Paying to Donate

If you log on to the web site of the National Marrow Donor Program and try to register yourself as a potential donor, you're met with an unexpected surprise: a $52 fee.

Budget constraints have forced the registry, which facilitated 3,200 transplants in 2006, to charge a fee for a kit used by potential donors to swab their cheeks for cells. The organization's web site says that this fee may be waived in certain situations.

Still, in a showing of altruism, over 6 million eligible Americans have signed up to be donors.

But not surprisingly, that's well short of the optimal number of people the registry needs to ensure that patients suffering from diseases like leukemia and lymphoma can find a potentially life-saving match, write economists Ted Bergstrom, Rod Garrat, and Damien Sheehan-Connor of U.C. Santa Barbara.

Below are two charts showing the donor gap (it's particularly a problem for non-white ethnicities) and the chance that there's no match for the average person who needs a transplant:

The costs associated with actually donating bone marrow (and of volunteering in general) outweigh the benefits for most. The procedure usually involves the use of general or local anesthesia.

But perversely, the more people register, the less chance that they will be called upon to donate.

The researchers estimate that the optimal registry would contain 21.5 million people, and while donor numbers are growing, there will likely be a shortfall in the number of registrants needed to maximize the chance that every patient finds a match.

So how to get more donors?

The researchers propose a plan familiar to economists and libertarians alike: paying people for their marrow. This fee would only be paid to those who wind up donating, not to those who only register.

Much like congestion pricing, I'd argue that this is an idea whose time has come (or should come soon). With the right regulations and proper oversight to prevent abuse, why prevent people from being compensated for providing a service that will save lives?