How About Economic Incentive for Organ Transplant Donors?

DANIEL S. GREENBERG

September 01, 1992|By DANIEL S. GREENBERG

WASHINGTON. — Washington -- Since almost everything else is for sale, why not a market in healthy human kidneys and other organs that can be spared, taken from cash-hungry donors for transplanting into patients with ready cash?

Why not? In India, Egypt and other third-world countries with centers of high-tech medicine, a booming trade in kidney transplants benefits wealthy patients and provides several thousand dollars for each donor.

In the wealthy West, that may look like blood money, and little of it for what's involved. But sums of that order represent an otherwise unattainable fortune in countries where per-capita incomes are a few hundred dollars a year.

By providing the purchase price for a business or a farm, the proceeds from the sale of a kidney can free a Third-World family from unrelenting poverty. And it's possible to live a long, healthy life with one kidney. The kidney market is arguably not a bad deal in the harsh context of Third-World deprivations.

But in the United States, the practice is considered so grisly that the purchase or sale of human organs was outlawed by federal legislation in 1984. It violates the sanctity of the human body and collides with the most basic precept of medicine: Do no harm.

The U.S. transplant system relies on voluntary donations, from live relatives and dead donors -- mainly highway accident victims.

The yield from the donor system, however, remains inadequate to the need by a wide mark. As a result, many people die for lack of transplantable organs, even as transplant techniques become more sophisticated and life-extending.

The national organization for orchestrating collections, the United Network for Organ Sharing, reports that last year, 39,872 patients were registered as candidates for transplants. Of these, organs were available to provide transplants for 16,025. Another 2,518 died while waiting for organs, while the remainder survived and hoped.

The system of collecting organs from cadavers is gradually producing better results. But the pace of change remains slow and the shortfall continues to be large. In 1989, at least one, sometimes several, organs were collected from 4,014 cadavers; in 1990, the figure rose to 4,512. But last year it was nearly unchanged, at 4,534.

The slowly changing numbers reflect the fact that preparation for death is not popular among the young and healthy -- the most desirable sources of post-mortem transplantable organs.

In the absence of a living will authorizing organ removal, close kin must provide consent, not always obtainable in the emotional disruption of unexpected death.

Results from education campaigns in behalf of transplants, directed at the public and the health-care professions, have more or less plateaued.

Many of the frustrated managers of the nation's runaway medical expenditures no doubt feel that's a blessing. But public sentiment is clearly in favor of go-for-broke high-tech medicine, as evidenced in generous contributions to televised pleas for children who need costly transplants.

Is there a way to get more organs within the present cultural bounds? A possibility that's talked of now and then would provide a financial incentive for persons authorizing post-mortem removal of their organs for transplanting.

Those doing so could designate a small sum, perhaps $1,000 to $2,000, for heirs, funeral expenses or whatever. Tacked onto the bills of transplant patients, the legacies would be a very small premium compared to the potential health benefits.

Even if not forbidden by law, outright sale of organs collides with too many cultural and ideological sensitivities to be tolerable in the U.S. Legitimate concerns would arise about exploitation of the poor by queue-jumping rich patients abetted by greedy doctors. Precisely such concerns have been raised in the Third-World nations where organ transplants are for sale.

But that problem is avoided if the benefits accrue only to the heirs of the dead organ donor and the sickly patient hoping for reprieve from otherwise burdensome or fatal illness.

Would more people sign the donor card in return for a minor enhancement of their legacy? It's surely worth a try.

Daniel S. Greenberg writes a syndicated column on scientific and medical issues.

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