Organ donation is the gift of life, and in the case of living donors, it doesn’t have to come at the cost of life. Even with promotion of organ donation, though, shortages are a continuous problem and many patients develop serious complications while waiting for organs — or die before they have a second chance at life. The American Society of Nephrology, one of many medical associations that’s acutely aware of this problem, took a look at this issue and came up with a surprising finding: paying living donors might be the best solution, at least when it comes to kidneys.
The idea of compensating organ donors has long been taboo in the United States. While providing coverage for people during hospitalization is considered acceptable, as they wouldn’t be in the hospital and undergoing surgery if they weren’t offering an organ for someone who needed it, direct compensation is not allowed. The reasons behind this are sound: advocates worry about exploitation, people being pressured into “giving” organs, or the creation of an organ market where organs only went to those who could afford them.
What this study shows, though, is that the current system simply isn’t working. Too many people are living longer with more complex medical conditions, and they need organs. The expense of treating them while they wait and managing the transplant system is high, whereas getting organs where they’re needed improves outcomes and quality of life. Compensation might sound like it would cost the health care system more, even at the relatively low proposed sum of $10,000, but it would save money over the patient’s life. The cost savings represented by improved quality of life are trickier to calculate, but an important part of the equation.
This situation creates quite an ethical conundrum, and it’s sparking lively debate. For one thing, organ donation in the United States tends to be lower than in other nations, and for another, the United Network for Organ Sharing (UNOS) has worked very carefully to develop guidelines for managing organ donation and waiting lists. Some of those guidelines have included respectful collaboration with religious groups to ensure that people of faith can participate freely in donation without fearing that they’re violating religious precepts. Since some faiths bar selling organs (and some religious leaders interpret religious texts as doing so), UNOS could risk losing entire congregations by permitting the compensation of living donors, something that might feel too much like organ sales to some people.
Bioethicists have considerable concern about any donor compensation scheme, although it actually wouldn’t set a precedent: people can already receive funds for donating white blood cells and bone marrow extracted through apheresis. They’re calling for caution and a thorough review to determine if a compensation program would be cost-effective, and what kind of safeguards could be put in place to prevent exploitation and protect patients.
In the meantime, plans to boost organ donation overall in the United States are also important. One of the most obvious solutions is the creation of an opt-out system, like that used in several nations: instead of asking if people want to be donors, the government could presume everyone’s a donor unless informed otherwise. This tactic has radically increased the availability of organs in countries where it’s used, in addition to sparking a conversation about how to make people more aware of the value of organ donation.
Photo credit: Army Medicine