The Global Organ Shortage: Economic Causes, Human Consequences, Policy Responses was written by three economists. Given that one, David Kaserman, has previously championed incentives for donation, it is not surprising that the authors' conclusion favors incentives. The book starts, “The organ transplantation policies by the vast majority of the world's nations have failed.” That said, the authors have made a superb attempt to acknowledge and present detailed strengths of arguments both for and against incentives [1-3]. Their stated goal is to focus attention on the problem and provoke further discussion of solutions.

The book has excellent flow, with each of its nine chapters building on momentum from previous ones. The first chapter (Introduction) defines the problem of a global shortage of organs and outlines the format of the book; the last (Conclusions) reviews the authors' arguments.

Chapter 2 describes the evolution of transplant policies throughout the world and their almost universal basis in the concept of ‘altruism.’ Chapter 3 states the human consequences of these policies—an organ shortage with thousands of candidates dying or becoming too sick to transplant each year while waiting on the list for a transplant.

Chapter 4 discusses the social costs and benefits of transplantation versus alternate therapies. As noted in previous publications, transplantation can save health care systems billions [4]. Consequently, the authors believe that reforms increasing the number of transplants would be advantageous for both patient outcomes and society. They show through economic modeling how incentives would increase both living (LDs) and deceased (DDs) donation. Although cost–benefit analysis is most clear for kidneys, they note that with increased DDs, candidates on all lists could benefit. Chapter 5 outlines the consequences of a “zero (dollar/euro) point price for organs” and the causes of a lack of system reform. Although the authors believe that the major cause of the organ shortage is that compensation is illegal, they acknowledge other contributing factors, and comment that those opposed to incentives favor other reforms to increase donation, albeit “within the current paradigm.” Chapter 6 provides a history of attempts to reform the donation system to increase both living and deceased donation. The authors note that some—e.g. Spanish Model, use of ECDs—have made an impact, but a severe shortage persists. They conclude, “In our view, the introduction of more radical reforms, including [compensation for LDs and DDs], is imperative.”

Chapter 7 addresses the moral basis of objections to compensation. The authors portray these objections realistically, stating that the organ shortage is “perhaps the most complex and morally controversial medical issue aside from abortion and euthanasia.” Each previously described concern is addressed; ultimately the authors believe that the possibility of saving lives outweighs any other argument. Chapter 8 provides their proposal for a Public Monopsony for Organ Acquisition (for both LDs and DDs) [4, 5]. Again, acknowledging counterarguments, the authors state, “The reform we propose tries to advance the policy of preserving life while respecting important social taboos and taking seriously widely shared moral convictions.” Their modeling shows how a variety of incentive systems could increase both LDs and DDs, and they comment that different systems may work better for different countries.

Overall, the book has many strengths. The authors provide an international perspective while respectfully describing both the pro and con perspectives on incentives. There are a couple of minor weaknesses: (a) as with any book, some of the data (e.g. current donation rates) is out of date, and (b) although a non-economist can understand the general concepts, following the mathematical models is difficult. Fortunately, little of the book addresses these formulas.

The book is easy to read and should be of value for those interested in obtaining an overview of the topic from a single source; and, in its detailed discussion of the pros and cons of incentives for donation, it can serve as a resource for those who argue either side of the topic. I would recommend it highly.


  1. Top of page
  • 1
    Richards JR. Nefarious goings on. Kidney sales and moral arguments. J Med Philos 1996; 21: 375416.
  • 2
    Danovitch GM, Delmonico FL. The prohibition of kidney sales and organ markets should remain. Curr Opin Organ Transplant 2008; 13: 386394.
  • 3
    Garcia GG, Harden P, Chapman J, for the World Kidney Day Steering Committee 2012. The global role of kidney transplantation. Curr Opin Organ Transplant 2012; 4: 362367.
  • 4
    Erin CA, Harris J. An ethical market in human organs. J Med Ethics 2003; 29: 137138.
  • 5
    Working Group on Incentives for Living Donation. Incentives for organ donation: proposed standards for an internationally acceptable system. Am J Transplant 2012; 12: 306312.

Corrections made after online publication June 3, 2013: formatting has been altered and reference citations have been updated.