ donors. See here and here.
• Switching from opt-in to opt-out.

My prior posts on organ donation are on the "Organ markets" tag; some of them are linked above.