David Farrar neatly shows why low organ donation rates are not a complex issue, though Peter Dunne says they are.
But Labour’s new found enthusiasm for ‘tough love’ incentives suggests the solution.
Labour want benefit entitlement suspended for failure to register to vote. National should have seized that with both hands and extended it to other normal social obligations of decent citizenship, like not preying criminally on your neighbours, and getting your kids to school after a good breakfast.
But Labour’s rediscovery of the power of incentives also points to a simple way to get family wishes on organ donation rapidly lining up with the wishes of their dear departed would-be donor.
New Zealand has a disgraceful shortage of donated organs. Under rationing it should be elementary, and widely known, that those in the queue who have ticked the donor box themselves rank ahead of those who have not. Those who tick more recently should rank behind those who have always been donors.
And donors whose families have not irrecocably waived their veto power should know that it is likely to disqualify them, or at least put them at the end of the queue, and possibly also affect the chances of their dear pre-departed.
Reciprocity is the basic element of social obligations, and mutual respect. What could possibly be more fair, more simple and more speedy than to announce reciprocal generosity as the basis of future policy. Once free-riding on the anticipated generosity of other families ceased to look so likely, New Zealand’s shameful organ donor statistics would rapidly turn.
Research shows that a feeling that social cheating or bludging is rewarded is among the most corrosive factors in loss of social or civic capital.
Mr Dunne you could probably fix this without needing to lift a legislative finger. The current organ rationing criteria are not legislated. That does not need to change. It would just require the doctors concerned to announce that they will take reciprocal fairness into account, and to act accordingly.
Hippocrates would approve. I researched the current medical culture’s resistance to ‘moral judgments’ some years ago and found it to be of very recent development.
RSS feeds available for 
There are two elements to this situation. Firstly, low organ donation rates could be enhanced through incentivisation, as you say; however, to move a person up or down the queue for social benefits on the basis of his/her donation status could be of only indirect benefit on the one hand (thus resulting in no more than a lukewarm response), or potentially punitive on the other (prompting antipathy, a further erosion of social cohesion, and endless political hand-wringing). A more direct method of reward (as adumbrated in my book, which I sent you a year or so ago) would – if one believes in the power of psychological conditioning – yield rapid and solid dividends. In other words, this particular issue is but a paradigm for both a wide range of issues relating to the social contract, and also the means by which we may drag the lazy, socially irresponsible, and apathetic out of their selfishness.
Secondly, you are right about doctors’ reluctance to make moral judgments. There once was a time (when I trained in the profession) when this was part and parcel of our responsibilities: we were skilled at medicine, and both expected and encouraged to exercise wisdom in making difficult ethical calls. This was all swept away by the tide of ‘anti-paternalism’ that characterised the new era of health care; patients became ‘health consumers’, Jack was deemed to be as a good as his master, and those with an axe to grind set about bringing the medical profession to heel. The result is that nowadays doctors are, in the main, afraid of speaking out of turn because they’re likely to find complaints and criticism raining down on them. Even if they have a defensible position, it’s hardly worth the candle: the resultant fuss and bother makes it all too stressful and bothersome. That’s why I retired from medicine prematurely. There will have to be a major culture change if this sorry state of affairs is to change, but I can’t see it happening any time soon.