Monday, February 9, 2009

Organ Donor for Hire

An interesting essay from Sally Satel advocating the controversial position that organ donors ought to have the option of being remunerated for their generosity. With 78,000 people on the kidney transplant waiting list, there is clearly a shortage of available organs. Currently, a big part of the screening process of potential living donors involves a thorough assessment of donor motivations. Why are you doing this? Any suggestion of financial incentive would usually disqualify a potential donor from consideration. Donation has been defined as an act of pure altruism. The gift of life. Anything extraneous or compensatory betrays the dignity of the donor/recipient relationship, according to contemporary medical ethics dogma....

But is altruism ever truly "selfless"? Intangible benefits of organ donation certainly exist; the sense of moral rightness (even superiority), a sense that you alone are responsible for the well being of another can be an intoxicating high. Moreover, the tyranny of the gift can be a burden that ties a recipient to his/her donor for life. This sense that one owes another person something of such value, a gift that was completely unsolicited and philanthropic, can be an overwhelming burden to bear for the recipient.

So what if we offered compensation for donors (either tax breaks or lifelong free health insurance or cold hard cash) and commodified the act of organ donation to some extent? Would the organ shortage be solved? Would the recipient be liberated from this stifling sense of indebtedness? Would poor people rush to sell their organs for pure financial benefit, risking their own lives? The consequences are not all entirely foreseeable but I think it's important to at least consider the possibilities of compensated donation. As Satel concludes:
To be sure, these skeptics have a right to their moral commitments, but their views must not determine binding policy in a morally pluralistic society. A donor compensation system operating in parallel with our established mechanism of altruistic procurement is the only way to accommodate us all. Moreover, it represents a promising middle ground between the status quo—a procurement system based on the partial myth of selfless altruism—and the dark, corrupt netherworld of organ trafficking. The current regime permits no room for individuals who would welcome an opportunity to be rewarded for rescuing their fellow human beings; and for those who wait for organs in vain, the only dignity left is that with which they must face death.


Anonymous said...

NEJM article 2 weeks ago seems to think carefully screened donors
do well; GFR's were higher than their control pop up to like 20-30 years out.

MiamiMed said...

This made me think of one of my own blog posts:

Anonymous said...

Hmm so I can deduct 50 cents a mile for business travel, but get nothing for a Kidney??? Thats why they're 78,000 behind.

Kolekona said...

When Patty Died Because An Organ Was Unavailable I Promised to Find a Solution!

Now, we have the SOLUTION to end the severe shortage of organ donation in America. It can save up to 100,000 individuals' lives while it preserves at least $6,055,519,000 in taxpayer funds. It works side-by-side with altruism. but will never work with altruism-only and NOTA because those are the problems.


Cristy at Living Donor 101 dot com said...

There are so many flaws in Ms. Satel's argument that I hardly know where to begin. I will focus on the most obvious and easiest point -

While compensating a living donor might save the government money for those on medicare, not every would-be recipient is on medicare.

Private, for-profit, insurance companies, otoh, won't pay for breast cancer gene screening, so they certainly won't open their substantial coffers to compensate a living donor unless they are federally mandated to do so.

Finally, not every would-be recipient is on dialysis, and research indicates that a transplant is more successful if it can be done before dialysis is started. How can the 'savings' be calculated when we can't determine how long a patient might potentially be on dialysis that hasn't begun?

On a related note, the UMinnesota studies everyone is buzzing contains many limitations, including the very stringent criteria used to choose the donors. This criteria has been expanded, ironically, in an attempt to reduce the organ shortage, which has potentially put a lot of LDs at risk of long-term complications.

But hey, we're healing sick people, right? So who really cares about those pesky living donors?

Why is no one focusing on how to reduce the demand for donor organs instead of devising ways to coerce healthy people to endanger themselves? Diabetes is the biggest kidney killer in the U.S. and many types of diabetes can be prevented and treated. Yet, we seem to fear appearing politically incorrect if we insist that people make healthy lifestyle choices.

Understand that there is NO long-term comprehensive data regarding living donors' health and well-being. Good grief, there weren't ANY policies or oversight AT ALL until 2006! Meanwhile LDs have suffered from bleeding, blood clots, hernias, reduced adrenal gland function, testicular swelling, chronic fatigue, hypertension, and severely reduced kidney function,and that's just off the top of my head.

It's accepted knowledge that some living donors suffer from depression, anxiety and PTSD-like symptoms, yet transplant centers have NO support system or aftercare programs.

Some living donors have ended up on the waiting lists themselves.

And insurance companies all-too-often deny living donors coverage due a 'pre-existing condition'.

Money does not solve everything. If Sally Satel bothered to have a single conversation with one living donor, she'd know that.