Ease the market for organ donors

It's time for incentives

Published September 3, 2006 at midnight

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On Thursday, the President's Council on Bioethics will publicly discuss a medical crisis that afflicts tens of thousands of Americans: the worsening shortage of human organs eligible for transplantation.

About 90,000 Americans now wait for transplants, with 70 percent of those patients seeking a healthy kidney from a donor, dead or alive.

Roughly 60 percent of those on the waiting list at any given time will die before finding a matching donor.

The demand for healthy organs is growing faster than the supply. The United Network for Organ Sharing, a nonprofit that helps connect donors with recipients, predicts that the wait for a kidney will soon double, from about five years now to a decade by 2010.

The council will release a report on the ethics of organ transplants. We hope it will also consider policy alternatives. Because the current system is indefensible, medically and morally.

Since a person can function normally with a single kidney, a patient with renal failure can receive a transplant from a live donor, and both people can be perfectly healthy within weeks after surgery. In fact, recovering from the surgical procedure, which is now routine, may be the biggest health risk a donor faces. Meantime, a transplant can free the recipient from the constant pain, inconvenience and lack of mobility that dialysis patients must endure.

Many of these deaths might be avoided were it legal to entice live donors to come forward. But it's not.

A 1984 federal law prohibits organ donors from receiving any "valuable consideration" for their life-saving generosity. A live donor can be compensated for medical expenses (which are usually paid by the recipient's health insurance), travel and lost wages, but nothing more. And if you choose to donate organs at death, your survivors get nothing.

The medical establishment has long considered it anathema to allow donors or their survivors to "profit" from their beneficence. The worry is that poor people will sell their organs out of financial desperation and thus in some cases compromise their health. But there are ways to minimize the risk that such a fully open market might pose.

For example, Washington could alleviate the shortage by considering pilot programs. One idea is federal income tax relief along the lines of laws operating in eight states, including Utah. Those states offer up to $10,000 in income-tax deductions to repay donors' travel expenses and lost wages.

Another possibility: "futures" contracts, in which recipients would pay up front some of the funeral expenses of those who elect to donate organs at death.

And the medical establishment should drop its objections to organizations like MatchingDonors.com. This site lets organ recipients find willing live donors and make transplantation arrangements privately.

We're certainly not comfortable endorsing a full-fledged market in organs, a regime that would allow donors to auction kidneys on eBay. But the current system is not compassionate; it amounts to a death sentence for thousands of Americans each year.

Ethicists and medical professionals need to acknowledge that fact and consider life-affirming alternatives.

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