Putting a price on organ donation

Some say altruism isn’t enough to increase organ donation.

Organ trafficking allegations in New Jersey this summer cast a new spotlight on the debate over the best ways to get more people to donate legally. Last year more than 4,500 people in the US died waiting for a kidney, and all sides acknowledge that the need for organs overwhelms the supply. Beyond that, disagreements flare up about which incentives are ethical and practical. (Photo: Gray’s Anatomy)

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Kidneys are in high demand. Tens of thousand of patients spend years tethered to dialysis, waiting for a transplant. In 2007, the government spent more than $8 billion on dialysis treatments and medication. Economist Alex Tabarrok says it’d be cheaper to share some of that money with willing donors.

Tabarrok: So if we could pay $15,000, increase the number of transplants, reduce the amount of dialysis, we could actually save lives, improve lives and save money at the same time.

Tabarrok is a research director at George Mason University.

Tabarrok: There’s some feelings that this type of market is repugnant. So people just feel … ‘Ugh, I don’t think we should be selling organs.’

Others say paying for organs will push poor people into an unwanted surgery. But policy analyst Sally Satel says offering deferred, non-cash incentives such as retirement contributions or tax credits would persuade more people to donate and eliminate the concerns over exploiting donors.

Satel: The way to protect against something like that, is not to offer what desperate people want, which is cash immediately.

In 1994, Pennsylvania approved a pilot program to offer money for funeral costs. But some state officials worried the payments would violate the federal ban on the sale of human organs. The program never got off the ground.

Last year Pennsylvania Senator Arlen Specter floated a draft bill that could have cleared the way for states to offer non-cash incentives. Analyst Sally Satel, who got a kidney from a friend in 2006, loved that idea.

Satel: It’s a clarification that it is not a felony for a third party to reward donors, that’s it. It would mean that the widow in Harrisburg who accepts a $3,000 funeral benefit wouldn’t go to prison.

But groups including the National Kidney Foundation rejected Specter’s proposal, now a spokeswoman for the Senator says he has no plans to introduce the bill.

Boston transplant surgeon Francis Delmonico says donors should receive compensation for their altruism, but not profit from their gift. He favors government guarantees for loss wages, child care and travel expenses.

Delmonico: Making certain that they are not at a loss of out-of-pocket expenses, making certain that they are well cared for by having insurance. Ninety percent of the transplant people across this country want to see that happen.

Ohio resident Donna Lubeke donated a kidney to her sister 15 years ago. These days, she helps to run the Living Donor Advocate Program.

Lubeke: If a donor needs to have a re-operation, or re-admission, or suffers a life-long complication as a result of the kidney donation, who’s responsible for that? That’s our big issue.

The advocate program is helping a man who recently developed high blood pressure and kidney disease. He’s paying for his own medical expenses out-of-pocket because his health insurance company says his elective organ donation years ago caused his current medical problems.

Lubeke says other donors don’t even have health insurance.

Lubeke: These are people that can’t even access health care for a broken arm, and you take a kidney from them. They say: ‘Well the recipient’s insurance pays for everything.’ They don’t pay for lifelong monitoring of their renal function.

As a nurse, Lubeke gets annual check-ups to track the health of her remaining kidney, she wants health insurance reforms to make sure all donors have access to long-term, follow-up care.

Lubeke: You live the rest of your life with reduced kidney function you don’t grow back kidney tissue when they’ve taken 50 percent of it.

Lubeke says the transplant system needs to do more to care for people who’ve already come forward before handing out valuable perks to lure other donors.

The World Health Organization is studying the pros and cons of offering incentives in exchange for organs. The advisory group makes its recommendations in October, and members say the group will likely reject the idea.

The United Network for Organ Sharing tracks the number of patients waiting on the transplant list.