Monday, June 30, 2008

AMA meeting: Delegates seek to change law on organ donor incentives

From American Medical News:

The proposal would make it legal to conduct ethically designed pilot studies of payments for cadaveric donations.

"As many as 7,000 patients die while on the waiting list, and since 1988, 75,000 have died waiting for a donor organ"

By Kevin B. O'Reilly
Chicago -- With the United Network for Organ Sharing waiting list approaching 100,000, the AMA House of Delegates voted in June to put the prospect of paying organ donors high on its legislative agenda.

Six years ago, the house approved studying benefits and harms of financial incentives for cadaveric organ donation. But even testing the idea on a demonstration basis is illegal under the 1984 National Organ Transplant Act, which bans "valuable consideration" in exchange for organ donation. The change would not apply to living organ donors.

"If there are other ways to increase the supply of transplantable organs and do it in an ethical way ... it is worthwhile to at least study," said AMA Board of Trustees member Joseph P. Annis, MD. "We need to expand the number of donors, and we should look at every ethical way that we can do that."

Alternate delegate Gerald A. Wilson, MD, a Columbia, S.C., general surgeon, said that in his work with the state organ procurement organization, he has encountered families of donors who ask for financial help with burial expenses.

"By law, we're prohibited from doing that," said Dr. Wilson, who introduced the resolution adopted by the house. "We cannot put a price on tissue or human life, but there is a need to see if it's possible to increase the number of organ donors."

As many as 7,000 patients die while on the waiting list, and since 1988, 75,000 have died waiting for a donor organ, according to the resolution.

Since 1981, AMA delegates on multiple occasions have adopted or reaffirmed policy calling for pilot studies of ways to increase organ donation.

One approach is mandated choice, in which individuals are required to say "yes" or "no" to cadaveric organ donation when getting a driver's license or filing tax returns. Another is presumed consent, in which the dead are legally assumed to be donors unless they expressed wishes to the contrary.

Many delegates opposed any form of paying for organs, saying it could lead to exploitation of the poor and drive down donation rates.

"Organ donation is currently based on altruism, and it's a very brittle altruism," said Peter N. Bretan Jr., MD, a Novato, Calif., renal transplant surgeon. "Any perception we give forward that doesn't give the freedom to opt out or allows payment ... will specifically hurt altruism and decrease altruism."

Dr. Bretan said reform efforts should focus on removing financial disincentives, not inducing donation with big-money offers.

But Thomas G. Peters, MD, a Jacksonville, Fla., transplant surgeon, argued that a regulated payment for cadaveric organ donation, similar to the death benefit given to the families of fallen soldiers, is ethically appropriate and could forestall grislier alternatives.

"This is a gratuity from America for service to Americans," Dr. Peters said during committee debate. Pushing again for the resolution on the house floor, he said "circumstances have gotten to the point that the lack of domestic cadaveric organs has driven a move to transplant tourism."

The AMA Council on Legislation will propose language to change federal law in line with the adopted resolution and lobby Congress.

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