Der Mangel an Spenderorganen – Ursachen und Lösungsmöglichkeiten aus ökonomischer Sicht / The Shortage of Transplants – An Economic Analysis of Causes and Possible Solutions

Summary There is an increasing shortage of human organ transplants in Germany. This paper aims at understanding the reasons for that shortage and discusses various ways to alleviate it by changing the rules of donation and procurement. In particular we consider creating adequate incentives for hospitals and individual donors to participate in the process. In Section 2 we provide a stylized account of the nature and extent of organ shortage in Germany in terms of some key data. Then, in Section 3 we will turn to the incentives of hospitals and their employees, in particular those of intensive care units. When they intend to participate in the process of procuring cadaveric human organ transplants, they may face some rather severe obstacles. In Section 4 we turn to the role of potential organ donors and their families. We discuss different strategies to increase consent to a donation of organs after brain-death has been diagnosed. We particularly consider monetary and other incentives as well as the introduction of the presumedconsent rule. In Section 5 we conclude that organ shortage is due not to natural constraints but to inappropriate social institutions. Introducing a presumed consent rule, reciprocity in organ allocation, better payments for hospitals and for donors are proposed as potential remedies.