Con il sistema attuale di donazione la carenza di organi disponibili per i trapianti è sotto gli occhi di tutti, la gran parte dei malati in attesa di un rene attenderà invano. E’ questo il dato di fatto da cui parte Alexander Tabarrok per proporre la riforma contenuta in “The Organ Shortage”:
The current system for motivating the supply of human organs has failed to end the shortage. Thousands of people die every year while they wait helplessly for an organ transplant and thousands more will die in the next few years… Today, roughly 60,000 people are waiting for organ transplants, although less than 10,000 will become donors.
Già in passato molti economisti hanno affrontato il problema chiedendo di istituire un mercato degli organi:
… For many years, a number of economists and economics-minded lawyers have offered their solution to the crisis: remove the legal restrictions on the purchase and sale of human organs (Becker 1997; Epstein 1993, 1997; Cohen 1989; Pindyck and Rubinfeld 1998; Barnett, Blair & Kaserman (1996, this volume).' The economic argument is familiar. Just as rent controls create a shortage of rental apartments, government rules that outlaw the buying or selling of organs on the open market hold the price of organs at zero and make an organ shortage inevitable…
Senonché la soluzione è apparsa a molti “ripugnante” e respinta al mittente. Non c’è motivo di dubitare sulla veridicità di questo giudizio visto che tra gli scontenti ci sono anche alcune Associazioni di malati:
… Discomfort with organ sales is so strong that even some people who are desperately waiting for an organ are against allowing monetary compensation for donation. Many people feel that organ sales violate a moral intuition about the inalienability of the body…
Altri temono le diseguaglianze. Difficile arginare unb problema del genere senza perdere l’efficienza garantita dal mercato.
Others believe that opening a market for human organs would lead to an unfair distribution of organs… Allocating organs, at least in part, by ability to pay is often perceived as unfair… Monetary compensation to the donor could be arranged without the necessity of payment from the recipient, thereby avoiding this issue. But the counterargument of those who think that markets are unfair is that monetary compensation is the "thin edge of the wedge" that would eventually usher in monetary purchase…. Organs are treated like fish in a lake owned in common. Anyone is allowed to fish in the lake, but the decision to restock is private and voluntary.
Del resto oggi il donatore ha solo costi: difficile aumentarne il numero:
Anyone is allowed access to the supply, but contributing imposes private costs on signers of the organ donor card.'… The costs of signing an organ donor card are in part psychological-perhaps the potential donor does not want to think about his own mortality or suspects that donation will interfere with proper enjoyment of the afterlife.' More concretely, some potential donors fear that if they sign their cards and are involved in a life-threatening accident, they are less likely to be revived than nondonors…
Una soluzione che sembra superare in parte i problemi esposti potrebbe essere rappresentata dalla regola “no give no take”: se non doni non ricevi. In questo modo è possibile premiare i donatori imponendo un costo ai non donatori.
The traditional solution to a tragedy of the commons problem is to enclose or "privatize" the commons. In the case of transplantable human organs, this can be done by restricting organ transplants to those who previously agreed to be organ donors; in short, a "no-give, no-take" rule… At present, nonsigners face no costs to not signing their donor cards. The no-give, no-take rule raises the costs of not signing or, equivalently, increases the benefits of signing, and thus it will increase the number of organ donors… Children would be automatically eligible to receive organs until the age of sixteen, when they would have the option to sign their cards…
Il sistema ha qualche problema ma si puo’ rimediare:
To prevent people from signing after learning they were in need, there would be a mandatory waiting period of at least one year after the age of, say, 18 before the right to receive an organ took effect…
Il sistema comporta la morte di alcune persone che sarebbero sopravvissute col sistema attuale ma mi sembra una conseguenza moralmente accettabile anche per un cattolico.
The no-give, no-take rule may result in the deaths of some people who would have lived under the current rules. Thousands of people are dying today, however. If the no-give, no-take rule increases the number of potential donors, then fewer people will die on net. If enough people sign their donor cards, this plan could even produce a surplus of organs… Any remaining organs could then be allocated on the same basis to nonsigners…
In una versione più edulcorata potremmo dire che diventare donatori ci fa guadagnare qualche posizione nella fila d’attesa:
A more modest version of the no-give, no-take rule could be implemented by stating that, henceforth, points should also be awarded for previously having signed one's organ donor card.' It would then be allowable, for example, to give an organ to a nonsigner before giving it to a signer if the nonsigner had been on the waiting list for a long time…
Ripeto, il maggior vantaggio del sistema proposto è che supera gran parte delle obiezioni etiche avanzate, anche quelle di natura religiosa:
A considerable advantage of the no-give, no-take rule over organ markets is that far fewer moral qualms are raised… Although it is understandable that some people may have misgivings about becoming donors for personal or religious reasons, why should someone who was not willing to give an organ be allowed to take an organ?…
COMMENTO PERSONALE
Il mio saggio ideale: limpido, chiaro, non schierato (sebbene l’autore sia schierato, e questo lo posso dire esclusivamente per mia conoscenza personale). Ma soprattutto si prende atto delle posizioni contrapposte senza caricature proponendo una via di mezzo senza nascondere i problemi che restano insoluti. Insomma, leggere Alexander Tabarrok è consolante, fa persino sperare che gli economisti servano a qualcosa.
