As of November 25, 2014, there were 123,959 individuals in the U.S. waiting for a lifesaving organ, a staggering figure compared to the 9,512 organ transplants conducted so far this year. Clearly, society is not doing enough to close the gap between those in need and those willing to donate organs. Given the inadequacy of our altruism-based system, now is the time to consider other means to incentivize organ donation, including monetary compensation.
In 1984, Congress passed the National Organ Transplant Act (NOTA) making it a felony to exchange something of material wealth for an organ. With the best of intentions, the law’s authors aimed to prevent the creation of a private market for organ sales and eliminate its concomitant exploitation. In turn, this law limited donation to those individuals with sufficient altruistic motivation to give away an organ. As noble as these intentions may be, on average 21 people die each day waiting for a transplant. We need to think of new and better ways to improve the efficiency of this market.
I am not advocating for direct cash payments from donors to recipients or for moving the black market for organ donations into the open, both of which are known to induce exploitation. Instead, we should start examining what types and what levels of compensation would sufficiently increase both living and deceased organ donation, while protecting donors from exploitation. Ethical concerns must be seriously considered, but some enterprising states and countries are already testing new initiatives, and their ideas are certainly worth exploring.
For instance, in 1994 Pennsylvania enacted a law providing a burial benefit of up to $3,000, paid by the government directly to a funeral home, to help the families of deceased organ donors. The payment was meant to provide meaningful support in a time of need and to incentivize an increase in deceased organ donation. However, the size of this policy’s impact remains unknown, as the state never implemented the law over concerns that it ran afoul of NOTA.
Australia is also beginning to explore new ways to increase organ donation. The country is currently in the middle of a two-year pilot program that remunerates donors for six weeks of lost wages incurred while recuperating from kidney or partial liver donation surgery. The plan only compensates those donors who are currently employed and pays all recipients at the national minimum wage. Dr. Alex Markwell of the Australian Medical Association of Queensland notes that the program is intended to alleviate some of the financial pressure associated with the procedure. He told ABC News, “It’s certainly not supposed to be compensation or anything other than some financial relief for the time taken off work.”
In the U.S., paid medical or sick leave is a far from universal. Imagine the financial burden imposed on a living donor who has taken time off from work for testing, surgery, and recovery. Is that individual’s time not worth compensating, considering the life-saving gift they are prepared to make?
In the case of the U.S., it would also be important to consider health insurance. Despite the recent health insurance mandate, insurance remains unaffordable for many. Policy initiatives for the government, or even private insurance companies, to provide increased access or reduced cost health insurance to donors could serve as another means to achieve higher donation rates. Also, ensuring living organ donors have access to insurance is good medical policy, as organ donation comes with the risks associated with any major surgery.
These ideas are still in their infancy but are certainly worth consideration for pilot programs.
For those who think the government does not have the financial resources for such initiatives, consider the cost of a one-time $3,000 payment for funeral expenses or six weeks of wages compared to the $88,000 it costs per person, per year for Medicare to provide dialysis, which it provides to all citizens whose kidney failure requires it, regardless of age.
Compensation for organ donation is also a fairly popular idea in the U.S. An NPR-Thomson Reuters Health Poll conducted in 2012 showed that approximately 60 percent of Americans would support some type of moderate compensation for living organ donors. Specifically, 60 percent supported compensation in the form of credits for health care needs and even 41 percent viewed cash payments favorably.
In this 30th year of the NOTA, it is time to reconsider the implications of our purely altruism-based organ donation system. No one should view organ donation as a monetary windfall, but we need to consider policy changes that ensure individuals do not have to take financial risks on top of the sacrifice they are already making when donating an organ. A relatively minor legislative revision to the NOTA allowing the testing of incentive mechanisms could go a long way to saving countless lives.
Jessica is a full-time Health Policy and Management student at NYU Wagner, where she focuses on federal health care issues relating to Medicare and Medicaid. She currently serves as the Philanthropy Fellow in the area of Health and People with Special Needs at the New York Community Trust and, before coming to Wagner, worked in political communications and health care policy on Capitol Hill and at Washington DC-based nonprofits.