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Controversy: Should We Take Organs Without Consent? January 22, 2008

Posted by Bob Aronson in Presumed Consent.
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In my on-going effort to promote organ donation I’ve found that the altruistic approach, (doing one’s civic duty) while admirable, has not done enought to increase the number of available organs.  Thousands are dying each year because the number of people needing organs is outpacing availability.  Something must be done!  In that light I have embarked on an effort to explore alternatives to altruism.  Today’s blog explores one of them. 

Implied or presumed consent is the norm in several European countries and the Prime Minister of England has stated that he would like the system in place by the end of the year.  In effect presumed consent means that unless you have pre-registered your desire NOT to be an organ donor, your organs may be taken upon your death with permission from no one.  The idea is has been studied in the U.S. for some time with the idea that adopting such a policy might cause a significant increase in the number of available organs.

OPTN (The Organ Procurement and Transplantation network) is a part of UNOS (United Network for Organ Sharing) the Government regulated organization that matches available organs with those who need them.  

In 1993 an OPTN committee determined that such a policy was not appropriate at that time.  But now, it is 15 years later and the need for organs is far outpacing the supply.  Is it time to begin considering presumed consent again?  Below are the OPTN pros and cons.

OPTN URL:   http://www.optn.org/resources/bioethics.asp?index=2

 Excerpt from OPTN, the Organ Procurement and Transplantation Network:

“Advocates of presumed consent advance the following in support of their position:

  • Efficiency is Good. Increasing the supply of organs — that is, supply-side efficiency — is a worthwhile goal. It is sufficiently important to collect more organs that other goals and values, within limits, may be compromised;
  • Asking for Consent can be Cruel. Presumed consent would obviate the need to ask the donor’s family for consent at a time of family’s painful grieving.
  • Individual Conscience Can be Respected. Presumed consent respects the principle of individual choice by giving objectors to organ donation an opportunity to empower their anti-donation preference;
  • Individuals Owe Society the Effort to Register their Objection. Individuals who object to organ donation should be burdened with the task of registering their preference to the public authorities because organ donation is, presumptively, socially desirable. The burden of communicating objection should be placed on objectors to organ donation.

Presumed consent, advocates argue, combines the principles of supply-side efficiency, respect for individual conscience, and individual’s positive, yet qualified, duty to promote the good of society.

Opponents of presumed consent base their position on the following presuppositions:

  • There will be false positives, that is, persons who were ‘presumed” to consent but who, in fact, objected to donation. Under a policy of “presumed consent,” some individuals who do object to organ donation in principle will not register their preference with public authorities because of one of many factors. For instance, individuals on the margins of society might not learn of their option to register their refusal. Furthermore, individuals have differential access to the mechanism for registering refusal, as in the case of itinerant persons who may not receive a postcard informing them of the opting-out alternative
  • Problems in Registering and Transmitting Objection Status. The mechanism for registering and transmitting objection status is likely to be inadequate. Only a nationwide database of objectors is ethically justified because individuals may suffer irreversible cessation of brain function outside their state of residence. There is uncertainty whether mailed-in objection notices will be entered on the database and whether the information will be distributed to organ procurement organizations in a timely fashion.
  • Individual Autonomy Speaks to a Core Value. Asking individuals to publicly express their objection to donation does not respect the individual’s right not to choose. Individuals do not have a social duty to express an objection.
  • To Decide Whether to Consent is Not a Dichotomous Choice. Individuals should have the right to delegate the decision to family members. Presumed consent would authorize collection of organs of a non-objector who had trusted his family to make the decision.”

Once again I am asking for your comments.  Increasing the number of organs is a real matter of life and death.  One over which we have total control.  We must continue to talk, but we also need to do something — we need action.  My action is to get people to think and then pass your comments on to policy makers and opinion leaders across the U.S.  What’s yours?  What are you going to do?

More On Compensation for Organ Donors January 21, 2008

Posted by Bob Aronson in Donor Compensation.
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Just yesterday I wrote a blog on compensating organ donors.  The response has been excrellent.  Obviously there are many people with very strong opinions on the subject most of which support some kind of compensation, like paying for funeral expenses.  Doing so would not only help donor families but might also serve as an incentive for future organ donors.  The “devil” though, is always in the details.  We would have to find a compensation method that is fair perhaps one similar to the current system where the recipients insurance pays for donor related medical expenses.  Funeral’s probably are far less expensive that the cost of the medical team that removes and transports the organ.  The information on the “Motley Fool” site may be helpful to you as you consider the issue.   http://www.fool.com/foolu/askfoolu/2002/askfoolu020305.htm

Excerpt from “The Motley Fool”  Here’s a breakdown of average costs, nationwide, according to a 1999 National Association of Funeral Directors (www.nafd.org) survey. Some parts of the country will be more expensive, though, and others will be less expensive. In addition, you can spend a lot more or a lot less, depending on some decisions you make.    Of course, this isn’t all that’s involved. It’s just what a funeral director would typically be involved in. Here are some additional expenses:

  • Cemetery plot: $500 to several thousand
  • Opening and closing the grave: $350 to $1,500, depending on the time and day of the week
  • Headstones, statues, or markers: $500 to several thousand
  • By contrast, a cremation can cost just $1,500 or less.

So far the discussion has concentrated on donors who die, but what about living donors, the people who give a kidney or a portion of their liver, how do we compensate them?  Transplant Living URL  http://www.transplantliving.org/livingdonation/financialaspects/costs.aspx

Excerpt from Transplant Living:  Medical expenses associated with living donor evaluation are covered by either the recipient’s insurance or in certain circumstances, by the Transplant Centers Organ Acquisition Fund (OAF). In either instance, the living donor should not incur any expenses for the evaluation. However, expenses related to another health concern that may identified during the evaluation process will not be covered by the recipient’s insurace or the OAF.

