Paying organ donors' expenses at center of ethics debate

Paying organ donors' expenses at center of ethics debate

By Elizabeth Weise, USA TODAY
Updated 1/29/2009 11:29 AM

Organ donors, living and dead, would receive more money for expenses under an initiative being proposed today designed to shorten the wait for transplants.

The National Kidney Foundation, a New-York based non-profit, released a set of recommendations it says could end the wait for a kidney in 10 years.

Currently, 78,209 people are waiting for kidneys in the USA, representing 77% of all those waiting for donated organs.

Organ donation "is a good thing to do, it's the right thing to do, and no family should be hurt by doing it," says John Davis, the foundation's chief executive. "Families … fall through the cracks and get bills from hospitals and funeral homes, and they didn't expect it."

Of the recommendations, the most controversial may be that organ-procurement organizations cover donation-incurred funeral expenses for families who donate a relative's organs. Preparing the body for burial can require extra time and expense. In 2007, 22,049 of the 28,360 organ transplants were from deceased donors, according the United Network for Organ Sharing.

Ethical concerns are being raised. Helping people with funeral expenses "crosses over into helping bribe them," says Arthur Caplan, a bioethicist at the University of Pennsylvania. "You're edging towards financial incentives rather than compensation."

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The foundation also calls for all living donor costs to be covered because unexpected expenses can add up.

When Tom Falsey of Shawnee, Kan., donated a kidney to a stranger, the patient's insurance paid for the medical costs, but Falsey paid to travel to Nebraska for tests and the transplant. He also had to pay hotel costs for his wife, who accompanied him. "It was about $1,000," he says. "I knew there would be expenses, but I didn't know that they would be so high." These peripheral expenses are not covered by Medicare or private insurance.

About 4,500 people a year die waiting for a kidney. The number of people who will go on dialysis and need a kidney is expected to double in the next few years, as the population ages, says David Hull, head of transplantation at Hartford Hospital in Connecticut. Sally Satel, a kidney recipient and scholar at the American Enterprise Institute who writes on the need to create financial incentives for kidney donation, says it doesn't go far enough. She supports incentives that go beyond covering expenses.

"This is not original and will be by no means sufficient to close the gap between supply and demand," she says. "It's too timid."

The foundation says it will work with Congress to draft a bill that would implement its recommendations, which would be paid for by a combination of Medicare and private insurance.

Other recommendations for the foundation's "End the Wait!" initiative include:

•Covering immunosuppressive drugs for life. Medicare pays for only three years. After that, some patients can't afford the drugs and go back on dialysis. The drugs cost about $12,000 a year; dialysis, $71,000 a year.

•Guaranteeing living donors health care coverage and life insurance for all medical issues related to the donation.

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