organgiving_logo5_lowres.jpg (65961 bytes)

Home Bulletin Board Results

Feedback

Proposal to Congress

Press Coverage
(in chronological order)

Pittsburgh Tribune-Review opinion piece, October 9th, 2005, by Bill Steigerwald
Pittsburgh Tribune-Review front-page headline article, May 30th, 2003, by Luis Fabregas
Associated Press article, May 30th, by Todd Spangler
Clarion-Ledger (Mississippi) article, June 6th, by Pamela Berry
Palm Beach Post column, June 11th, by Carolyn Susman
Chicago-Tribune editorial, June 14th (by Paul Weingarten)
Birmingham News guest column, June 29th, by Greg Pence
American Medical News article, Aug. 11th, by Andy Robeznieks
Boston Globe article, Oct. 8th, by Carey Goldberg
Pittsburgh Tribune-Review editorial, Oct. 13th
USA Today editorial, Oct. 16th

Pittsburgh Tribune-Review

By Bill Steigerwald
Sunday, October 9, 2005

It's a simple, deadly problem of supply and demand.

As of Wednesday, 89,576 Americans need organ transplants or they will die. Most need new kidneys and livers. Some need hearts, lungs and intestines. But there aren't enough new organs from either living loved ones and friends or from dead donors. Therefore, every year more than 7,000 Americans die waiting for transplant organs that never become available.

You'd think having 19 people a day die while waiting in line for kidneys and livers would be big news. Yet you really only hear about it when it's dropped into stories like The Washington Post's recent report on desperate organ-seekers who are using the Internet like a dating service to improve their chances of finding a matching donor.

No ethicist quoted in The Post story was upset about those 7,000 perennial deaths. They were more worried that people using the Internet were gaining an unfair advantage or undermining the official system that allocates all organs from cadavers anonymously to patients on hospital waiting lists.

No ethicist called for a congressional investigation into the causes of our permanent organ shortage. But the solution is as simple as Econ 101, say free-marketeers like law professor Lloyd Cohen of George Mason University: repeal the 1984 National Organ Transplantation Act, which prohibits people from buying or selling human organs, and allow people to be paid for donating their organs.

Cohen has spent 16 years urging market-oriented legal reforms that would increase the supply of organs from cadavers for transplant patients. His best idea, which he describes in Regulation magazine, is to create a futures market whereby "healthy people would be offered the opportunity to give an 'option' on their transplantable organs."

The organs, recovered after their donors die, would sell for a predetermined price of, say, $5,000 for a kidney. The money would be paid to the donor's heirs or estate.

Most medical ethicists reject the thought of letting the grubby hands of commerce infect the organ allocation process. They'd rather see organs buried and people die. But dignified, medically and morally sound ideas exist for using economic incentives to increase the supply of organs.

Selling body parts on eBay in not one of them. Neither is buying kidneys from poor people in the Third World. In fact, as Cohen told me Wednesday, this "organ tourism" would disappear if we allowed a market in the organs of dead people. So would the need for most living donors.

Cohen's idea, tragically, has been ignored for years. So have others, including the "rewarded gifting" idea of University of Pittsburgh neurobiologist Harold Kyriazi, which would allow money to be paid to families for the right to harvest organs from their recently deceased kin.

Just as we have ample amounts of blood, plasma and sperm, because we allow people to buy and sell them, we could also have all the life-giving major organs we need -- if we stopped relying only on love or altruism to supply them.

We should wise up and recognize the power of self-interest to do social good, Cohen says. "The only thing that keeps the current practice in existence is that those who suffer from it are still few in number and far from here," he said, adding that "the idea of condemning people to death on the altar of not recognizing self-interest as an important motivating factor is just evil, and absurd."

Bill Steigerwald is the Trib's associate editor. Call him at (412) 320-7983. E-mail him at bsteigerwald@tribweb.com.

Back to Top

Pittsburgh Tribune-Review

Group pushes to pay organ donors' families

By Luis Fabregas, Friday, May 30, 2003

The federal government should pay up to $5,000 as an incentive for people to donate the organs of deceased relatives, according to a group led by a University of Pittsburgh researcher.

