Bill would allow studies on organ donation incentives

Opponents say financial incentives for families of cadaveric donors might deter living donors.

By Andis Robeznieks, amednews staff. Aug. 11, 2003.

More than a month after a hearing on the subject, and more than a year after the American Medical Association endorsed the concept, U.S. Rep. James Greenwood (R, Pa.) has introduced a bill that would allow studies to determine whether financial incentives could increase cadaveric organ donations.

The AMA and other groups have pushed for these studies, but current federal law forbids financial compensation for organ donation. So before anything else can be done, the law needs to be changed so incentives can be offered and studies can be conducted on their effects. Greenwood's bill would grant U.S. Health and Human Services Secretary Tommy Thompson the power to authorize demonstration projects to study the impact of financial incentives on organ donation.

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Greenwood introduced a similar bill last year, and Robert M. Sade, MD, a member of the AMA Council on Ethical and Judicial Affairs, said CEJA recommended that it be more specific. Instead of having vague references to demonstration projects, Dr. Sade said the bill should have authorized specific studies scientifically designed to answer a particular question.

Although the vague language of last year's bill is repeated in this year's version, Dr. Sade said it is still worthy of support. "I would rather they would have done everything CEJA had recommended, but it's such a major step in the right direction I would be pleased if the bill -- as it is -- passes," said Dr. Sade, a cardiothoracic surgeon at the Medical University of South Carolina, Charleston.

The United Network for Organ Sharing also will support the bill. "Our board agreed in June of last year that we would support studying the impact of incentives on organ donation," said UNOS spokeswoman Annie Moore. "We will support any studies that are conducted on incentives for organ donation, whether they be financial or general incentives."

In a July 22 "Dear colleague" letter seeking co-sponsors, Greenwood quoted AMA policy concerning the study of financial incentives and noted that there are 82,000 patients on the organ transplant waiting list.

82,000 patients are waiting for organ transplants.

"There are simply not enough usable organs to meet the demand," Greenwood's letter stated. "Through the use of incentives, we may increase the number of donors to alleviate the considerable shortage of organs, potentially saving thousands of lives."

Greenwood introduced the bill July 24, and by the next day it had four co-sponsors: Martin Frost (D, Texas), Rush Holt (D, N.J.), Donald Payne, (D, N.J.) and the Virgin Islands delegate, Donna Christian-Christiansen.

"I find it very encouraging, but we have to get something similar in the Senate for [studies] to go forward," said University of Pittsburgh neuroscientist Harold Kyriazi, PhD, who helped organize a group called the Ad Hoc Committee for Solving the Intractable Organ Shortage.

Dr. Kyriazi said his group might help with designing some studies as well as organizing a group of people on the organ transplant waiting list to help lobby for the bill.

"One thing opponents of financial incentives seem to worry about is, if we allow money for cadaveric donation, how can we still philosophically oppose money for living donations?" Dr. Kyriazi said. "But if we're able to increase the supply of organs through cadaveric donations, there'd be less need for living donations."

While testifying at Greenwood's June 3 hearing on organ donations, Dr. Sade noted that opponents also think financial incentives might deter altruistic individuals from donating a family member's organs and might fuel a trend toward viewing the human body as a source of profit.

"For its part, the AMA notes that there is a dearth of scientific data supporting these concerns," Dr. Sade said. "Nearly all the arguments against financial incentives are based on assumptions that can be proven or disproved by objective empirical studies."

The AMA has not endorsed specific incentives, but others have suggested tax credits up to $10,000 for deceased donors' estates, reimbursement for funeral expenses, charitable donations, direct payment and medals of honor.

ADDITIONAL INFORMATION:

Weblink

U.S. House Energy and Commerce Committee hearing on organ donation, June 3 (energycommerce.house.gov/108/Hearings/06032003hearing946/hearing.htm)

Thomas, the federal legislative information service, for summary, status and full text of the bill authorizing the secretary of Health and Human Services to carry out demonstration projects to increase the supply of organs donated for human transplantation (HR 2856) (thomas.loc.gov)

AMA information on organ and tissue donation (www.ama-assn.org/go/organdonation)

AMA ethical opinion E-2.151, "Cadaveric Organ Donation: Encouraging the Study of Motivation" (www.ama-assn.org/apps/pf_online/pf_online?f_n=browse&doc=policyfiles/CEJA/E-2.151.HTM)

Ad Hoc Committee for Solving the Intractable Organ Shortage (www.pitt.edu/~htk/organgiving/proposal.htm)