Paying Organ Donors Would
Set Us Back
Rudolf García-Gallont is a transplant surgeon in Guatemala and a board
member of the Declaration of Istanbul Custodian Group.
UPDATED AUGUST 22, 2014, 11:40 AM
We don't need to test the effect of increasing incentives for
becoming a living organ donor. The harm that would cause,
and the ethical problems it would create are obvious. Even in
countries with apparently reliable regulatory systems, living
organ donor systems would not be safe from exploitation.
If the U.S. considers incentives and payment for
living organ donation, it would have a profound
negative effect on our work to promote legitimate
organ donation in Latin America.
In Latin America we have been studying what the U.S. and
Europe have done to alleviate organ shortage. If the U.S.
considers a trial on incentives and payment for living organ
donation, it would have a profoundly damage our work to
promote legitimate organ donation in the region over the last
decade. Deceased DONATION PROGRAMS are being
built here with great effort. The erroneous idea that the
donation of an organ can generate a financial gain has
already led to serious incidents and damages the progress of
legitimate organ donation in the region.
Fostering deceased DONATION PROGRAMS in Latin
America will render much better results to meet the needs
for organ availability than debating about rewards for living
donation. By doing so, the whole discussion about financial
rewards and incentives would become superfluous, and we
could start taking the burden of organ donation away from
the always controversial living donor.
Remove Disincentives to
Organ Donation
Alan Langnas is chief of transplantation at the University of Nebraska
Medical Center and immediate past president of the the American Society of
Transplant Surgeons. Daniel R. Salomon is the medical director at the
Scripps Center for Organ Transplantation and Scripps Research Institute
and the immediate past president of the American Society of
Transplantation.
UPDATED AUGUST 21, 2014, 6:51 PM
A financial incentive for organ donation elicits strong
feelings because it touches on practices that could have a
direct impact on organ donor and patient lives. We take this
seriously but note that the history of medicine is written by
those with the courage to challenge convention and embrace
innovation.
The history of medicine is written by those with the
courage to challenge convention and embrace
innovation.
The organ DONATIONS SYSTEM in the United States is
dysfunctional. The most cost effective and life-enhancing
therapy for those suffering from end stage renal disease
remains kidney transplantation. The only alternative
treatment is dialysis. A growing list of over 100,000 patients
wait more than 5 years for a kidney transplant; 4,000 die
each year on this list and many more are taken off because
they are too sick. The current system does not provide
enough donor organs for transplant.
Organ donors, and in particular the live kidney donor, are
being asked to altruistically support a system with sizable
financial costs to themselves. These costs represent a
considerable disincentive to organ donation. Too begin to
MOVE the dial on this we must engage in a process of
identifying and removing those disincentives.
The American Society of Transplantation and the American
Society of Transplant Surgeons propose initiating an “arc of
change.” At the start of this arc are steps like reimbursing
costs of travel for evaluation and donation. But further along
the arc we need to be addressing reimbursement for lost
wages and long-term HEALTH INSURANCE that our
generous donors are being asked to shoulder.
Pain and suffering is a common metric in the medical/legal
world; can this be measured and be compensated for in the
realm of living kidney donation? Would these steps violate
the offering of “valuable consideration” in the National
Organ Transplant Act of 1984?
The only way to answer these questions and others will be to
propose pilot projects in the U.S., subject these projects to
rigorous review and then evaluate their impact in clinical
practice. Central to any steps will be public policy, laws or
regulations that ensure fairness, access, transparency and
respect for all parties concerned.
Our position as physicians can at times lead us to act
paternalistically, often to a fault. We must do all we can to
retain our patient’s and the public’s trust. Addressing the
issues of removing disincentives and exploring new
strategies is needed to to responsibly confront the limitations
of U.S. organ donation.