The proposal, circulated in a letter sent to members of Congress this week, aims to help the estimated 6,000 Americans who die each year waiting for hearts, livers and kidneys, said Harold Kyriazi, a Pitt neurobiology researcher who is leading the effort.

Kyriazi, whose group includes about two dozen scholars, transplant surgeons, religious leaders and organ donation experts, said the payment would be nothing more than a token of thanks for helping to save another life. A 1984 federal law bans the sale of organs, but the group wants Congress to study whether a cash incentive would boost organ donations.

More than 80,000 people are on transplant waiting lists, according to the United Network for Organ Sharing, the private agency that allocates donated organs nationwide.

"It's just human nature that if you're getting something, you should give something in return," Kyriazi said Thursday. "I wouldn't feel right to just ask for an organ. I would feel like a beggar. I would like to offer some kind of compensation as a way of saying thanks and keeping it at an even exchange level."

The proposal is the latest attempt to use money as a way to deepen the shallow pool of prospective donors. The American Medical Association in late 2001 said it intended to study whether it would support compensating donors' families. Perhaps most significantly, the American Society of Transplant Surgeons has said modest compensation would not be unethical.

At least one medical ethicist disagrees, calling the plan a bad solution that fuels the idea that "If you can pay for it, you can get it."

"It immediately says 'Gee, how much money is someone else's life worth?'" said Dr. Lawrence J. Schneiderman, a medical ethicist at the University of California, San Diego. "Anytime that you say we are going to give you money to do something, it brings it into the commercial area in that we are trying to get people to do something for the sake of something else. It just encourages people to make a deal that's financially rewarding rather than 'this is life and death' and showing respect for the process of health care."

There has never been a study conducted to determine the effect of compensating people for donating the organs of loved ones, said Dr. John Fung, chief of transplantation surgery at Pitt's Thomas E. Starzl Transplantation Institute.

"I suspect that it would have an impact, but I don't know, so it's definitely worth exploring," he said.

The plan's supporters include some relatives of patients who died waiting for organ donors. Rosemary Woods of Scott Township said financial incentives could have helped find a heart and liver for her son, Jonathan. The brown-eyed boy died on March 30, 1998, one day before his 10th birthday, because doctors couldn't find suitable organs.

"I firmly believe that my son's life may have been saved if anything could have been offered to a family suffering with the burden of grief," Woods said. "I think a monetary reward would definitely encourage families to give donation a closer look. Unfortunately, my Jon didn't have that chance."

To avoid giving the wrong impression, the group's plan involves a flat fee, regardless of the donor's age or number of usable organs or tissue. The money would be paid to the donor's family even if doctors are unable to use the organs.

"We want to get away from the idea of haggling," said Alexander Tabarrok, a group member and professor of economics at George Mason University in Fairfax, Va.

Relatives would likely be approached about the incentive after the potential donor dies. The group said the fee should not be less than $3,000, an amount that would help pay for the donor's funeral.

Officials at the Center for Organ Recovery and Education in Pittsburgh, the local organ soliciting agency, say the incentive could boost the number of potential donors. Only about half of those who are asked agree to donate, said spokeswoman Pat Kornick. Last year, 157 out of 311 medically eligible people donated organs locally, Kornick said.

Kyriazi said the cost of paying relatives, which the group estimates could be around $25 million a year, could be covered with money saved from medical treatment required for sick patients on organ waiting lists.

"It will end up saving money to society because right now people who need kidneys are undergoing extensive dialysis that is very costly," he said.

Kyriazi said he believes a reward would help people overcome one of the top reasons why relatives often say no to donation -- the grief caused by the thought of their relatives being disfigured.

"People understand money on a gut level, too," he said. "It would be a way of overcoming the gut level revulsion of having your loved ones cut open."

Luis Fabregas can be reached at lfabregas@tribweb.com or (412) 320-7998.

Back to Top

Associated Press story, by Todd Spangler

Group proposes testing cash incentives for organ donations

By TODD SPANGLER The Associated Press 5/30/2003, 3:49 p.m. ET

PITTSBURGH (AP) — A group of transplant surgeons, academics, religious leaders and activists wants Congress to test whether cash incentives would encourage more families to donate the organs of relatives following their deaths.

