Opinion 2.151 - Cadaveric Organ Donation: Encouraging the Study of Motivation
Physicians have an obligation to hold their patients’ interests paramount and to support access to medical care (Principles VIII and IX). To discharge these obligations, physicians should participate in efforts to increase organ donation including promotion of voluntary donation. Beyond educational programs, however, physicians should support innovative approaches to encourage organ donation. Such efforts may include encouragement of and, if appropriate, participation in the conduct of ethically designed research studies of financial incentives.
Because the potential benefits and harms of financial incentives for cadaveric organ donation are unknown, physicians have an obligation to study financial incentives. Whether or not they are ethical depends upon the balance of benefits and harms that result from them. Physicians should encourage and support pilot studies, limited to relatively small populations, that investigate the effects of financial incentives for cadaveric organ donation for the purpose of examining and possibly revising current policies in the light of scientific evidence.
Pilot studies of the effects of financial incentives for cadaveric organ donation should be implemented only after certain considerations have been met, including: (1) Consultation and advice is sought from the population within which the pilot study is to take place. (2) Objectives and strategies as well as sound scientific design, measurable outcomes and set time frames are clearly defined in written protocols that are publicly available and approved by appropriate oversight bodies, such as Institutional Review Boards. (3) Incentives are of moderate value and at the lowest level that can be reasonably expected to increase organ donation. (4) Payment for an organ from a living donor is not a part of any study. (5) Financial incentives apply to cadaveric donation only, and must not lead to the purchase of donated organs; the distribution of organs for transplantation should continue to be governed by United Network for Organ Sharing (UNOS), based on ethically appropriate criteria related to medical need. (I, III, V, VII, VIII, IX)