The actual donation surgery expense is covered by the recipient’s insurance. The transplant center will charge a recipient’s insurance an “acquisition fee” when he or she receives a transplant. The medical costs related to the donation procedure and required postoperative care are also covered by this fee. In some instances, the actual itemized bill for the donor procedure is submitted to the recipient’s insurance.

Anything that falls outside of the transplant center’s donor evaluation is not covered. These costs could include annual physicals, travel, lodging, lost wages and other non-medical expenses. Although it is against the law to pay a living donor for the organ, these costs may be covered by the recipient. Be sure to check your specific insurance policy or ask a transplant financial coordinator about concerns related to your specific circumstances.

Here’s another great source: Washington University Medical School in St. Louis.  http://mednews.wustl.edu/tips/page/normal/8102.html

Excerpt from Washington University Medical School in St. Louis: “Last year nearly 7,000 people donated a kidney, segment of the liver or lobe of a lung to help someone in need of a transplant. In fact at some major transplant centers — like Barnes-Jewish Hospital and St. Louis Children’s Hospital at Washington University Medical Center — the number of transplants involving living organ donors now exceeds the number of transplants using organs from deceased donors.

In an effort to close the gap between organ supply and demand, researchers at Washington University School of Medicine, the University of Michigan and the American Society of Transplant Surgeons are studying ways to reimburse living donors for some of their out-of-pocket expenses when they choose to donate an organ.”

Obviously the issues are numerous but we can only change things if we speak out and let the world know what we think about them.  As I said in yesterday’s blog, I will forward all comments to policy makers and thought leaders around the country.  Please, Please comment. 

PS After writing this blog I noticed a comment that directly address the issue of living donors.  Please read the comment but here is a very helpful URL  http://www.ama-assn.org/amednews/2008/01/28/prsb0128.htm

Controversy: Compensating Organ Donors — Should We? January 20, 2008

Posted by Bob Aronson in Donor Compensation.
4 comments

The issue of compensating organ donors is important.  A decade ago it was rarely discussed, today the discussion is increasing in frequency and getting some very serious consideration by leading transplant physicians, medical ethicists, government regulators, insurance companies, politicians and many others. 

I have not ventured into controversial issues before but this one is too important to ignore.  Let’s begin a discussion here, to get your comments and ideas.  I’ll make sure they are passed on to legislators, regulators, the health care industry and other important audiences.   

The primary consideration is this; “How do we stop the dying by increasing the number of organ donations?”  We know that each year the number of people dying has increased.  Organ donation advocacy is wonderful and has met with some success but — it hasn’t been effective enough.  Can we devise some kind of compensation program that does not encourage the “sale” of organs? 

Below I have included excerpts on the issue from three sources along with the URL’s so you can read the entire story.  Please comment.  This is one of the most important issues we can discuss.

ABC News story on Donor Compensation  http://abcnews.go.com/US/Story?id=91551&page=1

ABC News story excerpt:“Dr. Lewis Teperman, director of transplantation at New York University Medical Center, says there are about 7,000 liver transplants done in the United States a year. However, there are “about 20,000 people waiting, and most of those people die,” he says.”

That’s why Teperman advocates offering the relatives of a deceased donor a thank you in the form of a monetary gift — to cover funeral expenses.

Teperman says the small gift could offer a subtle, inoffensive incentive to would-be donors and their families.

“It is time to … give a small amount of money for a funeral expense,” Teperman says, “let’s say $500 that would be given directly to funeral home for everyone who donates.”

President’s Council on Bioethics and Transplantation http://www.bioethics.gov/background/org_transplant.html

President’s council excerpt:  “These proposals take different forms: some offer full or partial reimbursement of funeral expenses; some offer tax credits or rebates; some offer direct cash payment. Defenders of such compensation proposals often seek to distinguish them from organ markets: the compensation would be public, not private, and thus would represent the appreciation of the entire community rather than a private contract between parties; a compensation system would set firm limits on what could be compensated – for example, allowing reimbursement for funerals of the deceased but not payment for living donors who wish to sell one of their organs; and a compensation system for procurement would be kept separate from the system of organ allocation so as not to endanger the equity of organ allocation, whereas the right to sell ones organs in the open market might also mean giving special advantages to wealthy prospective recipients”

News Report, Buffalo News http://www.independent.org/newsroom/article.asp?id=285

Excerpt from Buffalo News: “…. goodwill alone has never produced enough organs to meet demand. Although organ donation increased by 10 percent over the last decade, the number of individuals in need of a transplant increased by 30 percent.That the current policy has persisted for so long is a moral outrage. Even its defenders have difficulty claiming that the policy is successful. Instead, they argue that market-based alternatives, such as compensation for organs, are unethical and deter current “gift givers.” More outrageous is the fact that supporters of the current system advocate its continuation on humanitarian grounds. What is so humanitarian about letting people continue to die while awaiting transplants, just so we can feel good about “giving”? Clearly we’re not generous enough if approximately 6,000 people die annually, while another 79,000 or so are relegated to waiting lists.

Recently, the medical community has moved closer to recommending compensation for organ donation as a remedy for the shortage. The American Society of Transplant Surgeons has already endorsed payment for cadaveric organs. And the American Medical Association’s governing house of delegates will meet in June in Chicago to vote on a pilot program that would test the effects of different motivators, including payment, for cadaveric organ donations.”

I purposely have not taken a position on the issue because I’m still researching it and trying to make my own determination.  I do believe that a “Thank you” alone is not sufficient for the gift of life.  Your thoughts will help me and many others including those who make the policies that govern organ donation.  Please comment.