The Case for Paying Organ Donors

Articles & Commentary

The Case for Paying Organ Donors
By Sally Satel
Wall Street Journal Europe
Sunday, October 18, 2009

Abstract

In a joint study released last week, the Council of Europe and the United Nations put forward a two-pronged strategy that will do more to hurt, not help, the organ shortage problem. Its call for a ban on both organ trafficking and the legal compensation of organ donors will restrict the supply of organs even more while driving illicit activity further underground. What we need is true global leadership that charts a course for legally rewarding organ donors and saving lives, instead of reinforcing the inadequate status quo.

Last week the Council of Europe and the United Nations issued a joint study on trafficking in human organs. According to the study, up to 10% of all kidneys transplanted worldwide are obtained in the organ bazaars of Africa, Asia, Eastern Europe and South America.

These underground markets exist, the paper rightly says, because of "the desperation of patients waiting for transplants." But its two-pronged solution won't solve the problem. It will likely make it even worse.

Let me explain. First, the study calls for a ban on organ trafficking. At first blush, this seems reasonable. After all, the depredations of illicit organ markets are stark: Corrupt brokers deceive indigent and illiterate donors about the nature of surgery, cheat them out of payment, and ignore their post-surgical needs.
Although I am a blessed beneficiary of someone's altruism—a glorious friend donated one of her kidneys to me in 2006—I know that altruism is not enough.

But this brings us to the second prong of the study's approach: Prohibiting the legal compensation of donors, which could be used to increase the number of organs available for transplant. A number of countries such as Singapore, the Netherlands, Israel, the U.S. and Saudi Arabia have contemplated offering benefits such as lifetime health insurance to kidney donors, or plan to do so. International prohibitions on the practice, as championed in the joint study, would undermine their efforts and stifle humane pilot programs elsewhere.

Together, these two approaches spell disaster. Clamping down on unlawful organ sales without first expanding the organ pool will mean not less criminal activity, but more patient deaths. I say this as an American who contemplated going overseas to find a kidney when I needed a transplant a few years ago.

Most likely, the efforts to stamp out trafficking will also drive corruption rings further underground, thereby increasing the risks to recipients and donors or cause markets to blossom elsewhere around the globe.

Without question, more countries need to improve their rates of obtaining organs at death from volunteers. But even in Spain, which is famously successful at retrieving organs from the newly-deceased because of its robust procurement infrastructure, there are still patients dying on its waiting list.

The bold fact is that organ trafficking will stop only when the dire shortage recedes. How to make this happen? Enable more patients in wealthy countries to obtain transplants at home by empowering their governments, under strict regulation, to offer incentives to prospective donors.

Regrettably, the U.N. and Council of Europe renounce this approach. One reason is practical, the other abstract. First, the task force is worried that buying organs, even if done legally, will encourage very poor people to sell their organs out of desperation. A fair point. The answer is a plan that circumvents donor exploitation. If in-kind rewards were offered to donors, such as a contribution to a retirement fund, an income tax credit, or tuition vouchers for their children--rather than lump-sum cash payments--the program would not attract desperate people who might otherwise rush to donate for a large sum of instant cash.

Such an incentive program would carefully screen would-be donors for physical and emotional health, as is currently done for all volunteer living kidney donors everywhere. A months-long waiting period would ensure that donors are not acting impulsively or with less than fully informed consent. Finally, all donors would be guaranteed follow-up medical care for any complications.

Notably, the incentives would be provided by a third party such as a governmental entity, charity or insurer; not by individual patients. Thus, organs procured in this manner would be distributed to the next needy patient in line--with no special advantage to the well-off.

Not only would more lives be saved through legal means of donor rewards, but it would also result in fewer people from rich countries paying kidney brokers to haunt the back alleys of China, Pakistan, Egypt, Colombia and Eastern Europe in search of hapless donors.

This plan, alas, runs afoul of the principle of altruistic giving. "Altruism is the bioethical foundation . . . or obtaining organs in a manner consistent with human dignity," the joint study says. "Organs should not give rise to financial gain."

I reject this logic. Dignity is affirmed when we respect the capacity of individuals to make decisions in their own best interest, protect their health and express gratitude for their sacrifice. Financial gain, per se, is not inconsistent with this. The true indignity is to stand by smugly while thousands of people die each year for want of an organ.

As for the donor, why shouldn't he be able to accept a reward for saving the life of another human being? After all, he is the one who takes a risk and relinquishes the precious good. The doctors, nurses, and hospital all receive compensation when a transplant occurs--yet no one insists they volunteer their services. And rightly so, because the more transplants performed, the more suffering averted and the more lives saved.

Although I am a blessed beneficiary of someone's altruism--a glorious friend donated one of her kidneys to me in 2006--I know that altruism is not enough. Twelve citizens in the European Union die daily because they could not survive the wait for a transplant. In the U.S., 18 people die each day.

But instead of forging solutions, the Joint Council wants to reinforce the status quo. "Changes in the relevant values might well alienate the public who have grown used to the existing bioethical framework," the report says.

Grown used to? What a poor excuse for global leadership. New ideas are imperative when a tired policy regime has proven itself inadequate. Sadly, the study's prescription ensures more needless death and suffering--a dire outcome that we must refuse to grow used to.

Sally Satel, M.D., is a resident scholar at AEI.

You can find this article online at http://www.aei.org/article/101191