The group, based in Pittsburgh, sent a letter Wednesday to 40 U.S. senators and members of Congress, asking that a 1984 law prohibiting financial incentives for organ donations be rewritten to allow a demonstration project. The project would award $5,000 to families that authorize a deceased relative's organs to be used for transplantation.

The proposal would limit such donations to those organ procurement organizations involved in a test project developed and monitored by the federal Department of Health and Human Services. The prohibition on financial incentives for live donors would remain in place.

"It would just greatly increase the number of organs that are donated," Harold Kyriazi, a University of Pittsburgh neuroscientist who organized the group, said Friday.

About 22 people are part of the unnamed group, including Dr. John Fung, director of the Thomas E. Starzl Transplantation Institute in Pittsburgh; David Kaserman, an economics professor at Auburn University; Gregory Pence, a medical ethicist at the University of Alabama at Birmingham; and the Rev. Phillip Adams, director of Lighthouse Christian Ministries in Oklahoma City, Okla.

Under the proposal, representatives for organ procurement agencies would approach families after a relative has been pronounced brain dead and offer the $5,000 "as a way of saying thank you for giving the gift of life." The money would go to the deceased person's estate.

The coalition's letter was first reported Friday in the Pittsburgh Tribune-Review.

The United Network for Organ Sharing says more than 6,000 people died last year waiting for organs. More than 80,000 people are currently awaiting transplants.

Dr. Thomas Peters, a transplant surgeon in Jacksonville, Fla., who signed the proposal, said only about half the families approached each year about donating a deceased relative's organs agree to do so.

"Financial incentives should be studied in well-controlled and appropriately designed trials. That's all we're asking — that this approach be given a try," Peters said.

Both UNOS — the nonprofit organization that administers the nation's organ procurement network — and the American Medical Association have called for studies of financial incentives for organ donations from cadavers.

But UNOS spokeswoman Anne Paschke said her organization is not prepared to back any specific project yet, believing the details need to be carefully worked out. Some focus has been shifted back toward more traditional ways of getting people to donate organs, and Paschke said Senate Majority Leader Bill Frist currently has legislation that may allow the federal government to test whether financial incentives increase after-death donations.

"Everyone wants to make sure it's very carefully designed," Paschke said.

Dr. James Burdick, a former UNOS president and a transplant surgeon at the Johns Hopkins Medical Institutions in Baltimore, called the proposal well crafted. But he said it still may not address the issue of whether there's something intrinsically wrong with taking organ donations out of the purely altruistic realm.

Once money is introduced into the process, he said, some people willing to donate now might feel like they are selling a loved one's organs and refuse. A family might worry after accepting the money that they did it for the cash, Burdick said.

He agreed, however, that such a proposal needs to be looked at.

Kyriazi said the project would pay for itself, maintaining it costs much more to keep someone awaiting a transplant alive than it does treating someone who has received a new organ.

Kyriazi said the members of Congress selected to receive the letter were those who have introduced similar legislation in the past or who sit on committees that would consider such a proposal. One of those receiving the letter is House Energy and Commerce Committee chairman Billy Tauzin, R-La., who has scheduled a hearing on organ donation issues for Tuesday.

___

On the Net:

United Network for Organ Sharing: http://www.unos.org

Organgiving.com [sic]: http://www.organgiving.org

Copyright 2003 The Associated Press. All rights reserved.

Back to Top

Clarion-Ledger (Mississippi) article

June 9, 2003

Group seeks study of organ payments

Would donor compensation ease shortage or taint gifts?

By Pamela Berry pberry@clarionledger.com

Chuck Ivey didn't hesitate to say yes when doctors approached him years ago about allowing his brain-dead teenage stepson to be an organ donor.

"We were kind of an unusual case because we were good friends with a couple of people who had been organ recipients," said Ivey, 60, of Brookhaven.

But had the request for 19-year-old Justin Hickman's organs been followed by an offer of monetary compensation or a government death benefit for donating, Ivey said his stepson's gift of eight organs would have been tainted.

