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From Medical Ethics Advisor

19 Jul 2016 11:11 AM | Cathy Teal (Administrator)

AHC Media: Continuing Medical Education Publishing

Study: $50,000 Would Make Most Americans More Likely to Donate a Kidney

Yet compensating donors remains illegal

June 24, 2016

The majority of U.S voters surveyed by telephone stated they’d be more likely to donate a kidney if they received $50,000 in compensation, according a recent study.1 However, paying donors remains illegal under the National Organ Transplant Act of 1984. The study’s key findings include the following:

  • 68% of participants would donate a kidney to anyone, 23% would donate only to certain people, and 9% would not donate.
  • 59% said being paid $50,000 would make them more likely to donate a kidney, 32% said compensation did not sway them, and 9% were negatively influenced by payment.

The researchers conclude that, “because thousands of lives might be saved should compensation increase the number of transplantable kidneys, laws and regulations prohibiting donor compensation should be modified to allow pilot studies of financial incentives for living kidney donors.”

Thomas G. Peters, MD, FACS, FASN, the study’s lead author and professor emeritus in the department of surgery at University of Florida’s College of Medicine in Jacksonville, views the findings as a call to action.

“The striking number is the 59% that would be moved further toward donation if offered compensation,” he says. “That’s six out of ten people.”

From 2004 to 2013, the authors note, 63,742 patients died or became too sick for a transplant while waiting for a kidney. “The ethical implication, in my view, is that we have a potential source of lifesaving organs that is not being accessed,” says Peters. “Because of that, people who are fully evaluated and deemed appropriate for treatment with a kidney transplant are dying while they are waiting.”

While some programs reimburse donors for lost wages, travel expenses, and follow-up care, many donors do not qualify. “The ethical question, in my view, is that we have identifiable, salvageable individuals who are facing needless death because we don’t have the means to save them,” says Peters. “These people have a name, they are cared for by a particular medical center in America, and are on a waiting list.”

Peters uses the analogy of an orthopedic surgeon caring for a patient needing a knee replacement, who could put in an artificial knee, enabling the patient to walk that same day. “It’s the same with kidneys — only we can’t replace the kidney we’d use today with a kidney we might get tomorrow from a living donor,” he says.

The following are ethical arguments used against paying kidney donors:

Such payment would commodify body parts.

“The fact is, though, that in America it’s legal to pay surrogate mothers, and ova and sperm donors,” Peters says. “And certainly everyone in the transplant endeavor is paid.” That includes the hospital, the transplant surgeon, the transplant coordinator, nurses on the transplant floor, and immunology experts. “Everybody is paid but the donor,” says Peters.

A black market for organs could develop.

“But our concept is that this all would be highly regulated,” says Peters.

Payment could coerce persons to perform an act that they ordinarily would not perform: donating a kidney.

“Well, that’s the whole idea. That’s what we want,” says Peters. “Even though our paper indicates that the vast majority of people are willing to give a kidney to anyone or someone, over 90%, it really doesn’t happen.”

What people say they’ll do is not necessarily what they do in reality, he says.

“In our cohort of respondents, most people were positive about donating,” says Peters. “But if you offer the money, that moves the needle. And it might move it in real time.”

Peters says it’s important to consider the history behind the National Organ Transplant Act of 1984, which made it illegal for individuals to sell organs. “Those persons who said we should not pay donors were mostly the transplant surgeons, who opined at the time that altruism was the motivation that ought to drive organ donation,” says Peters.

The idea was reinforced when a businessman attempted to start a brokerage service paying individuals for kidneys, which was completely unregulated. “We were all appalled by that,” says Peters. Peters and others met with former Vice President Al Gore, at the time a Tennessee Congressman, who wrote into the bill the clause about barring compensation.

“However, Gore said at the time, that if the circumstances of organ donation without compensation does not meet the need, then we should reconsider whether or not some form of compensation should be tried,” says Peters. “That is something that is very seldom spoken about.”

The origins of the law, says Peters, “were largely the brainchild of those of us who were practicing at the time.” Though the numbers of individuals on a waiting list who died needing a kidney were small at the time, Peters still viewed the deaths as needless. “There were not a lot of people who agreed with me at the time. I was outspoken about this and did not have a lot of collegial support,” he says.

Over the next decade or two, the numbers of people on the transplant recipient list grew. “We were able to save more and more lives, but the lives we were saving were of a miniscule number compared to the need,” says Peters.

The need is now so great, and the resources so scant, says Peters, that other approaches are needed to increase the recovery of transplantable organs. “A lot of smart people have tried to do it,” says Peters. “All of the ideas for the last 30 years that have been tried have failed.”

Pennsylvania Congressman Matt Cartwright recently introduced legislation that would allow for certain non-cash incentives, such as contributions to a retirement fund, to compensate donors.

“There is no question that what we are doing currently is failing,” says Peters. “Even the opponents say we have to improve organ donation. It’s failing, and it is costing lives needlessly.”

REFERENCE

  1. Peters TG, Fisher JS, Gish RG, et al. Views of US voters on compensating living kidney donors. JAMA Surg. Published online March 23, 2016. doi:10.1001/jamasurg.2016.0065.

SOURCES

  • Thomas G. Peters, MD, FACS, FASN, Professor Emeritus, Department of Surgery, University of Florida College of Medicine, Jacksonville. Phone: (904) 244-3925. Fax: (904) 244-3870. Email: tgpetersmd@hotmail.com.

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