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Organ donation: Time has come for study of incentives

Innovative ways to encourage organ donors, including financial approaches, need to be examined in order to see which ones may be effective in increasing the number of cadaveric organs available for tranplants.

Editorial. Aug. 19, 2002.

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In the words of the immortal Emcee and the entertaining Kit Kat girls of the Broadway musical "Cabaret," money makes the world go round.

Indeed, our current obsession with the daily ups and downs of the stock market would seem to prove this true.

Yet, there are still things the almighty dollar cannot buy in this country. Like a heart. Or a kidney. Or a liver. And mainstream media misrepresentations aside, the AMA House of Delegates did not vote earlier this summer to change that.

What it did do is open the door to scientific examination of what motivates people to donate organs and whether modest financial incentives for cadaveric organs would prompt more donations. After several years in which the number of organs needed has far outstripped the supply, this call for serious study and consideration is an idea whose time has come.

The oft-quoted statistics on donation rates are disturbing and worth repeating. About 6,000 patients per year -- 16 per day -- die of organ failure while waiting for a transplant.

The need for organs has grown nearly five times faster than the number of cadaveric donors. From 1990 to 2000, the increase in the number of patients on the transplant waiting list has increased an average 14.1% per year while the increase in donors has increased an average 2.9% per year.

Clearly, previous initiatives to increase organ donation, ranging from public information campaigns to donor registries, have not produced the desired result -- a significant drop in the number of people who die while waiting for a transplant.

Each year thousands of opportunities are missed. Studies show that only 35% to 50% of potential donors consent to donation. These numbers include those whose wishes are expressed and carried out by family members and donors whose families consent following their death.

What would it take to get many more potential donors to just say yes?

The American Society of Transplant Surgeons and the United Network for Organ Sharing have joined the AMA in deciding it's time to ask them.

Financial incentives can come in a variety of packages.

One that has been repeatedly discussed is a future contract under which a person agrees before death to donate. Once the organs have been judged suitable for transplantation, a tax credit would be applied to the estate of the deceased. Another incentive that has been discussed is direct monetary payment to families who agree to donate. One study has shown that payment of $500 to $1,000 for donation would increase donation rates sufficiently to nearly eliminate the kidney waiting list.

These approaches might work or they might not. That's where a study comes in.

Among the concerns cited by those against financial incentives are that they would devalue altruism and reduce the human body to a commodity. It takes a scientific study, however, to properly evaluate the validity of those concerns.

How quickly a study might yield insight, however, will be left up to Congress. Legislation that would give the U.S. Dept. of Health and Human Services secretary authority to conduct financial incentive studies is now before the federal lawmaking body. The National Organ Transplant Act of 1984 made it illegal to offer "valuable consideration" to donors for their organs.

Until the legal status of financial incentives changes, it is up to physicians to continue to participate in efforts to increase promotion of voluntary organ donation and to support innovative approaches to increasing donations -- including, when the time comes and if appropriate, participating in ethically designed research studies of financial incentives.

The AMA Principles of Medical Ethics call for nothing less.

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