'Mutual Insurance Pool' Could Improve Transplant Organ Shortage

July 30, 1998

Two Simon Fraser University researchers say a chronic shortage of human organs needed for transplant in North America could be effectively alleviated through the implementation of a traditional "insurance" program.

In an article to be published this fall in the Journal of Health Politics, Policy and Law, SFU business professors Aidan Vining and Richard Schwindt are selling the idea of a "mutual insurance pool" as an alternative incentive program to their proposed future delivery market for organs, which generated continent-wide interest and controversy more than a decade ago.

The major stumbling block of the earlier future market scheme, in which individuals could sell the rights to their organs, to be delivered at death, was its emphasis on monetary incentives.

The researchers, both public policy analysts in SFU's faculty of business administration, argue that an insurance pool would be more "politically feasible."

"The concept of mutual insurance is an old tradition," notes Vining. "It has a long and respected lineage, which should help to support the social and political acceptability of this idea."

According to the proposal, an individual would receive priority for a transplant upon agreeing that his or her organs will be available to other members of the insurance pool upon death.

In cases where there are multiple members of the pool waiting for the same organ type, pool "managers" would use an intrapool priority system, based on standard matching procedures.

"In an insurance pool, an individual's commitment to having his or her organs delivered at death is a form of insurance premium," explains Vining.

"The insurance benefit is the priority right to an organ if an individual falls into the recipient class," he adds. "It's equivalent to the benefit an insured person receives when claiming for property fire or flood damage. The premium, or 'price,' in this case is the commitment to provide one's own organs upon death."

The researchers initially came up with the insurance pool idea as a solution to the growing need for organs for children, as youngsters would have been unable to participate on their own behalf in the formerly proposed future market system.

The pair propose the pool be organized as a government-run monopoly to simplify the collection and transferring of organs to pool recipients, and to ensure a level of trust that would encourage potential donors to join.

They also expect the idea would be more attractive to "risk-averse" individuals, such as those with higher incomes, who would tend not to be enticed by monetary incentives.

To avert the problem of too many "high-risk" individuals insuring, sending "premiums" escalating, the researchers recommend required medical examinations for applicants, and only admitting those with a "normal probability" of needing a transplant. Another option would be to create "risk classes" and give low-risk individuals first-priority access to organs donated within their class. "This would encourage low-risk individuals to join, increasing the supply of organs to the benefit of all groups," says Schwindt.

The researchers expect that non-pool members would probably benefit from the scheme, even if the government mandated that non-pool donors organs not specifically targeted elsewhere were first made available to pool members. "That would certainly raise the incentive to join the pool," adds Schwindt, "and the number of organs available."

Given the right factors, Vining and Schwindt believe the mutual insurance pool has the potential to bring supply and demand on par. "What is still uncertain," notes Vining, "is precisely how individuals will respond to this idea -- and how many would chose to join."


Aidan Vining, 604-291-5249
Richard Schwindt, 604-291-4166
Marianne Meadahl, media/pr, 604-291-4323

Simon Fraser University

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