Group proposes benefits for kidney donors

[okarol]

Group proposes benefits for kidney donors

UAB doctor's article calls for pay, tax breaks

Wednesday, October 25, 2006
DAVE PARKS
Birmingham News staff writer

In an effort to break a medical and ethical stalemate, a broad group of transplant authorities is proposing a package of benefits worth up to $32,800 for kidney donors, according to an article written by a UAB doctor and published in a medical journal.

Dr. Robert S. Gaston, a nephrologist at the University of Alabama at Birmingham, said the proposal - created by doctors, an ethicist, a lawyer and an economist - is being presented as a starting point for a serious national discussion about removing financial barriers to kidney donation.

"We think we're in the ball park," said Gaston, lead author of the article being published in the November edition of the American Journal of Transplantation.

However, an editorial published in the same edition of the journal dismissed the proposal as a "smokescreen" obscuring moral problems associated with buying and selling organs.

The National Organ Transplant Act forbids the offer of any "valuable consideration" in exchange for an organ, but it does allow "reasonable payments" to donors for expenses, housing and lost wages, something that is seldom done and often viewed as medically unethical in the United States.

Gaston contends it's time to make organ donation a break-even deal for donors, who often sacrifice much financially and medically. The article proposes these benefits:

A one-year, $1 million term life insurance policy.

Immediate eligibility for Medicare coverage.

Reimbursement for out-of-pocket expenses such as lost wages.

Compensation of $5,000 or a $10,000 tax deduction for inconvenience, anxiety or pain.

Trade-off for Medicare:

The value of the compensation package would range from $23,525 to $32,800, and the cost could be shouldered by the Medicare program, Gaston said. Medicare now pays for dialysis treatments for kidney patients. Gaston said the proposal would save Medicare money in the long run by encouraging more organ donations and getting kidney patients off dialysis.

About 70,000 Americans need kidney transplants, with about 2,600 of them on a waiting list at UAB. Only about 15 percent of those patients will get a transplant this year because of a shortage of donated organs. Waiting times can run five to 10 years, and the waiting list is expected to surpass 100,000 names by 2010.

An editorial written by Mark D. Fox of the Bioethics Center at the University of Oklahoma sharply criticized the proposal and said it goes beyond compensating donors for their losses.

"In fact the authors present a thinly veiled reward for living donation," the editorial states. "While the proposed benefit may not be a deciding factor to the CEO of a Fortune 500 company, to someone earning only minimum wage, the compensation may represent several months' pay."

The proposal represents the "folly of the privileged, not the reality of the poor," the editorial states.

Gaston said the proposal's intent is not to create a market for organs from poor people. "We're not trying to incentivize the guy at Jimmie Hale Mission to donate a kidney," he said.

Sides polarized:

He called the editorial disappointing because it doesn't provide specifics about what should be done to support organ donors. It just says what shouldn't be done.

He said there are two opposing camps in the debate about compensating donors. One side wants the marketplace to determine the price of an organ, while the other side wants absolutely no compensation.

"People conducting this argument are so polarized," he said. "We went to great lengths to find the middle ground," Gaston said.

In Europe, donors routinely are compensated for their costs, and it makes sense to do the same in the United States, Gaston said. "We ask donors to take a huge hit," he said. It's only fair to provide them with insurance coverage and compensation for losses, he said.

One of the most contentious aspects of the proposal was the $5,000 payment or $10,000 tax deduction. There was wide disagreement among experts in the group about whether such a payment should be included and how much it should be, Gaston said. In the end, the amount proposed was relatively small when considering how much a kidney donor must go through.

Gaston said that, personally, he would be willing to eliminate that provision if it would advance other aspects of the proposal.

"To me, that's a very small piece of the overall proposal," Gaston said. "We in no way see this as the final, ultimate proposal."

He said the group hopes the proposal stimulates the debate and moves the issue forward, perhaps through the creation of a pilot project.

"We're looking for a consensus to be developed on what the next step should be," he said.

E-mail: dparks@bhamnews.com

original: http://www.al.com/news/birminghamnews/index.ssf?/base/news/116176890790390.xml&coll=2

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