In addition to their willingness to undergo a potentially risky invasive procedure for the benefit of someone else, living organ donors also are financially generous. Their out-of-pocket expenses average $5,000 because, although a recipient’s insurance covers the donor’s medical expenses, it doesn’t cover transportation, lodging, child care and lost wages.
So there’s a movement to relieve this enormous burden that could spur an increase in organ donations. Given this country’s extreme shortage of donor organs, that would be w welcome development.
According to Reuters, experts suggest that removing the financial barriers to organ donation might include “careful consideration and testing of potential financial incentives for organ donation.” That is, an ethical way to “get rid of financial ‘disincentives'” to donating one’s organs.
Writing in the American Journal of Transplantation, the Incentives Workshop Group said that any changes in current procedure must pass strict measures of both efficacy and ethics. The group is composed of representatives of the American Society of Transplantation and the American Society of Transplant Surgeons.
“Every person in the chain of an organ donation, except one, profits,” Dr. Daniel Salomon told Reuters. He is an author of the paper and medical director of the kidney and pancreas transplant program at Scripps Health in San Diego.
Tom Mone, CEO of OneLegacy, a large organ procurement organization, told Reuters that “Donor costs should be incorporated into the cost of the transplant. The donor should bear no economic detriment.”
That seems like a no-brainer – when someone is literally giving of himself or herself so that someone else can live, what kind of messed up society expects the donor to pay for it, on any level?
One that isn’t comfortable “selling” body parts.
No credible voice is suggesting that, but that’s the “ick” factor that has kept organ donation a strictly voluntary surrender of organ, time and money.
The workshop group believes that covering a donor’s costs upfront would result in huge, long-term savings for insurers by generating greater organ donation. The United Network for Organ Sharing (UNOS) is the nonprofit organization that manages the nation’s organ transplant system under contract with the federal government. It pegged the number of living kidney donors in the U.S. last year at a paltry 5,817.
Salomon said that for every kidney patient that stays on dialysis awaiting a donor organ, the payer (insurance company) loses $60,000 a year.
As of this writing, the U.S. Organ Procurement and Transplantation Network reports that 123,389 people are on the waiting list for a lifesaving organ transplant. Approximately 4,000 die each year.
Reuters pointed out that the 1984 National Organ Transplant Act made donor compensation illegal. But the workshop group says it’s time to consider other incentives that don’t compromise altruism. Families of deceased donors, for example, might have their funeral costs subsidized.
The tricky terrain for living donors was described for Reuters by Elisa Gordon, a medical anthropologist at Northwestern University and a member of the workshop. She said that offering them incentives “is so ethically charged. We don’t know if that would result in exploitation or undue inducement.”
Salomon saw the other side in stark terms: “We have a responsibility to living donors. But, we basically take their kidney and say goodbye.” He supports giving donors lifetime health coverage; some other members of the group members support coverage for a specified time.
Some people worry that any such offer is dangerous. Any loss suffered by a living donor, such as medical costs and wages, some believe, should be addressed, but lifetime care might be seen by some potential donors as an incentive.
“We are the only developed country in the world that doesn’t see health care as a universal right,” Salomon told Reuters. “What a statement it would be about our society if people decided to give an organ so they could get health insurance.”
Working group members seek a balance between burdening people with donation costs and compensating them. Such a balance should be found in certain incentives … but not cash.
Salomon wants a dialogue with the Centers for Medicare and Medicaid Services, private insurers and donors who have experienced difficulty themselves. A fair, ethical solution is unlikely to found without all stakeholders – patients, families and subsidizers – participating in the discussion.