Should Organ Donors Be Compensated?In an effort to both encourage and reward organ donation, the Pennsylvania state legislature in 1995 passed a law that approved a $3,000 stipend for the family of a deceased organ donor to help pay for that donor's funeral.
However, ethical questions and concerns that the law might violate the National Organ Transplant Act of 1984 — which, among other things, bans the sale of human organs in the United States — ultimately doomed Pennsylvania's rather progressive legislation.
|In 1990, the waiting list for an organ in the U.S. hovered around 20,000 people. Today more than 100,000 people are waiting for an organ transplant.|
Dr. Sally Satel, a resident scholar at the American Enterprise Institute for Public Policy Research, and a staff psychiatrist at the Oasis Clinic, both in Washington, D.C., has closely followed the attempts of Pennsylvania and other states to compensate organ donors, and not just as a policy expert.
In 2004, Dr. Satel, a Cornell University graduate, learned that she was in need of a kidney transplant. Before ultimately receiving a donor kidney from a friend, Dr. Satel learned of the stark realities of organ donation in the United States.
In 1990, the waiting list for an organ in the U.S. hovered around 20,000 people. Today, according to the Organ Procurement and Transplantation Network — which was created by the 1984 National Organ Transplant Act — more than 100,000 people are waiting for an organ transplant.
"The shortage of organs is real, so it has forced us to consider transplanting organs which five years ago we would have paused and thought twice about," said Dr. Sandip Kapur, chief of transplant surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
Nationally, almost 80,000 people are waiting for a kidney and nearly 17,000 for a liver. In New York state alone, the wait for a kidney transplant can be as long as eight years.
|The spirit of altruism, the selflessness and generosity that punctuates organ donation, is not something the medical community wants to see compromised on the open market.|
In her Dec. 16 presentation entitled "When Altruism Isn't Enough: The Case for Compensating Kidney Donors" delivered at the Weill Cornell Medical College's Department of Public Health Ground Rounds, Dr. Satel argued that our current altruistically based system and non-living donor organs can't possibly fill the current and future need for transplantable organs in the U.S. and abroad.
According to Dr. Satel, of the 2 million or so Americans who die each year, less than 1 percent is declared dead by brain death, the criteria most often used for deceased organ donation. Even if everyone agreed to become an organ donor by signing their driver's license, the shortage would be reduced only modestly.
"I am among those who believe that we have to have to reward people who are willing to give a kidney to a stranger as a way to motivate others to do the same," Dr. Satel said.
The resistance to compensating organ donors springs largely from the fear of the poor and desperate being exploited into selling off their organs in potentially dangerous procedures. Also, the spirit of altruism, the selflessness and generosity that punctuates organ donation, is not something the medical community wants to see compromised on the open market.
"Dr. Satel's personal narrative and the fact that she is a recipient speak to the compelling human need to improve organ donation. This is a debate that we need to have," said Dr. Joseph Fins, chief of the Division of Medical Ethics at the Medical College, who introduced Dr. Satel at the presentation. "However, I would hate to transform the donative act into a commodity. That betrays the notion of gift-giving."
|"Altruism is insufficient to meet the pressing need for organs. Until we stop thinking of transplantable organs as gifts, we are never going to have enough of them."
–Dr. Sally Satel
"As the recipient of a live kidney, I am the beneficiary of someone else's altruism," Dr. Satel said. "But as public policy, altruism is insufficient to meet the pressing need for organs. Until we stop thinking of transplantable organs as gifts, we are never going to have enough of them. We put value on things that mean a great deal to us and but that does not invalidate them."
To protect the poor and desperate from potential exploitation, Dr. Satel suggests employing forms of compensation that wouldn't appeal to those groups; namely, no immediate cash for kidneys.
Instead, state or federally provided payments such as a tax credit, tuition voucher, 401(k) contribution or Medicare voucher would see that the donor is fairly compensated without encouraging hasty, dangerous decisions made by those in need of a quick buck. With payment furnished by a government entity there would be no allowances for personal, individual-to-individual transactions.
"The process could proceed as it does today," she said. "Use of the same procurement and distribution infrastructure, the same testing, the same safety and processes. The only difference would be that the donor receives a material benefit."
Dr. Kapur, who was not in attendance during Dr. Satel's presentation, agreed that at a minimum, the discussion of compensating donors is one worth having.
"The truth is I am sure compensation happens in kidney transplantation in the United States," he said. "Our laws say it can't, but our patients' desire to live will outpace our laws, so I think we may as well face it and arrive at solutions that can provide for our society based on the great need that exists."