patientRecently Walter Payton, former Chicago Bears running back, announced that he has a rare form of liver disease and is awaiting a transplant. How do hospitals in the United States determine who should receive a transplant and when? You will practice your decision making skills by developing various methods of rationing livers. You will analyze the effect of various government policies on the incentive structure that affects people's decisions.


In this lesson you will explain the consequences of a non-market rationing process, evaluate the consequences of restricting organ transplants to U.S. citizens, and suggest alternative policies to reduce the scarcity of organs for transplant.


First, use the Web to learn more about Walter Payton's prospects for receiving a liver transplant. Read two articles at CNNSI

Does Payton's status as a former pro football player make it easier for him to get a transplant?

Knievel Counsels Sweetness - Why does Kneivel suggest that Payton go to Florida?

What does Dr. Ramos say affects the length of time a patient waits?

View the UNOS National Patient List (see Organ and Tissue Donation)

What is the total number of people awaiting transplants?

How many are on the list for a liver transplant? .

How many people received transplants during 1997?

Visit the UNOS site - What is the purpose of this section?

How will education affect the supply of donors?

Pretend you are a member of a surgical team in a leading U.S. hospital. As a team, you must decide which patients should receive liver transplants as donated organs become available. Recently your hospital received an organ donation from the family of an accident victim. As best as your team can determine, each of the three candidates' bodies would accept the liver without major threat of rejection. The cost of this operation, surgical fees and hospital care, would come to approximately $50,000. Decide which patient will receive the liver transplant operation. Identify the criteria you used to evaluate each patient.

Potential Liver Transplant Recipients

  1. A 40-year-old Canadian male construction worker with a wife and five children. Until recently, he provided most of the family's income. Now his wife works at part-time jobs to earn the family income. His insurance would cover about one-half of the costs of the operation and post-operative medical care.
  2. A 30-year-old female working as a sales representative for the regional telephone company. She has no family. She plans to marry as soon as her health improves as a result of the liver transplant. Her health insurance will cover the costs of the operation.
  3. A 45-year-old former pro-football player with a wife and children. His health insurance will cover the cost of insurance.

What economic principles apply in this situation to help us understand the problem?

Suppose a member of Congress, reacting to the large number of liver transplants provided for non-U.S. citizens, introduced a bill to require an "Americans First" policy. This policy would require all hospitals and organ procurement agencies to provide organ transplants to foreign nationals only after conducting a lengthy, thorough and unsuccessful search for a suitable U.S. recipient.

  1. Would such a law change your earlier decision on the transplant recipient?
  2. Would such a law increase or decrease the supply of donated livers?
  3. Would such a law help increase or decrease the number of people who want an organ transplant?
  4. How might other countries react to such a law?
  5. Do you think the legislator feels that Americans are more deserving of a transplant?
  6. Whose interest is he serving?


For discussion:

  1. Would an "Americans First" policy influence of the decisions of doctors?
  2. How would an "Americans First" policy change patient incentives?
  3. Is an "Americans First" policy on liver transplants different from other trade restriction laws?
  4. Do non-market rationing programs correct the problem and provide equal treatment to everyone?