Opinion | It is time to consider profit-incentives for organ donations, currently illegal
Published: Friday, November 1, 2013
Updated: Friday, November 1, 2013 02:11
Paying people for their organs seems intuitively grotesque, but it may be the solution to a growing crisis in organ transplantation.
A new Canadian study suggests paying living donors $10,000 to part with their organs would save money over the current system of altruism, even if donations only go up 5 percent.
Dr. Braden Manns, an associate professor and clinical professor in nephrology at the University of Calgary led the study and his team determined that paying living kidney donors $10,000 apiece would save about $340 per patient, compared with the ongoing costs of dialysis, according to NBC News.
“We have a problem. We don’t have enough organ donors coming forward,” Manns said.
According to the Organ Procurement and Transplantation Network (OPTN), 120,482 people are candidates on the waiting list. Those seeking kidney transplants account for 98,463 of those people.
Between January and July 2013, 16,670 transplants occurred in the United States, but there were only 8,215 donors.
To put the waiting list in perspective, though, Harvard Medical School professor of surgery Francis L. Delmonico, noted that almost half the people on waiting lists are “medically ineligible” for the surgery anyway. That is, they are too sick.
Still, the disparity between the demand for organs and the supply of available organs, whether from living donors or cadavers, is great and has been expanding since 1989, when data first began.
Quite obviously, too, getting a donation from a living donor is preferable to a cadaverous donor because of the increased potential for a successful transplantation; a living donor presents more optimal conditions for the procedure.
For example, one year post-kidney transplant from a living donor, the survival rate is 95, whereas with a cadaveric donor, it is only 89 percent.
The latest figures from 2013 indicate that 4,785 of transplants were from a deceased donor, whereas 3,430 were from a living donor.
Every day, 18 people die waiting for a life-saving organ.
However, the National Organ Transplantation Act, established in 1984, which also created OPTN, bans the sale of human organs.
Some, like Manns, think we ought to consider solutions that could increase donations, such as introducing a profit incentive.
Ethically, however, many organizations and doctors oppose such a measure. For instance, philosopher Samuel Kerstein of Harvard’s Program in Ethics and Health worries about human dignity.
“To have value as a person is to have incomparable worth,” he said.
Tony Calland, with the British Medical Association, sees opting-out instead of opting-in as a solution.
Only about 45 percent of adults in the U.S. -- nearly 109 million people -- are organ donors, according to NBC News. Those 109 million people opted-in.
An opting-out solution would mean an individual is automatically an organ donor upon his or her death.
“We believe that…this will increase the number of deceased donors, but more than that, it will lead to a change in thinking, where organ donation after death will become the societal norm,” Calland said.
Penn Medicine addressed the concerns such as exploitation of the poor and diminished altruism in a 2010 study. Scott D. Halpern, led the study, and said money does not seem to blind people to the risk.
“People seemed to weigh the possible risks of kidney donation just as clearly in the face of a $100,000 payment as they did without any offer of payment,” he said.
Over 6,000 Americans charitably donate a kidney every year in the United States. Halpern said he does not see a money incentive as detrimental to that.
“Our study suggests that one’s willingness to donate an organ for free is not affected by learning that payment for kidneys could be an option,” Halpern said.
If compensation took the form of credits for health care needs, about 60 percent of Americans would support it and cash for organs was seen as okay by 41 percent of respondents, according to a NPR-Thomson Reuters Health Poll.