Friday, October 31, 2008

A Way To Reward Organ Donors

By Sally Satel and Benjami Hippen

With so many on the waiting list for a life-saving organ transplant, ideas keep emerging on ways to provide incentives for living donation or for people to sign donor cards and register to be a donor. The U.S. National Organ Transplant Act makes it a felony for donors to receive compensation and Sen. Specter, R-PA plans to introduce a bill in November to remove this restriction, as noted in this article.

"So here is our proposal: The government should devise a safe, regulated system in which would-be donors are offered incentives to donate a kidney--not necessarily cash payment but material reward of some kind"

A grim medical milestone has just been reached: Over 100,000 people now wait for a new kidney, liver, heart or lungs. Sadly, this is no surprise. Ever since the first successful organ transplant took place in 1954, there have never been enough organs.

Kidneys are in greatest demand. Over three-fourths of the national list comprises people waiting for one, according to the United Network for Organ Sharing, the entity that collects and distributes organs from the newly deceased under contract with the Department of Health and Human Services.

Only one in four people on the list will get a kidney transplant this year. The rest will languish on dialysis while their names crawl to the top of the list--an ordeal that can take five to eight years in big cities.

Every day, eleven people die waiting for a kidney than never arrives. Tragically, they were healthy enough to benefit from a transplant when first listed. But since no friend or relative was willing or able to donate (a healthy person can live a perfectly good life with just one of his two kidneys) they had to wait for an organ from someone who died.

Some have taken matters into their own desperate hands. They rent billboards, place ads soliciting kidney donors and join online sites to find a sympathetic donor. Some even go abroad with the sickening knowledge that their new organ might come from an impoverished third world native or an executed prisoner in China.

Despite decades of public education about the virtues of donating organs after death, only half of all Americans have designated themselves as donors on their drivers' licenses. And if family members are unaware that their loved one wanted to give, they are just as likely as not to deny permission for the organs to be taken.

Last year 6,306 people gave a kidney to a loved one--the lowest number since 2000. Bless all these altruistic souls, but if we are to save thousands of lives each year policy makers must face the fact that altruism alone isn't enough.

So here is our proposal: The government should devise a safe, regulated system in which would-be donors are offered incentives to donate a kidney--not necessarily cash payment but material reward of some kind.

Creative ideas abound. Perhaps a donor could receive something as simple as lifelong health insurance. The most efficient plan would be for states to implement their own creative ways of giving a combination of incentives to donors: tax credits, tuition vouchers or a contribution to a tax-free retirement account.

Keep in mind, it would not be the sick person who reaches into his own bank account to reward the donor, rather the government would provide compensation. That way, no matter how big or modest one's income, everyone in need of a kidney would benefit. And, in keeping with the current system for distribution of organs from the newly deceased, the kidney would go to the next person in line.

Donors, of course, would receive education, undergo careful medical and psychological screening and receive quality follow-up care. Would the promise of a reward exploit poor donors who saw it as an offer they couldn't refuse? Unlikely. A months-long screening process and a non-cash reward won't appeal to those in desperate need of financial help. What they want is quick cash. And that's not what our proposal calls for.

Within such a framework, altruistic donation would proceed in parallel with a system that offers compensation. But first Congress must revise the 1984 National Organ Transplant Act (NOTA) so it is no longer a felony for donors to receive compensation. This would clear the way for pilot studies of incentives.

Sen. Specter, R-Pa., is circulating a draft bill called the Organ Donor Clarification Act of 2008. He plans to introduce it in November. The bill simply clarifies that NOTA had never intended to preclude government action to encourage organ donation.

Thus, if the Act passes, there will be no doubt that state-sponsored in-kind incentives, such as a tax credits for living kidney donor or funeral benefits for deceased donors, would be legal. Meanwhile, existing penalties for organ brokering are increased.

Surprisingly, a major obstacle to incentives has come from the predominant advocacy group for patients with renal failure: the National Kidney Foundation. The foundation worries that offering benefits to donors will "cheapen the gift," according to its spokesman.

We don't see it that way at all. When one of us, Sally Satel, needed a transplant two years ago and was searching for a donor, any kidney--whether its previous owner received compensation or not--would have been precious beyond measure.

The same goes for the other of us, Benjamin Hippen, a nephrologist who sees patients suffer on dialysis everyday. Some die waiting for an organ that never arrives. He wants to see more kidneys transplanted safely, no matter whether they are given by a loving friend, by a relative or by a stranger who accepts a reward for having saved the life of a stranger.

This year, thousands of Americans will die needlessly for want of an organ. We already know what isn't working. It is time to try something else.

Sally Satel is a resident scholar at the American Enterprise Institute. She is editor of When Altruism Isn't Enough: The Case for Compensating Kidney Donors. Benjamin Hippen is a nephrologist in Charlotte, N.C., and former member of the United Network for Organ Sharing ethics committee.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at or Download Donor Cards from OrganDonor.Gov

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants. One tissue donor can help up to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves


Dave said...

The generosity of live organ is wonderful. It's a shame we need so many live organ donors. Americans bury or cremate 20,000 transplantable organs every year.

There is another good way to put a big dent in the organ shortage -- if you don't agree to donate your organs when you die, then you go to the back of the waiting list if you ever need an organ to live.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. About 50% of the organs transplanted in the United States go to people who haven't agreed to donate their own organs when they die.

Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Cristy aka Conspicuous Chick said...

The first, relatively simple, step the US could take to increase donor organs is to implement an 'opt-out' system of donation as opposed to the current 'opt-in' system. People of driving age would actually have to stipulate they DONT want their organs donated upon death, which would save physicians and otherwise from having that 'difficult' conversation with patient's families when they are in the throes of grief. Other countries have done this and it has narrowed the gap considerably.

Of course this won't completely solve the problem, but then again, I'm not sure anything will. What I do know is that offering living donors lifetime health insurance, with the dismal state of the health insurance situation in this country, is just asking for abuse. Millions of people in this country have no insurance, mostly through no fault of their own and it doesn't take a specialist on human behavior to know that if this offer were dangled out there, folks in desperate situations would go running to sign up for organ harvesting - for all the wrong reasons.

Another sideline of any 'reward' is that a certain segment of potential donors would lie about their medical or psychological history to be chosen for donation. I realize the litany of tests potential donors must endure before being "cleared" (because I donated a kidney in Aug 08) but again, someone is paying for those expensive diagnostics (usually the intended recipient's insurance company) so these 'wasted' costs will be passed on to the rest of us (consumers).

Here's another issue - the biggest kidney killer in the US is diabetes and like it or not, many forms of diabetes are preventable and/or very controllable. If you speak to the nurses at LODAP, they'll regale you with tales of naive and ignorant kidney patients who think that a transplant is a 'cure' for whatever ails them. Consequently, they're not particularly concerned about staving off a transplant. Americans, with their unprecedented preponderence of obesity, need to be strongly encouraged to practice PREVENTION and making positive LIFESTYLE CHOICES that will reduce the possibility they'll ever be in a position to need a new kidney.

A transplant is not a cure, and life post-successful-transplant will never be as carefree and 'normal' as life with two natural, functioning kidneys. The medical community cannot wave their magic wands and make everyone better. There simply isn't enough money or resources to go around. It's time the citizens stopped expecting them to.