Carroll: Why not pay organ donors?

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Carroll: Why not pay organ donors?
By Vincent Carroll
POSTED: 01/26/2011 01:00:00 AM MST

The Senate sponsor of an "opt-out" organ donor bill seemed surprised by the vehemence of her critics. "There is a lot of misinformation out there, and people are scared and upset," declared Sen. Lucia Guzman, D-Denver, in withdrawing her bill.

Yet maybe the critics understand that by changing the standard so Coloradans would have to declare they don't want to be considered a possible organ donor, we would erode the voluntary nature of the transaction. And never mind that some European countries already operate successfully under "presumed consent" laws. Americans value their autonomy and resent government attempting to settle highly personal decisions on their behalf.

Still, give Guzman and Rep. Daniel Pabon, D-Denver, the House sponsor, credit for highlighting an immense and quiet tragedy: the growing gap between the number of people who need new organs — kidneys, hearts, livers, lungs — and available donors.

Thousands die each year for lack of an organ. Tens of thousands survive in an anxious limbo — with most of those on kidney dialysis.

In Colorado, an impressive 66 percent of people registering for their driver's license opt into the organ donor program. But even if you could greatly boost that figure under presumed consent — and it's not certain you would, according to some experts who've studied Europe's experience — it wouldn't eliminate the backlog. Not when only a tiny fraction of hospital deaths are the type in which an organ donation is possible.

What to do? How about a strategy worthy of the magnitude of the problem?

How about compensating donors?

After all, by far the largest category of need involves kidneys, and healthy people can donate one of their kidneys with no ill effects (see, for example, the Jan. 29, 2009, issue of the New England Journal of Medicine).

"Outlawing payments to donors is ostensibly a way to keep the system fair, giving rich and poor an equally lousy chance of getting a kidney," Virginia Postrel wrote in The Atlantic two years ago. The other great worry of compensation critics, according to Sally Satel, a doctor and scholar at the American Enterprise Institute in Washington, is the exploitation of would-be donors who are poor.

"So many physicians and bioethicists doubt the ability of low-income people to make decisions in their own best interests," she told me, while expecting donors to be altruistic. "Altruism is a glorious virtue. It's why I have a new kidney," Satel says. But she is practical. "The true goal of transplant policy is to increase the number of organs and save lives."

Postrel and Satel are hardly idle theorists. When Postrel heard that Satel needed a kidney a few years ago, she offered hers, and a grateful Satel took it. Like the vast majority of donor/recipient pairs, they knew each other beforehand. Unfortunately, erasing the organ backlog won't be achieved by relying predominantly on the compassion of family and friends. Thousands of strangers must be lured into the mix.

And not necessarily with cash — a non-starter politically. "The general idea for compensation involves a government sponsored tax credit, tuition voucher or lifetime health insurance," Satel explains. (And please note: A tax credit would be most attractive to middle-class donors).

What, you protest, another costly government program? No. Dialysis already is an entitlement that costs, Satel notes, a breathtaking $72,000 a year. Even if donors were offered $50,000 in tax credits and the government paid for the costly medications that a recipient must take later, there would be a net lifetime savings.

Satel is optimistic that compensating donors really would take care of the organ shortage — at the very least, she says, we should test it — and notes that the precedent is hardly radical. We allow payments to donors of plasma, sperm and eggs, as well as to surrogate mothers.

If Colorado lawmakers want to help solve the organ shortage, they should pass a resolution urging Congress to revise a 1984 law prohibiting organ donors from receiving any "valuable consideration." And they should lobby our delegation to champion the idea.

E-mail Vincent Carroll at vcarroll@denverpost.com.



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