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Facebook Inc. took a momentous action last week. And I don’t mean its announced intention to sell shares for $28 to $35 in an initial public offering later this month.
Of more importance to at least one segment of the population was the company’s invitation to users to register to become organ donors. Forty-eight hours later, more than 100,000 people had indicated, on Facebook Timeline, their wish to be a donor when they die.
As a result, online state donor registries experienced a remarkable 23-fold surge, according to Donate Life America, a nonprofit alliance of national donor advocate organizations.
Better yet, a week later, the traffic was sustained. Typically, Web-based promotions lead to a spike of interest that dissipates within hours.
For the 114,000 people waiting for a kidney, liver, heart or lung — 7,000 to 10,000 of whom die each year — Facebook has performed a great public-health service. For more than two decades, advocates have been urging people to sign up as donors when they renew their driver’s license, yet only about 43 percent have done so. Facebook has made registering much easier.
And although this impressive achievement won’t be enough to fill the great demand for transplantable organs, it may also help show the way forward to encourage live donations.
Facebook’s donor-registration strategy is unique in that it allows people to announce to their friends what they have done, encouraging them to become donors, too. Studies have shown how information about people’s decisions to perform a public good can persuade others to follow suit. In 2004, for example, researchers at the University of Zurich reported that students were more likely to donate money to help financially disadvantaged students when told that more than half of their peers had given in previous years. If told that less than half of the previous students had given, they were less likely to donate.
Similarly, a 2009 study of public-radio on-air fundraising found that when listeners were told about a recent large donation, the amount of money promised rose 12 percent. In that same year, other researchers found that towel reuse at a hotel increased by a third when guests were told that almost 75 percent of other guests reused their towels.
None of these studies involved social media, however. Given Facebook’s reach, the site might be able to amplify positive peer pressure and drive awareness more powerfully than standard public-health appeals do.
“We are now in a great position to understand patterns of behavior — what kinds of people are enthusiastic, who needs more persuasion,” said Judd Kessler, an economist at the University of Pennsylvania’s Wharton School. He plans to analyze the demographics of people who now join state organ-donor registries.
Organ-donation groups are rightly thrilled with Facebook’s initiative. Yet it’s important to keep the larger picture in mind. Even if every American agreed to be an organ donor, there still wouldn’t be enough kidneys for transplantation.
I specify kidneys because people with renal failure represent about 80 percent of those on the national organ waiting list. Last year, roughly 91,000 people needed a renal transplant, but only one fifth of them received one.
Now look more closely at the donor math: Of the roughly 2 million Americans who die annually, it has been estimated that only 10,500 to 13,000 possess organs healthy enough for transplanting. So, if every eligible person donated his organs at death, surgeons might be able to double the number of transplant surgeries. (Last year, 7,433 deceased donors yielded an average of 1.5 kidneys each, for a total of 11,043 operations; the rest were done with organs supplied by living relatives and friends.)
Without doubt, a deceased-donation windfall would shorten the time some people languish on dialysis, and it would prevent the premature deaths of others.
But a “shadow list” of ill people is waiting in the wings. These are patients on dialysis who could benefit from transplantation, but whose doctors have never referred them for the surgery. Jesse Schold, an epidemiologist at the Cleveland Clinic, estimates this pool to number from 80,000 to 130,000 people.
Thus, the true waiting list may be double its current size. And with enhanced public awareness of efforts to generate more donations, people who are not currently listed (perhaps their physician never enrolled them; perhaps they thought their chance for a transplant was too slim to bother) might now come forward. Their family and friends may now be more likely to urge them to do so.
In other words, paradoxically, more awareness will bring new donors but also greater demand. The supply of organs from the deceased will not be able to keep up.
More living donors are needed, as well.
Can the Facebook initiative be leveraged to increase living donation? Deciding to give a kidney while alive to a loved one, let alone a stranger, is very different from checking a box that instructs medical professionals to take your organs when you are gone. (I myself received a kidney transplant from a living donor.)
What’s needed to complement Facebook’s breakthrough are rewards for living donors. These could take many forms — perhaps a contribution to a retirement fund, an offer of lifetime health insurance, a tuition voucher or a large charitable contribution in the donor’s name.
In-kind rewards such as these would not attract desperate people who might otherwise rush to donate for a large sum of instant cash. Living kidney donors would be carefully screened for physical and emotional impediments to safe donation and be guaranteed follow-up medical care for any complications.
Right now, such incentives are illegal. The 1984 National Organ Transplant Act considers any kind of donor enrichment a felony punishable by a maximum of five years in prison and/or a fine of as much as $50,000. With ample public support, that law could be changed to allow pilot trials of incentives.
Facebook’s donor sign-up is a brilliant way to harness the power of social networks to save lives through donation after death. Next, perhaps the social-media giant can add another status question that allows people to “like” the idea of rewarding people who are willing to give a kidney and save more lives — and tell their friends.
Sally Satel is a resident scholar at AEI.
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