Remove Financial Barriers to organ donation, experts say

[Rerun]

Taking the financial burden of organ donation off the shoulders of donors and their families is not only more fair, but it might also lead to more organs for transplant, experts say - and they urge Americans to find ethical ways to get rid of financial “disincentives” to organ donation.

In addition to removal of financial barriers, they would also like to see careful consideration and testing of potential financial incentives for organ donation.... see article below



http://www.foxnews.com/health/2015/04/07/remove-financial-barriers-to-organ-donation-experts-say/

[KarenInWA]

What's sad is whenever I've seen this topic be brought up on some of the kidney facebook groups, a lot of kidney patients get offended at the idea that a donor should be financially compensated at all for giving them the gift of life. Apparently, in their little world, the donor is supposed to face financial uncertainty because expecting any kind of compensation, including wage replacement, is "negating" the gift. That if one truly wants to give a kidney, they will expect nothing in return. While that is nice in theory, it is simply unrealistic. It seems like too many kidney patients do not want to or are unable to fully see the big picture concerning this issue.

KarenInWA

[PaulBC]

Apparently, in their little world, the donor is supposed to face financial uncertainty because expecting any kind of compensation, including wage replacement, is "negating" the gift. That if one truly wants to give a kidney, they will expect nothing in return. While that is nice in theory, it is simply unrealistic. It seems like too many kidney patients do not want to or are unable to fully see the big picture concerning this issue.

Compensation is clearly one of the thorniest ethical questions around living donors. I'm unfamiliar with this attitude coming from kidney patients, but there is a cultural norm that separates generosity from acting of out self-interest, and I guess it doesn't surprise me if this even shows up in patients who could benefit directly. I agree that requiring a show of altruism is not helpful. It's a hard enough thing to do anyway, and nothing should be required besides informed consent.

I would make the following distinction between removing barriers and creating incentives. I'll start by stating it as neutrally as I can, without expressing any ethical judgment:

• If someone has decided that they are enthusiastic about donating a kidney, they will still be concerned with losing quality of life and possibly future income. The loss of one kidney is a given, but other things can be mitigated with money. That is removing a barrier.
• If someone would not be inclined to donate a kidney, but might be willing to do it if they think that it will leave them better off due to financial compensation, that is creating an incentive.

So (judgment here), I think that money should absolutely go to removing barriers. Nobody should feel worse off and resentful as a result of making a life-saving choice like this. However (I am not a Libertarian), I am completely against incentives as in the second case.

First off, I think anyone who seriously believes they'll make out on the deal is probably mistaken. It's a cliche that "If you have your health you have everything." but if you start trading off your health for other stuff, I believe you will usually regret the decision. I can imagine counterexamples, but in realistic cases, the amount anyone is going to pay you for a kidney is far less than what you can gain by taking your good health and applying it to your financial improvement in other ways. So I think it would really be wrong to put policies in place that create a class of suckers who sold their healthy kidney "for a mess of pottage." (Did I mention that I'm not a Libertarian?)

I think the policy question is how to remove barriers without creating bad incentives. Expecting altruism is unhelpful, but understanding the motives of potential donors is important to making the call in such cases.

[PaulBC]

In simpler terms (yeah, talking to myself here), I wonder if the policy question comes down to a matter of regret or lack thereof.

As long as a living donor can look back on the decision and say they'd do it all over again, then I do not see a serious ethical problem. Granted, others may depend on the continued health of the donor, and that could extend the regret beyond the individual level.

My main concern is that no kidney donor will ever receive fair compensation unless the act of donating the kidney is the main part of the compensation. In most cases, this is due to the urgency of wanting to help a loved one (which is not altruism) but there are true altruistic donors as well. Any attempt to introduce routine financial incentives will increase the number of donors who made a personally bad decision in retrospect, because no reasonable amount of compensation is going to look as good as having two healthy kidneys if you can't think of some other good reason for giving up one of them. (E.g., if Donald Trump offered me $20 million for a kidney I might give it serious consideration, but it is not reasonable and isn't going to happen in reality.)

This is not the same as making it possible for someone to donate if that is what they really want to do, though it is not an easy thing to separate out.