The ethics of paying kidney donors

A new study seems to knock down some of the ethical objections to paying people to donate an organ. The study authors are with the University of Pennsylvania and the Philadelphia VA Medical Center.

A new study seems to knock down some of the ethical objections to paying people to donate an organ. The study authors are with the University of Pennsylvania and the Philadelphia VA Medical Center. [audio:100316tekidney.mp3]

The researchers studied people’s willingness to donate a kidney with or without a cash incentive. Penn assistant professor Scott Halpern says his study suggests that financial incentives would increase the number of organs available for transplant without exploiting low-income people.

Halpern: Payments did not seem to influence the poor any more than they influenced the rich. Ten thousand dollars offered to people earning more than $100,000 a year didn’t seem to have any different effect than that same $10,000 when offered to people earning less than $20,000 per year.

Nearly 84,000 people are waiting for a kidney transplant in the United States. Last year, a United Nations commission concluded that it would be very difficult to effectively regulate a kidney market, even in a prosperous country like the United States.

University of Pennsylvania bioethicist Arthur Caplan says creating a market for kidneys would cause too many problems. Caplan was not involved in the new study, but he served on a the U.N. commission that studied potential fixes to the worldwide organ shortage.

Caplan: It would take a lot of policing and oversight to make sure that people weren’t getting their arms twisted to sell a kidney if they had gambling debts, or even by family members if somebody said: ‘We’ve been good to you, so now you’ve got to pay us back.’ The prospects for being able to regulate that were very poor.

Caplan says the United States should create a system that assumes everyone wants to be an organ donor and would force those who object to opt-out. Right now, the United States has an opt-in system.

Some ethicists worry that payment would blind donors to the health risks of giving up an organ, but Halpern says his study suggests that’s not the case.

Halpern: We allow people to get paid to play in the NFL or to be workers in a coal mine or to be stunt doubles in a movie all the time. They take money in exchange for the risks. The risks of kidney donation are relatively small by comparison.

Each year, about 4,400 people in the United States die while waiting for a kidney.