Organ Donation Is a Market Problem—and Facebook May Have Just Solved It

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Facebook may have just solved a stubborn -- and heartbreaking -- public-health problem.

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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 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 notice, 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.

On the other hand, though: This is 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 social good is pretty much inarguable. The publicity is the point. And if goodwill accrues to Facebook in the process, well, great -- that will encourage the company to keep thinking of ways to marry its network's utility with net utility. It's not hyperbole to say that the organ donor option could see Facebook systematically saving lives -- and solving a conundrum 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 discrepancy between demand (those seeking organs) and supply (those 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 worldwide, are waiting for heart, kidney, or liver transplants. And an average of 18 people a day will die while waiting for organs to become available.

It's useful, from that perspective, to think about organ donation the way Harvard professor Nicholas Christakis does: in terms of cascades. In the book Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives, Christakis and his co-author, UCSD professor James Fowler, consider networked organ donation as a cascade not of information or of violence, as in the most classic senses, 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. The gratitude radiates. Empathy itself takes on network effects.

The problem in the past has been that network effects tend to be limited, ironically, by the constraints of 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 deceased donor 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, 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 donation, 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, too -- and about giving them an easy outlet for doing just that. The little "sign up here with the appropriate registry" link that Facebook includes in the Organ Donor field is, actually, huge. And while the registration option doesn't go so far as to make organ donation an opt-out thing, it takes a big step toward making opting in much, much easier. Facebook's approach, the economist Richard Thaler told me, is consistent with the model of "prompted choice" that he advocates. As Thaler has previously 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. Given that each donor can 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. This could be a model of what public health will look like in an age of digital connection. (As Tim O'Reilly puts it, "This is the kind of social engineering that once only governments could do.") So while it's easy, and important, to focus on Facebook as both an agent and a potential abuser of our personal interests, today's announcement is a reminder of what can come when its network is harnessed for the interests of the collective. Facebook may have just solved a persistent public health problem. And with little more than a click of a button.

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Megan Garber is a staff writer at The Atlantic. She was formerly an assistant editor at the Nieman Journalism Lab, where she wrote about innovations in the media.

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