"I just think it destroys the whole spirit of what organ donation is about," said Ivey, whose stepson committed suicide.

Supporters of compensating families for organ donations admit the issue of reimbursement is one rife with controversy and emotion and could prompt claims of "organ buying."

But they say the measure is something that must be explored if the nation's shortage of transplant organs is to be addressed.

Each year, more than 6,000 Americans die while waiting for a transplant operation. About 600 Mississippians are awaiting organs.

While the number of donors has remained steady, around 5,000 to 6,000 annually, the number of people needing transplants has skyrocketed from about 20,000 to 80,000, according to the United Network for Organ Sharing.

Federal law prohibits financial incentives for organ donation, and even research requires the approval of Congress.

Last week, a group of health-care professionals, scholars, transplant surgeons and others began lobbying Congress to change the law. The group wants lawmakers to allow for a pilot study to determine if $5,000 compensations for organs would lessen the shortage.

The American Medical Association is urging the issue be studied. Last year the AMA adopted a measure to support a study even after some members called the payments unethical.

"I don't know if we have had any response from lawmakers yet, but there is some interest in Congress on both sides of the aisle," said Dr. Thomas Peters, a transplant surgeon and director of the Jacksonville Transplant Center in Florida. "I think this will happen either this year or next because nothing else has worked. Even with the enormous amount of work put into it, the rate of consent hasn't changed."

Nationally, about 50 percent of families give their consent when approached about donating their loved ones' organs, Peters said.

But James Laird, a volunteer coordinator with the Mississippi Organ Recovery Agency, said he believes the way to increase the numbers is by reaching out to families rather than reaching into government coffers.

"I know the donors' families in this state because I've worked with them over the years, and I can guarantee you 99 percent of all donor families don't want to have anything to do with compensation," Laird said. "But, naturally, you may have one or two (who) hold a different view."

Dr. Henry Barber, surgical director of renal transplantation and professor of surgery at the University of Mississippi Medical Center, said while he doesn't question the motives of the group seeking to offer a "death benefit" to donor families, he's concerned about it making the donor experience "cheap."

"There is no question about the rising number of people needing transplants, but at the same time we don't want to do the wrong thing," Barber said. "In some ways, it's unfair to those that would have liked to be organ donors and whose loved ones die under circumstances where they can't be donors. I feel strongly about that. I'm also not convinced that financial incentives of any sort will really impact the number of donors available."

Barber said he's not against studying the matter but adds, "I wouldn't want there to be any public backlash on this issue. I think this has the potential to make it worse and bring up the issue that organs are for sale."

Laird said he understands the emotional desperation that would cause some families to push for compensating donors.

Laird's son, Jonathan, now 12, received a liver transplant in 1992 when he was 7 months old. The organ came from a year-old boy who died from a brain tumor.

"When you are waiting for an organ, you will do everything you can possibly do to help your child," said Laird. "A lot of times, you have to accept that this is the way it will be. But most people will do anything. At that time, even if it would have taken me to come up with several thousand, I would have done that. It's a tremendous roller coaster. One day, you're doing great and the next, they are on death's doorstep and you can only wait for a donor to be found."

Laird said he knows getting more organ donors is possible without paying families because he's seen Mississippi turn its numbers around. Nationally, Mississippi is second only to Florida for its organ donor rate.

"In 1998, Mississippi had the lowest rate in the nation," Laird said. "But we pushed for public education. Last year, we had 60 donors, and already this year we have had 30 to 32. The key to that has been educating hospitals and staff so that they are willing to work with us."

Kevin Stump, executive director of the Mississippi Organ Recovery, said he's willing to see the measure studied but fears what payments would do to the system.

"If this is what the government feels will help donations, then so be it," Stump said. "But we've only had one family in 10 years decline to donate because we wouldn't pay them. Giving a family an honorarium to help defray the cost of a funeral is one thing. But giving them money is something I'm not OK with."

Stump said he also fears offering compensation would harm the quality of the donated organs by encouraging people to lie about family medical histories so they would be eligible to donate.

Peters said if the study were approved, six to 10 organ donor organizations across the United States would participate and funding would come from the U.S. Department of Health and Human Services, which has an office dedicated to increasing organ donations.

