Living organ donation should be federally incentivized

Opinion Column: Under the Microscope

If you take a look at your license, you may see the words “organ donor” printed across the front. These words indicate that you are registered as a deceased organ donor — so when you die, your organs will be donated to someone in need. While deceased organ donation certainly saves lives, it alone will not solve the organ shortage crisis. First of all, deceased organs can rarely be used in a transplant procedures. The organ must be extracted and transplanted immediately after death for the procedure to be effective, and few donors die in a setting that allows for this immediate extraction. In general, patients receiving organs from deceased donors do not live as long as those who receive organs from living donors. Second of all, the gap between the number of patients waiting for an organ and the number of those receiving an organ continues to increase. In order to close this gap, living organ donation must supplement deceased organ donation.

However, the living organ donation rate, unsurprisingly, remains quite low in the United States. The costs of donation are large and numerous. The cost of meals, travel and accommodation during the donation procedure, the cost of future health care needs and the loss of income during recovery time are just some of the many expenses involved in living organ donation. Currently, there is a federal law in the United States that allows living donors to apply for compensation for sustenance relating to the donation process, but this reimbursement is not guaranteed. Because very few people are willing to pay these large prices for the sole purpose of saving someone else’s life, there are very few living donors in the United States. And the few individuals who do donate tend to be very wealthy or are relatives of those in need of organs.

So the big question is, "How can we encourage more people to donate so that all patients on the waiting list can receive transplants?" Organ donation should not be something that only the rich can afford, so how can we make organ donation accessible to everyone?

There are two sets of approaches that have been suggested. One involves removing the disincentives to donation, or the costs I mentioned above. The other method involves providing incentives to living donors, such as insurance or money, which is controversial. The United States should take a combined approach: It should remove most disincentives to donation, and it should provide some benefits to donors. Many other countries, such as Australia and the United Kingdom, have removed disincentives to donation without controversy or negative consequences, and most would agree that removing disincentives to donation is an effective and ethical way to increase the number of living donors.

The United States should develop a federal policy that lays out procedures for reimbursing living donors for lost income, childcare costs, travel costs, meal costs, accommodation costs and medical expenses relating to the donation process. In order to increase the number of living donors significantly, providing incentives to donate would most likely be the most effective approach. Think about it this way: Which method would convince you more to buy a small product — a discount on that product or receiving a free TV if you buy the product? Most people would choose the latter option. It’s the same way for organ donation. More people are willing to donate if they receive something in return. What should the government provide to donors as incentives? A financial reward would perhaps be most effective in increasing the number of living donors. However, this incentive is ethically questionable, for it may be coercive to the poor. The impoverished may risk their own lives and donate their organs for the sole purpose of receiving the cash reward. Some argue that providing financial incentives is less unethical than the current system of organ donation. This system in which only the rich — who can afford to privately compensate donors — can receive organs, while the poor people on the transplant list are left organ-less. Nevertheless, I do not believe that financial incentives is the most ethical solution to the organ shortage problem. Instead, perhaps the government can provide, in addition to the reimbursement of costs, two different incentives: long-term health insurance and priority in organ allocation. Providing long-term medical insurance would ensure that donors can afford to get medical care, if they suffer from a future illness that is attributable to their organ deficiency. In addition, giving donors priority on the transplant waiting list if they need an organ in the future is a great way to reward altruistic living donors.

If the United States implemented a federal law that compensated living donors for costs relating to the donation process that also provided living donors with long-term health insurance and priority in organ allocation, the organ shortage problem would diminish and thousands of lives could be saved.

Vandana Apte is a School of Environmental and Biological Sciences junior majoring in biotechnology with a minor in women's and gender studies. Her column, “Under the Microscope,” runs monthly on Thursdays.

Vandana Apte

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