I haven’t blogged in a while as life, work and (finally) summer have got in the way. But I can’t resist writing about today’s news story that proposals are on the table to create financial incentives for organ donors.
It is tragic that so many people die waiting for a transplant, and I entirely support the suggestion that donating become ‘opt-out’ rather than ‘opt-in’, which enables people to retain control over their body parts whilst ensuring that the majority, who are quite happy to see their organs used by someone else after death, are not foiled by having not got round to joining the donor register. But I’m not at all sure about the impact, or effectiveness, of offering inducements to nudge people towards making the decision to donate organs.
I got started studying charitable giving as a result of reading a wonderful book by Richard Titmuss called ‘The Gift Relationship: from human blood to social policy’. Published in 1971, Titmuss compares the blood donor system in the UK, where donors make a ‘free gift’ of their blood, with the system in the US, where donors are paid to donate. He concludes that the UK system produces healthier blood, as people are not incentivised to cheat by making excessive numbers of donations or attempting to sell infected blood. But, perhaps more crucially in the context of those of us trying to encourage charitable giving, he wrote that the importance of a voluntary national blood service lies in the fact that very few opportunities exist in modern, technical, large-scale organised societies for ordinary people to act altruistically outside their own networks of family and friends. He therefore concludes that we must maintain a voluntary, rather than incentivised system for donating blood (and, by extension, for donating organs) because it is important to create and support structures in our society that allow and encourage people to demonstrate generosity to strangers.
The voluntary giving of blood and organs is part of a wider set of norms regarding the exchange of significant gifts between strangers that fundraisers rely upon. We draw upon that tradition every time we ask someone to give away some of their private wealth to support the public good. I do hope that any changes to encourage organ donation do not end up threatening the concept of free gifts in our society.