A little-discussed medical crisis in the United States finally seems to be getting a lot of attention: our massive shortage of living organ donations. Lawmakers introduced legislation last week that may make it easier to reward people who donate their organs, which would hopefully help close the gap.
As of January, more than 121,000 people were on waiting lists to have failing organs replaced, with about 100,000 of those in need of new kidneys. And the problem is getting worse: A surge in kidney failure created a situation in which people being added to wait lists outnumber those receiving transplants 2-to-1.
Meanwhile, kidney dialysis treatment results in premature deaths, cuts hours out of patients’ days and saps enormous amounts of taxpayer money (more than 6 percent of the entire Medicare budget, or up to $72,000 per person for a full year of dialysis). Economists have found that paying $45,000 each for living organ could eliminate wait lists and save $45 billion each year.
Sounds great! So why don’t we have a compensation system to increase donations?
Because that would be illegal. It’s also generally considered unethical in the medical community to pay for human tissue, which is why doctors and health professionals have become some of the staunchest opponents of creating financial incentives for donations.
Given the dire need for donated organs, In Theory published a series in December about whether we should reconsider our ethical norms in this debate. Below are some highlights.
From Francis Delmonico and Alexander Capron, experts at the World Health Organization:
If U.S. law is changed to turn human organs into commodities, organs will be obtained from the poorest and most vulnerable — not only in our society but also from around the world. Countries with pervasive poverty that have recently adopted anti-sales laws would find it impossible to resist the pressure to repeal their own regulations. That would doom their nascent deceased donation programs and make transplantation less an emblem of medical ingenuity and more an engine of exploitation and injustice.
From Scott Sumner of Bentley University:
Before doubling down on [a ban of compensation for organs] that we know will cost thousands of lives each year, don’t we need to be pretty sure that our moral intuitions on the issue are correct and not something that will later change, as they so often do? I don’t know about you, but when I think of all the actual suffering caused by this regulation, I find it hard to justify not giving individuals a choice.
From Sally Satel of the American Enterprise Institute:
[To] save lives, let’s test incentives. A model reimbursement plan would look like this: Donors would not receive a lump sum of cash; instead, a governmental entity or a designated charity would offer them in-kind rewards, such as a contribution to the donor’s retirement fund; an income tax credit or a tuition voucher; lifetime health insurance; a contribution to a charity of the donor’s choice; or loan forgiveness.
The legislation introduced last week, sponsored by Rep. Matt Cartwright (D-Pa.), wouldn’t set up a specific incentive system as Satel suggested. It would, however, make it legal for donors to accept reimbursement for the costs of giving their organs, such as for travel, lost wages, medical expenses, legal costs, etc. — all expensive burdens that currently land on the shoulders of private donors.
If passed, the bill would also allow the Department of Health and Human Services to run pilot programs to see how non-cash incentives could affect organ donations. This could boost the number of organs available, which has stagnated, especially during the recession.
The legislation is still in its early stages, but it already seems to have some movement. It has a bipartisan mix of co-sponsors and has been endorsed by some big advocacy groups, including Americans for Tax Reform and the American Medical Association, among others.
The bill amounts to a bit of ethical needle-threading. You might not get paid to give up your kidney, but you also won’t have to pay to do it. Would it solve the organ shortage? Certainly not. But it might have the potential to save a few lives.