Researcher-driven versus policy-driven economic appraisal. The case of xenotransplantation

Worldwide ethical considerations have led to banning markets for human organs and to promoting supply of organs for transplantation strictly on a donor noncommercial basis. In most industrialized countries, including France, there is a shortage of organs available for transplantation. Following on the earlier debate between Titmuss and Arrow over banning the market for blood supply, this presentation first challenges the conventional economic view that the ban is necessarily responsible for these critical shortages. It will argue that it is the obstacles to adequate exhortation (i.e., the efforts to inform and persuade participants in the donor system who cannot be paid for what they supply) rather than the inefficiency per se of appeals to donor altruism that are the cause of a shortage. The paper will then discuss the way a market for non-human organs may be an efficient alternative to a donor system by supplying a substitute good. Data from a survey in a random sample of the French general population (> or = 18 years of age in June 1997; response rate = 62.0%; n = 1,011) show that less than half of the respondents (42.4%) agreed that xenotransplantations should be developed. Support for xenotransplantation was higher (50.6% vs. 38.2% in the rest of the sample, p < 0.001) among respondents who declare that in case of an accidental death of a family member, they would accept the use of his organs for transplantation, among those with the highest level of knowledge about transplantation (48.6% vs. 39.4%, p < 0.005), and among blood donors (45.9% vs. 38.3%, p < 0.02). Supply of non-human organs should remain under the control of the public sector in order to be consonant with current donor systems for human organs. Recommendations for adequate regulation of the R&D process of non-human alternatives for organ transplantations will be made.