"A crucial aspect of the proposal is that the gift be a set amount that is given to the estates of all brain-dead patients who are judged to be good donor candidates and whose families do indeed donate," Peters said. "There should be no possibility of unseemly haggling. Neither should there be any reduction of the amount of gift if a presumptively good donor turns out to have a few or no usable vital organs."

Ivey said even in light of the lives that could be saved, he's hopeful the measure will fail.

"There are too many possibilities of the whole system being contaminated and ruined," he said. "This is a life-and-death matter like anything else. Eventually, we all have to meet our maker, and I just truly believe in the bottom of my heart that this is not right."

Back to Top

Palm Beach Post column

Policies on organ donation still unhealthy

By Carolyn Susman, Palm Beach Post Staff Columnist
Wednesday, June 11, 2003

I read Maureen Dowd's recent New York Times column on her brother's liver transplant with more than passing interest. It was a testimonial to her niece's bravery. The young woman was a rarity, a living donor. She had given part of her own liver to her uncle, Dowd's brother.

That's truly brave, because there are terrible risks in undergoing live donation. Death, most particularly. One donor suffered that fate a year ago at New York's Mount Sinai Hospital, which was cited for "woefully inadequate post-surgical care" when the 57-year-old man died after donating 60 percent of his liver to his brother.

I read Dowd's column thinking of an interview I did two years ago when a rash of publicity was congratulating live organ donors for their selfless acts. They don't get paid for this extraordinary service -- that's illegal -- and the doctor I talked to, Daniel Shoskes, director of the kidney transplant program at Cleveland Clinic Florida in Fort Lauderdale, was telling me how far preferable live donation is to organs taken from cadavers.

And, surprising to me, how anyone who has a compatible blood group can give. The donor doesn't have to be a relative.

I read the column thinking of the e-mail I had received the week before from a group of doctors, academics and civic and religious leaders who want to see Congress stand up and admit that it created chaos by outlawing payment to the families of dead organ donors 20 years ago.

"That 1984 congressional ban was intended to prevent poor people from selling a kidney while they were still alive, but unintentionally put a lid on the supply of organs from brain-dead patients, resulting in tens of thousands of needless deaths and untold suffering since the law was implemented," wrote a George Mason University Law School professor, Lloyd Cohen.

This growing lobby wants to see money given to families who donate their loved ones' organs for transplant, because the organ shortage in this country is appalling, leaving many to die while awaiting transplants.

The group's proposal is to have the Department of Health and Human Services offer a $5,000 gift to donor families as a "thank you" and reward for public service and to see whether that will result in an increased rate of donation.

I read Dowd's column thinking of the year-old group, LifeSharers, (www.lifesharers.com) a free listing that gives its members preferred access to the organs and tissues of fellow members.

Most important, I read it thinking of my friend in Washington, D.C., who is on the list for a liver transplant and is still waiting, and my friends with hepatitis C -- a national epidemic -- who might one day need a new liver.

For all these reasons, I read Dowd's column happy that she changed her mind and will now carry an organ donor card -- she said she had been a "scaredy cat" for some reason she didn't explain, and had been afraid of donating her organs after death.

But I can't help wondering how futile this struggle might be if an educated woman with a brother in need of a transplant hadn't been moved enough before this operation to even sign a donor card.

carolyn_susman@pbpost.com

Back to Top

Chicago Tribune Editorial

Paying for organs

June 14, 2003

In Oregon, a fierce ethics controversy erupted recently over whether a convicted murderer on Death Row
there should be allowed to get a kidney transplant. Many were horrified at the prospect of a condemned man
taking a scarce organ, denying someone else on the waiting list a chance for a better life.

Such a case will always stoke outrage, as it should. But it would be more productive if some of that outrage
were channeled into doing something about the long waiting list for organs in this country. At last count,
almost 82,000 people were on lists, waiting for kidneys, livers and other organs. Some 16 die each day, still
waiting.

A year ago, the American Medical Association took a small but significant step in the right direction by
endorsing a proposal to study the effect of using money to motivate patients and their families to donate
organs. But neither it nor any other medical society has coughed up any money for such a study.

