Paying Big to Be A Donor

By Jason Feifer
Special to The Washington Post
Tuesday, March 20, 2007

Before Michael Friedberg donated a kidney to his wife last year, he underwent multiple tests and battled the usual jitters. Then he took one other step: He refinanced the family's home.

Friedberg, 60, works as an auto mechanic in Bladensburg, and he's paid on commission. Lifting heavy car parts soon after the surgery would be impossible, so he wanted to prepare for a drought of income by reducing his mortgage payments. The drought came: After the operation, he was out of work for two months and lost about $14,000 in wages.

"I didn't have a choice," he said. "It was that or my wife was going to die. The waiting list was, at that time, like eight years to get a kidney."

There were 6,196 living-organ donors last year, and Friedberg wasn't alone in his financial losses. The recipient's health insurance typically pays for the donor's medical costs such as the surgery and various pre- and post-op tests, but donors are on their own for the rest: travel expenses for the numerous trips to the hospital, nearby hotel rooms before and after procedures and wages lost while they recuperate.

Transplant advocates fear those costs are a deterrent to donating, and so have been searching for ways to compensate living donors, who can give kidneys, bone marrow and a few other body parts. But by doing so, they're inching up on a loaded question: Is it morally wrong to pay people for their organs -- or at least for some of the costs incurred in gifting them?

Virginia Gov. Timothy M. Kaine may weigh in on the question when he decides whether to sign a bill that would authorize an income tax deduction of as much as $5,000 for living donors to help cover uncompensated expenses.

The proposal is modeled after a $10,000 deduction that Wisconsin enacted in 2004. At least 10 other states have adopted similar incentives, and more are considering it.

Other reimbursement models have targeted donors' lost wages: The federal government and some states -- including Maryland and Virginia -- give their employees 30 paid days off if they donate an organ. Advocates have asked large companies to follow suit. But such measures, while appreciated by many donors, haven't solved their financial problems.

Ed Nicholson, of Eau Claire, Wis., was the first person to take advantage of his state's law. He lost about $3,200, mostly in missed wages, in donating a kidney to his brother; the tax law let him recoup a few hundred dollars. That's typical of the law's savings.

"It helps," Nicholson said, "but it doesn't go far enough."

Those who hoped a tax break might attract more donors have also been disappointed. Since the Wisconsin law passed, living-organ donations there have dropped from 199 in 2004 to 167 last year.

That's just the normal ebb and flow of organ donations, said the bill's sponsor, state Rep. Steve Wieckert. As the tax-break idea gains traction around the country, he predicts, organ donations will increase.

Who Pays -- and How

Some advocates see donor tax breaks as a matter of government responsibility.

"If a citizen is willing to step forward and . . . donate their own body, the least the state can do is pick up the expenses," said Idaho state Sen. Mike Burkett, the leading force behind a law in that state that allows living donors an income-tax credit. (A credit is more generous than a deduction: In Idaho's case, a donor can reduce his state tax bill by as much as $5,000 to compensate him for expenses associated with giving up an organ.)

The federal government is also preparing to provide compensation, through a four-year program that is expected to begin reimbursing donors later this year.

Donor reimbursements sidestep the law against trafficking in human organs, supporters say, because nobody stands to profit. Nor do they raise the kinds of ethical questions attached to buying and selling organs: They don't run the risk, for example, of turning retread organs into luxury items available only to the wealthy or of inducing murder because of a good organ resale price.

Still, while the medical community generally endorses reimbursement, health-care practitioners know they're on a slippery ethical slope, regardless of whether the practice increases organ donations and saves lives.

"I think that we have to be very careful about the debate, because I think the American public has shown that they're willing to donate but they have a lot of internal reservations about how to do it," said Cindy Speas, director of community affairs at the Washington Regional Transplant Consortium.

But economist David E. Harrington said the states' tax deductions are already tantamount to outright payment. If states were more direct about it, he said, more donations might follow.

Harrington, who teaches at Kenyon College in Ohio, compares the issue to the donation of cadavers to medical schools. The schools frequently pay for funerals or cremations after the cadavers have been used; in states where funeral costs are higher, more bodies are donated, Harrington said.

"Why don't you do the same thing with organ donation?" he said: Think of it as paying for the donor's eventual funeral expenses, rather than for his organ.

But other medical experts fear such gestures could upset the public. A report published last year by the Washington-based Institute of Medicine and co-authored by James DuBois, director of the Center for Health Care Ethics at St. Louis University, soundly rejected the idea of paying organ donors -- even for their funeral costs.

The report, however, didn't object to tax breaks for living donors. The difference, DuBois said, is that covering funeral costs can seem like a financial incentive, while tax breaks are generally considered an effort to remove a barrier to donation. It might be semantics, he said, but it makes a difference: "Will the public interpret [payment for funerals] as a sign of gratitude, or as a deceitful way of trying to buy organs?"

Making Do

In the meantime, living donors have had to find ways to cover their costs.

Some, like Hagerstown, Md., resident Lillian Ecton, said it's a matter of planning ahead. She knew for a year that she'd be donating a kidney to her brother, so she saved up as much vacation time as she could. In the end, she still had to forgo a week's pay last year, but she wasn't bothered by it.

D.C. resident Sahra Torres-Rivera donated a kidney to a friend in 2001 and took three weeks off to do it. She thought her company's medical leave policy would cover her surgery and recovery but learned that as a temporary employee she was not eligible.

Co-workers petitioned the company to reimburse her lost pay from an emergency fund into which they had contributed. "It was overwhelming, the support that I got from my co-workers," Torres-Rivera said.

Ultimately, the company decided to pay the wages itself.

And, of course, some have taken to the Internet. Luke Sams, a Seattle resident, last year launched a Web site through which he solicited -- and received -- $3,000 to cover his expenses in donating a kidney to a friend.

Although some donors interviewed for this article said the process had caused them financial hardship, none regretted their decision. A few weeks or months of lost wages doesn't compare to the potential loss of a loved one or friend, they said.

That's how Friedberg, the auto mechanic, sees it. His wife, Mary, is alive thanks to his kidney, and now he's hard at work, making up for the money he lost.

"The kidney's working good for her, and I've got good body parts," he said.

"I kid with her. I said, 'Listen, it's lasted me 60 years, so you should be able to use it for another 60.' " ยท

Jason Feifer is a freelance writer in Boston. Comments:health@washpost.com.


© 2007 The Washington Post Company