Increasing Organ Transplantation—Fairly

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Abstract
Ten to 30 times as many people die as a result of end-organ failure than are fortunate enough to undergo transplantation. To date, efforts to increase the donor pool or establish an alternative to transplant have failed. The authors’ goal was to define a revision to the transplant system that can use innate human motivators to lead to an increase in organ donation. People are motivated more by self-interest than by altruism. To increase organ donation, the incentive needs to be aligned with self-interests. Therefore, the authors propose that the priority to receive a transplant should be based on prior willingness to be a donor: to get, you have to be willing to give. This would replace the “time on list” as a key variable in determining priority and waiting time. The commitment to the system of transplant—being a willing donor—is the fairest way to prioritize recipient status. Such a system will encourage more donation as people on the donor list start to receive transplants themselves, especially when the transplant takes place quickly, before risk becomes excessive.

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