The act of donating one’s organs to help another human survive is considered honorable, no matter if the donor is living or deceased. However, the limited supply of transplantable organs from a living donor results in great need for cadaveric organ donations. Financial incentives for organ donation have been suggested as a potential way of increasing organ donation rates.
The provision of financial incentives may be enforced in three distinct ways: offering a financial incentive to an individual for a live donation, rewarding someone for registering as a post-mortem organ donor, or offering a financial incentive to a deceased person’s family if the decision to donate was not indicated by the individual before death.
The kidney donation program in Iran stands out worldwide by openly allowing payments up to several thousand dollars. This has helped to significantly reduce the wait list time for kidney transplants. In most other countries, however, an express consent system holds place where one must consent to organ donation over a formal agreement before death. There is no additional incentive for an individual to do so; it remains a purely altruistic act.
Opponents of financial incentives for organ donation are concerned about the ethics of putting a price on something as invaluable as an organ. The National Kidney Foundation refers to this act as “diminishing human dignity.” Providing any form of compensation for organs may be an affront to those who have already made an altruistic gift of life, and it could alienate those prepared to donate out of humanitarian concern.
If, however, incentives are successfully presented to the public as a gift rather than a payment, this strategy may have a high potential to promote an organ donation culture. Offering a financial incentive may not necessarily be in the form of a direct monetary offering. Tax deductions, discounts on health insurance premiums, or coverage of post-mortem expenses are also being considered by advocates of this system.
Patients waiting for organ transplants often require ongoing treatment that costs billions of dollars a year. For example, according to UCSF’s Kidney Project, hemodialysis care costs the Medicare system an average $28 billion annually in the United States. Providing these services at such high costs does not cure these patients, but only maintains their condition at a best-case scenario.
Some argue that reallocating capital to stimulate organ donation can help save thousands of lives on transplant waiting lists. In this situation, dollars would go towards saving lives, and not just extending the lifeline of sick individuals. More research is being done on the economic costs and benefits of such a system.
Another concern is that offering money for organs could potentially be viewed as an attempt to coerce those in lower socioeconomic brackets to participate in organ donation. The World Health Organization’s guiding principles on human cell, tissue and organ transplantation state that “Payment for cells, tissues and organs is likely to take unfair advantage of the poorest and most vulnerable groups.” Furthermore, they postulate that there are about a dozen countries involved in organ-trafficking networks. Some of the poorest and most vulnerable people in the world are being exploited by organ brokers to sell their organs for as little as $60. For those living in extreme poverty, economic opportunities are scarce; the shortage of organ donors perpetuates demand for these illegal organ sales.
In addition, affluent waiting-list patients have the ability to participate in “transplant tourism,” an act in which citizens of one country visit another to receive an organ transplant at a foreign hospital. Those without the financial means must patiently wait for an organ on the transplant list. Transplant tourism has been condemned by the international community, including the World Health Organization, and is illegal in many countries.
However, transplant tourism is a dangerous practice - one where the risks may outweigh the benefits. In a study from the University of California Los Angeles (UCLA), 33 kidney transplant recipients traveled abroad for transplant and returned to University of California, Los Angeles (UCLA) for post-transplant care. It was found that 17 of these 33 patients who received “tourist transplants” became infected, with nine requiring hospitalization.
The Future of Organ Donations
Saving a human life is, and always will be, a humanitarian act that should be placed above all other considerations. There is significant capacity to increase organ donation and potentially fulfill the need for transplantation.
Perhaps financial incentives are not the ultimate solution to this problem, but it has strong potential to strengthen the gift of life system for patients today, and years to come. Further research on organ donation systems and the use of incentives in healthcare markets have the potential to improve organ donation rates around the world.