“America faces a desperate organ shortage. Today, more than 78,000 people are waiting for a kidney transplant; only one in four will receive one this year, while twelve die each day waiting for help. Not surprisingly, many patients are driven to desperate measures to circumvent the eight-year waiting list—renting billboards, advertising in newsletters, or even purchasing organs on the global black market. Altruism (the current system where one donates an organ through the goodness of their heart) is an admirable but clearly insufficient motivation for would-be donors.
According to theInternational Society of Nephrology, kidney disease affects more than 500 million people worldwide, or 10 per cent of the adult population. With more people developing high blood pressure and diabetes (key risks for kidney disease), the picture will only worsen.
There are nearly two million new cases of the most serious form of kidney disease–renal failure–each year. Unless patients with renal failure receive a kidney transplant or undergo dialysis–an expensive, lifelong procedure that cleanses the blood of toxins–death is guaranteed within a few weeks”
The argument against paying people for their organs (living donors of kidneys and livers) is that the practice would prey on the poor. Supposedly o nly people who are in desperate need of money would sell their organs. “The rich or reasonably well off,” the argument goes, “Don’t need the money so few of them would become donors under such a system.” Additionally, wealthy people could buy organs from the poor but the poor could not afford to buy organs if they needed them. So the question; “Is it ethical to compensate people for their organs?” My answer is, probably not – if the exchange is simply cash from the recipient to the donor for a kidney. But what if there are other considerations? Dr. Satel offers some interesting options:
“My colleagues and I suggest a system in which compensation is provided by a third party (government, a charity or insurance) with public oversight. Because bidding and private buying would not be permitted, available organs would be distributed to the next in line–not just to the wealthy. Donors would be carefully screened for physical and psychological problems, as is currently done for all volunteer living kidney donors. Moreover, they would be guaranteed follow-up care for any complications.
Many people are uneasy about offering lump-sum cash payments. A solution is to provide in-kind rewards–such as a down payment on a house, a contribution to a retirement fund, or lifetime health insurance–so the program would not be attractive to people who might otherwise rush to donate on the promise of a large sum of instant cash. The only way to stop illicit markets is to create legal ones. Indeed, there is no better justification for testing legal modes of exchange than the very depredations of the underground market.”
Dr. Satel goes on to say that, “Momentum is growing. In the British Medical Journal, a leading British transplant surgeon called for a controlled donor compensation program for unrelated live donors. Within the past year, the Israeli, Saudi and Indian governments have decided to offer incentives ranging from lifelong health insurance for the donor to a cash benefit. In the United States, the American Medical Association has endorsed a draft bill that would make it easier for states to offer non-cash incentives for donation.”
Dr. Satel and her colleagues call on Congress to reform the 1984 National Organ Transplant Act (NOTA), which makes it a felony to provide material reward for an organ. The authors suggest that:
• Congress should amend NOTA so that existing criminal penalties for selling and brokering organ sales between individuals do not apply to any economic incentives offered by federal, state, or local governments. Such a revision would not require any such incentives; it would simply allow states and federal agencies to undertake experimental incentive programs.
• Compensation to prospective donors could take the form of health insurance, tax credits,
tuition vouchers, or contributions to tax-free retirement accounts.
• Rigorous protections for the safety of donors would be created.
• Because the compensation would be provided by the government, every patient in need
would benefit, regardless of income.”
The issue of paying for human organs is controversial to say the least but that does not mean it can’t or won’t work. Iran, which is usually not a good example for much of anything, allows for such a program and the result reportedly is that their waiting list has sharply declined and in some cases it has diminished entirely.
What we need in the United States is an open dialogue free of emotional outbursts that would allow for a small pilot program to test the concept. We need universal agreement on the need to elminate organ transplant waiting lists, much like the commitment the National Kidney Foundation made to eliminating the kidney waiting list within ten years. We must also agree, though, that the altruistic approach that we’ve tried for the last quarter of a century does not work. Every year the number of people who die while waiting for a transplant grows, yet we continue to cling to the notion that if we work a little harder more people will become donors. Well, everyone has worked very hard and we are still losing the battle. As I have written before about the United Network for Organ Sharing (UNOS) which regulates the entire process, “It’s not working and it is time we tried something that will work, we must stop the dying.” We’ve got to do something new and a pilot program somewhere in the United States would be a great way to start. What have we got to lose?
Please comment in the space provided or email your thoughts to me at firstname.lastname@example.org. And – please spread the word about the need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be a donor you may have saved or affected 50 or more lives.