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How About Providing Incentives for Organ Donors?

This is the second installment in a three-part series devoted to organ and tissue donation.

Two days ago, I posted about allegations that a teenager in China sold his kidney for an iPad and other electronics. The story seems to have a life of its own—picked up by the Telegraph , BBC, Fox News, Reuters, and  CNN Money. Chinese news coverage can be found here for those readers who speak Mandarin.

Images of Little Zheng’s scar provide a troubling, but very real picture of black-market organ selling. The scar is long, jagged, and wide. It’s pink and fleshy-looking, as if it hasn’t quite fully healed. It does not resemble the small incisions made through laparoscopic kidney removal or even the newest, least-invasive technology—the single, small incision inside a navel. The aesthetics can be brushed off, particularly when more sophisticated technologies are not available in the poorest areas of the world.

But the questions arising in the most recent Chinese kidney scandal spill over to other parts of the globe, and provide an opportunity to think about how we should procure organs in the United States. Currently, we are unable to meet organ demand. We have an altruistic system in the United States that forbids donors from receiving any “valuable consideration” for sharing an organ. This means not so much as even “a glass of orange juice” or a lollipop, says Frances Kissling, a visiting scholar at the University of Pennsylvania’s Center for Bioethics. And she is right.

"Little Zheng" and his mother

The National Organ Transplant Act (NOTA) has been problematic for some years. Under the Justice Department’s enforcement of NOTA, there was the prohibition of organ swaps, meaning a husband and wife who didn’t match couldn’t swap with neighbors who did match.

There’s been the continued frowning on directed donations from strangers, discouragement of solicited donations, retrenchment on funeral benefits given out by states, and wary skepticism about online organ matching systems like MatchingDonors.com.

Violation of NOTA can result in a felony conviction, with a five-year prison term and $50,000 fine. Some doctors and hospitals refuse to service patients who did not receive their organ from a transplant waitlist or who acquire their donor from MatchingDonors.com. The argument they make is that these types of donations violate the spirit of transplant policy and harm the interests of waitlist patients. Douglas Hanto, a Harvard Medical School physician, once said, “Organs should go to the person who needs them the most, not to people because they are members of a club.”

I have a different view. Ultimately this restrictive system results in thousands of deaths each year.  The urgent need for a more responsive transplant policy was publicly revealed in stark and chilling ways during the summer of 2009 through the federal indictment of Levy-Izhak Rosenbaum, the rabbi who brokered organs on the U.S. black market. If the federal case proves true, Rosenbaum can be rightfully remembered as a crook and shady organ dealer, but likely, he’ll just be forgotten. Rosenbaum’s lucrative underground business of coordinating kidney transplants for steep fees flourished as a by-product of a problematic federal system that regards any incentives, including that cup of orange juice, through a punitive lens, rather than as “patient-friendly.”

Currently, if you donate an organ, there is no obligation for your employer to pay your salary during your recovery (except if you happen to be a federal employee) or even to guarantee that a job will be waiting for you when you return to work. Who is supposed to pay the donor’s rent or mortgage while she’s recovering for five weeks? What about the gas, electricity, or telephone bills? Or something as small, but so necessary, as the children’s lunch money?  You see, being an organ donor is incredibly generous, but some people cannot afford to give. Altruism sometimes costs too much.

In 2000, 47,280 people were waiting for kidneys. In 10 years, not only had the number of persons admitted to the waitlist nearly doubled, but the average waiting time was practically unbearable. That continues to be the case. According to Dr. Benjamin Hippen, a prominent nephrologist, very soon kidney patients can expect to wait 10 years for certain organs. For kidney patients and their families, that is a death sentence.

So what to do?  Jake Linford, a young professor at Florida State University Law School, advocates for scholarships for kidney donations .  According to his plan, give a kidney and get a full scholarship. No loans or owing the banks with that proposal. Other incentive-based proposals include burial benefits for families who donate their deceased relatives’ organs, tax deductions, mortgage forgiveness, and free medical coverage for life. These all have merit and are worth considering by states and the federal government—now, not later.

The National Kidney Foundation reports that nearly 500,000 Americans are on dialysis for end-stage renal failure—a condition that can be resolved through organ transplant. This problem is huge and only getting worse. If we are committed to saving lives through organ transplantation, let’s do so.

Rather than putting our heads in the sand, let’s face reality—altruism has its limits. I don’t support black markets—not at all. But I do think the time has come for state and federal leadership to get rid of the “valuable consideration” clause that prohibits any acknowledgment or generosity for donating an organ. If we want people to step up to the plate to be organ donors in a healthy, transparent system, let’s give them something.  If police officers, fire fighters, and military men and women receive acknowledgments, including incentives for saving lives, why not show that same kindness to potential organ donors? It’s a much better and safer solution than black markets.

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