Category Archives: Donor Compensation
THIS IS NOT AN OFFER TO BUY ORGANS. ATTEMPTS TO SELL ORGANS HERE WILL NOT BE PUBLISHED.
Let me begin by quoting Sally Satel M.D., Kidney transplant recipient and Resident Scholar American Enterprise Institute: (Kidney for Sale, Lets Legally Reward the Donor http://www.aei.org/publications/filter.all,pubID.29515/pub_detail.asp)
“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 the International 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 only 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.
Please read and comment on my World Wide Issues blogs on http://blogsbybob.wordpress.com. Also…visit and join my Facebook site, Organ Transplant Patients, Friends and You at http://tinyurl.com/225cfh OR — my Facebook home page http://www.facebook.com/home.php
THIS IS NOT AN OFFER TO BUY ORGANS – EFFORTS TO SELL ORGANS HERE WILL NOT BE PUBLISHED.
While the organ shortage is bad here in the U.S. it is much worse in Australia where only 10 percent of its citizens become organ donors as compared to the U.S. where it is 27 percent. In both cases, though, the gap between those who need organs and available organs grows wider each year causing the needless deaths of thousands of people worldwide, 7,000 in the U.S. alone.
“I don’t support (illegal trade),” Carney said. “But I also do not agree with the fact that we should let people just rot on dialysis until they have been on dialysis so long they are untransplantable.”
Predictable, of course, was an outpouring of objections from the medical community and the ubiquitous ethicists. None of them offered anything but criticism. God forbid they should offer a solution; these people exist to object not to solve problems.
Fortunately, Thomas Mone who is certainly qualified to comment could at least see some merit to the idea. (Mone is chief executive of OneLegacy, a non-profit organ procurement organization serving L.A. and six neighboring counties. He is also president of the Association of Organ Procurement Organizations, and is a director of the United Network for Organ Sharing. He had many comments that you can read for yourself in his March 31, 2008 commentary in the Los Angeles Business Journal. (http://www.entrepreneur.com/tradejournals/article/178189602.html)
Among other things he says, “It isn’t difficult to identify a stronger incentive. If potential donors were offered cold, hard cash and made aware that they can lead a normal life with a single kidney, there’s little doubt that the donation rate would be much higher.”
But to do so in this country would raise a number of concerns.
How much should be paid for a kidney -and who should pay it? The recipient, or the government, via Medicare? A payment of $5,000 would probably be sufficient to attract more than enough donors to erase the current shortage of 45,000 kidneys a year.
“Or,” he notes, “Instead of a fixed amount for the kidney itself, should the payment also cover expenses for hospitalization and recovery? And what about wages lost by the donor during the donation and recovery period? Should donors get guaranteed insurance coverage rather than cash?”
Mr. Mone points out the downside, too, “…. there is little doubt that if payment for donation were permitted in this country, a huge percentage of the donors would be poor people. And if the recipients of kidneys, and not the government, were paying for them, the practice would be viewed by many Americans as allowing the rich to take advantage of the poor.”. To avoid the risk of readers saying I took Mr. Mone out of context, I urge you to read the full commentary by clicking the URL link above.
He sums up his article by saying, “I believe the best way to proceed would be with small-scale pilot programs that offer donors lifetime insurance coverage and see what the effect would be.
If such programs do not indicate that there would be any negative effect on the national organ donation process, then the practice of paying for kidneys through insurance coverage and similar non-cash incentives should be allowed”.
Here is what I believe. I think we have to change the current system to one of presumed consent tied to some form of compensation. I like the idea of providing donors with free lifetime healthcare. But even that may not be enough.
Thank you Mr. Mone. Finally, a voice of reason from those in the health care industry
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
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.