THE VAST majority of Americans talk the talk about organ donation: Ninety-five percent say they support it. But only 50 percent walk the walk as registered donors. At a summit Monday, the White House announced measures that could reduce the gap.
The White House and the universities, nonprofits and other organizations that participated in the summit hope to increase the number of yearly organ transplants in the United States, which last year surpassed 30,000 for the first time. More than 120,000 people remain on the waiting list — almost 100,000 for kidney transplants — and 22 die every day.
The efforts unveiled Monday, which include campaigns to promote donor registration as well as private and public pledges toward research to preserve and repair organs once they have been donated, are smart steps forward: Potential donors should not be deterred by complicated and confusing registration processes, and patients should not go without transplants because of inefficient matching procedures or organ expiration. Funding for tissue-fabrication research and efforts to ensure donors declare their intent to donate online are particularly promising.
But the White House’s announced actions raise additional questions about how to work through the wait list. For example, though efforts to ramp up registration should help, potential donors still have to opt into donation with their states’ departments of motor vehicles. Opt-out policies like those in countries such as Spain and Austria can yield registration levels six times those of opt-in countries. Critics say it would be wrong to presume a patient’s consent, but education around such a change could give everyone the opportunity to shed donor status and still save lives.
Then there’s the question of how to encourage living donors without exploiting them. Many say monetary compensation, banned in 1984 under the National Organ Transplant Act, could lead to a “marketplace” for organs and drive the poorest among us to donate in desperation — maybe even concealing their medical histories.
But if increasing incentives to donate poses problems, what about at least decreasing disincentives? For the majority of donors today, giving a kidney ends up costing more than just the organ — whether it’s the wages lost during time off from work, the price of transportation to doctor’s appointments or the risk of higher insurance premiums down the road. Legislation is pending in Congress that would offer donors protection against insurance discrimination and require that their jobs grant them unpaid leave. Another bill proposes allowing pilot programs that reward donation. It’s hard to draw the line between expense-covering and compensation — but donation should be cost-neutral at a minimum.