In the last couple of weeks, a Pittsburgh-based group of transplant surgeons, academics and religious leaders
has sent a letter to 70 members of Congress, asking that a federal law forbidding financial incentives for
donating organs be lifted to allow a test project. Such a project, the group said, would award $5,000 to
families that authorized a deceased relative's organs to be used for transplantation. The letter decries a
"failure of collective imagination--a failure to devise a policy that while respecting traditional social norms,
provides increased incentive" for organ donations.

That's exactly right. The leader of the group, Dr. Harold Kyriazi, a University of Pittsburgh neuroscientist,
says that encouraging more transplants would not only save lives, but in many cases, save the federal
government or private insurers billions now spent on kidney dialysis and other stopgap measures.

At a recent U.S. House subcommittee hearing, several medical leaders and others spoke positively about
exploring the idea of paying a reasonable incentive for people to donate a deceased relative's organs.

The results of all this talk?

So far, nothing. Doctors and lawmakers have been fretting over this issue for the better part of a decade,
while thousands of people have died. Studies have shown that paying for organs, even as little as $500 to
$1,000, will increase donations enough to virtually eliminate, over time, the kidney waiting list.

There are ethical concerns that any system beyond the current voluntary one will cheapen life, and create the
notion that body parts are mere commodities. Some also fear that paying for organs could discourage some
from donating out of altruism. All of those concerns are valid, but they do not change the basic equation. A
discreet and regulated system that encourages donation with a reasonable sum of money could save
thousands of lives.

A bill proposed by Senate Majority Leader Bill Frist, a transplant surgeon, would require the secretary of
Health and Human Services to conduct a study of the ethical implications of different ways to encourage
organ donation. After that, the secretary would be permitted to approve three demonstration projects, which
could include testing the idea of paying potential donors.

By all means, study the issue. But what's really needed is a sense of urgency. Remember, people are still
waiting--and dying.

Copyright 2003, Chicago Tribune

Back to Top

The Birmingham (Alabama) News

Time to pay for organs?

06/29/03
GREGORY PENCE

Should Americans die waiting for organs while most usable organs go into coffins? Every year over the past decade, 4,000 Americans died waiting for an organ that never came. At the same time, thousands of families chose not to donate organs of a brain-dead relative.

Is there nothing we can do about this continuing tragedy?

Recently, a few national leaders organized to advocate a trial of paying families for consent to donate. The coalition includes transplant surgeons Tom Peters and John Fung, University of Chicago law professor Richard Epstein, several economists, a medical ethicist (myself) and several others.

Earlier this month, we sent a letter to 40 members of Congress proposing a trial project in which families that agreed to donate organs of deceased loved ones would receive $5,000. Harold Kyriazi, a neuroscientist at the University of Pittsburgh, led this project.

The basic idea is not to start a market where rich people buy the organs of poor people, but rather to nudge ambivalent families toward consent. (The current system of distribution, where organs go to those most in need, would not change.) Why not test the idea on a small scale and see if it increases consent?

In a congressional hearing on June 3 before a subcommittee chaired by Rep. James Greenwood, R-Pa., the basic ideas of the proposal met a sympathetic response. Surgeon Robert M. Sade of the Medical University of South Carolina testified, on behalf of the American Medical Association that, "In June 2002, the AMA adopted a policy encouraging the medical community to support the re-examination of motivation for cadaveric organ donation. In particular, the report explored financial incentives as a possible strategy to increase organ donation, and recommended that the impact of these incentives on donation rates be studied."

Ethical problems:
Starting such payment certainly has ethical problems. Critics say it could cheapen life by putting a price on it, lead to a slippery slope of buying and selling organs, and discourage altruistic donation. These are good objections, but not knockdown ones.

First, how does it "cheapen life" to save life? The source of the organs is already dead and the only ones really affected are those anxious patients and their families waiting for organs. If anything, perpetuating the current system and doing nothing cheapen the lives of those waiting.

