Time for a new take on donor compensation?

The latest iteration of an ongoing debate over the propriety of compensating live organ donors is now transpiring in the pages of the AJT (12:306-12, 2012 with letters to follow). Current law in the US, the National Organ Transplant Act of 1984, outlaws “valuable consideration” in organ donation. Some defend the present scheme by decrying the impurity of introducing financial considerations into the process and noting the abuses associated with unregulated systems elsewhere. Others note that financial considerations already exist with recipients and providers all profiting from donor altruism, and recurring questions regarding donor protection in the current process. I must confess that my own thinking in this regard has changed dramatically in recent years.

Is compensating donors a reasonable approach in the developed world, assuming adequate oversight and protection is provided? Can it be done ethically? Is it desirable? How else might we deal with the crushing burden of years on the waiting list for our patients?


While it would be ethical to reimburse for expenses caused by the donation, such as health related expenses and missed work, payment for the organ donation would not. The organ becomes a commodity in a market, not a gift from the donor. The word "donor" could no longer be used, as it means giver of gift. It would be a seller or source, and this objectifies the human being. We have enough problems with objectification of human beings and the sale of the human body in our culture. Would it be reasonable to consider, on a state-by-state basis, different approaches to improving deceased donation. For example, could we have "presumed consent" for organ donation with an opt-out feature? Could we improve education, especially in minority communities, to assuage fears about organ donation? We know how our minority patients on the list need better matches.

This is the standard "ethical position", but what are we talking about here - is it ethical that we sit by while thousands are dying each year because of lack of a donor?

This debate has raged for many years without any resolution. During this time waiting lists continue to grow & patients die waiting for altruism to reach them. Clearly, a new approach to this critical issue is needed. I would suggest that Dr. Gaston appoint & empower a representative panel of members with divergent views to promptly address this issue. Based upon 32 years of transplant marketing experience, I believe a new consensus is possible.

Donor financial incentives and presumed consent were recommended in my ASTP Presidential Address in 1991 (Transplantation 1992; 53:1-11). Now, more than 20 years later, all that we have seen is an ever larger number of deaths on the waiting list. Are we ever going to wake up and and develop innovative solutions to alleviate the organ donor shortage, so that every end-stage organ subject has a better chance of achieving good health? Roy First

While my first proposal was for deceased donor (DD) family FI (JAMA 265: 1302-1305, March 13, 1991), I now believe that we must try FI in both LD and DD settings. Well designed pilot programs, regulated to maintain decorum and safety for all concerned, are a scientificly sound way to finally answer the question of efficacy and societal acceptance of FI. Altruism will not suffer--or if it should, saving the lives of those who may die waiting would supercede the importance of altruistic behavior.

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