Organ Donation Is a Market Problem -- And Facebook May Have Just Solved It
Facebook may have just solved a stubborn -- and heartbreaking -- public-health problem.
This morning, Facebook announced a new initiative:
Starting today, you can add that you're an organ donor to your timeline, and share your story about when, where or why you decided to become a donor. If you're not already registered with your state or national registry and want to be, you'll find a link to the official donor registry there as well.
First, it should be said: This is, in large part, a canny PR move, one that frames Facebook not just as a connector of people, but as an agent of empathy. The timing of the announcement itself, it's hard not to note, is particularly auspicious (or suspicious?): Facebook is anticipating that its IPO documents will get approval this week, after which Zuckerberg and his fellow executives will begin actively selling the company to potential shareholders. So.
But this is also, it should be said, a canny PR move. The advent of the organ donor designation is an effort to publicize a problem, to use Facebook's increasingly enormous platform to get the word out about something whose net social good is pretty much inarguable. The publicity is the point. And if goodwill accrues to Facebook in the process, then great -- that will encourage the company to keep thinking of ways to marry its network's utility with net utility.
And while it's easy to dismiss the move as yet one more piece of personal information included on Facebook, and as one more step forward for the sharing economy and for Facebook's role in creating it ... the organ donation option is actually much more significant than that. It's not hyperbole to say that the move could see Facebook systematically saving lives -- and solving a problem that has long plagued not only patients and doctors, but social scientists. At its core, organ donation is a market problem -- one that carries a high degree of motivational discrepancy, generally speaking, between demand (those seeking organs) and supply (the people who, preemptively, agree to provide them). It's that divide that leads to the heartbreaking statistics: More than 114,000 people in the United States, and millions more around the globe, are waiting for the heart, kidney or liver transplant that will save their lives. And an average of 18 people a day will die while waiting for organs.
It's useful, from that perspective, to think about organ donation the way Harvard professor Nicholas Christakis does: in terms of cascades. In his book Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives, Christakis and his co-author, UCSD professor James Fowler, treat networked organ donation as a cascade not of information, as in the classic sense, but of kindness. If I have a relative whose life is saved by a donated organ, I'm much more likely to become a donor myself -- as are my other relatives. And we're all more likely to encourage donation among our other social connections. "So you have a diffusion," Christakis told me, not just of behavior, but of something more explicit: gratitude. Empathy itself takes on network effects.
The problem in the past has been that network effects tend to be limited, ironically, by networks themselves. The word-of-mouth scenarios that have facilitated the organ donation cascade in the analog world mean that cascades can only go so far before they inevitably fade. That's why we can understand virality as a primarily digital phenomenon. And it's why Facebook's use of its platform to bring virality to organ donor registration could so significantly change the game when it comes to the social economics of organ donation -- and, potentially, of other forms of networked charity.
"I think it's great news that Facebook is going to encourage people to register as organ donors, and (maybe as important) to communicate to family and friends their intention," says Alvin Roth, an economics professor at Harvard who specializes in, among other things, market design and game theory -- both fields he has applied to his work with kidney exchange. "We need to be facilitating all sorts of donation," he notes, "if we're going to turn the tide on the shortage of transplantable organs."
"When I started working on kidney exchange," Roth told me in an email, "there were 40,000+ patients on the waiting list for deceased donor kidneys. Today there are 90,000+." And while kidney exchange "is winning some important battles," he notes -- among other things, it's currently the fastest-growing part of kidney transplantation -- "we're losing the war." There simply aren't enough suppliers to fill the demand. But the advent of online registries, like that of Facebook partner Donate Life, can change those dynamics -- and Facebook's social platform can, in turn, amplify them.
One of the biggest barriers to a wide supply of potential organs, after all, has been a pragmatic one: the difficulty involved in registering to become a potential donor. Registration in most states is done through the DMV: You check a box when you're applying for your drivers license. That's good in that it forces everyone who drives to make an explicit, yes-or-no decision about becoming a donor; it's terrible in that it forces everyone to consider that decision, generally speaking, only once every ten years. The DMV-based norm means that, if you have an experience that makes you want to become a donor -- if you have a relative who has benefitted from the practice, if you have a friend who encourages you to do it -- it's incredibly difficult to follow up on that desire. Your impulse is impeded. The DMV norm stymies the productive power of peer pressure.
Online registries, combined with the added elements of publicity and virality that Facebook provides, could change all that. It's not just about telling people you're an organ donor; it's about, implicitly, encouraging others to become organ donors. That little "sign up here with the appropriate registry" link that Facebook includes in the Organ Donor field is, actually, huge. (Tim O'Reilly, after all, makes an important point: "This is the kind of social engineering that once only governments could do.") And while the registration option doesn't go so far as to make organ donation an opt-out thing, the organ donation is taking a big step toward making opting in much, much easier. Facebook's "organ donor" option, the economist Richard Thaler told me, is consistent with the model of "prompted choice" that he advocates. As Thaler has noted, "many Americans say they want to be organ donors, but they just don't get around to acting on their intentions."
Facebook, of course, provides nothing if not an easy way to act on intentions. And, given that each donor can potentially supply an average of three organs to needy recipients, the effects of one person's action -- and her friend's action, and her friend's -- could be crucially amplified on its platform. Facebook may have just solved a stubborn and heartbreaking public health problem. And with little more than a click of a button.
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