Would such a system lead down the slippery slope to a commercial market for organs? I doubt it. We have had a dual system for blood for many years (now usually just plasma), where people can both donate altruistically or be paid, and it has not led to auctions for rare plasma. Nor does the fact that some people get paid seem to discourage people from altruistically donating blood, probably because people sell or donate blood for very different reasons.

A year ago, I wrote an op-ed for the Los Angeles Times urging the same kind of trial. At that time, 4,000 Americans died each year waiting for organs. According to the United Network for Organ Sharing, the number last year jumped to 6,000. It also says that 80,000 Americans currently wait for organs.

Five thousand dollars is about the right amount to offer families. Of course, no matter what amount is proposed, some critics will see it as coercively too much; others, as exploitatively not enough. Five thousand dollars would help with funeral expenses, a child's education or unpaid medical bills. But it's not like a half-million dollars, which really might be coercive to some families.

Another strange thing has recently happened: The number of organs from living donors has surpassed those from brain-dead patients. So desperate is the need that, more and more, families and friends of dying patients donate their organs.

This is admirable, but it also brings problems. At least two living donors have died, and others have experienced long-term problems from donation. It also started to create a norm where relatives are expected to donate. What happened to the ancient idea in medical ethics, "First, do no harm"? The person who gives up the organ is certainly made worse off by the surgeon than he was before.

On the other hand, if we had doubled the numbers of donations from cadaveric sources, few of these living donations would have been necessary.

Not expensive:
Surprisingly, economists claim that offering such incentives wouldn't be expensive. For example, kidney transplants get people off dialysis, and, after 2 years, the federal government starts saving $28,000 a year. For people at midlife, over 10 years the government would save $200,000. And as such people kept working, they would also pay taxes.

It is not as if offering incentives doesn't have ethical complications. It certainly does. But the question is whether those complications are so weighty that 6,000 American lives every year should be sacrificed to avoid them. Surely if we care about life, we should care about the lives of these dying Americans who await an organ.

Families don't consent for many reasons: distrust of the medical system, desires for closure, fear of criticism of other family members. Oftentimes, the easy route is not to donate, to get it over with. Our proposal would give them a reason to think otherwise. (Our Proposal to Congress may be viewed at www.organgiving.org.)

The 1984 law that prohibits cash incentives to families for organ donation was originated in reaction to a Jack Kevorkian of the time (H. Barry Jacobs) who planned to establish a commercial market for organs from living adults. Sometimes, in attempting to stop an aberrant individual, laws are passed too quickly that hurt other people.

All Congress needs to do now is authorize an exception to the 1984 law permitting an experimental trial of cash incentives. What has it got to lose?

Certainly, the patients who now wait in anonymity with their families need new hope. Why not give it to them?

Back to Top

Americal Medical News (official organ of the American Medical Association)

PROFESSIONAL ISSUES

Bill would allow studies on organ donation incentives

Opponents say financial incentives for families of cadaveric
donors might deter living donors.

By Andis Robeznieks, AMNews staff. Aug. 11, 2003.

More than a month after a hearing on the subject, and more than a year after the American Medical Association endorsed the concept, U.S. Rep. James Greenwood (R, Pa.) has introduced a bill that would allow studies to determine whether financial incentives could increase cadaveric organ donations.

The AMA and other groups have pushed for these studies, but current federal law forbids financial compensation for organ donation. So before anything else can be done, the law needs to be changed so incentives can be offered and studies can be conducted on their effects. Greenwood's bill would grant U.S. Health and Human Services Secretary Tommy Thompson the power to authorize demonstration projects to study the impact of financial incentives on organ donation.

Greenwood introduced a similar bill last year, and Robert M. Sade, MD, a member of the AMA Council on Ethical and Judicial Affairs, said CEJA recommended that it be more specific. Instead of having vague references to demonstration projects, Dr. Sade said the bill should have authorized specific studies scientifically designed to answer a particular question.

Although the vague language of last year's bill is repeated in this year's version, Dr. Sade said it is still worthy of support. "I would rather they would have done everything CEJA had recommended, but it's such a major step in the right direction I would be pleased if the bill -- as it is -- passes," said Dr. Sade, a cardiothoracic surgeon at the Medical University of South Carolina, Charleston.

The United Network for Organ Sharing also will support the bill. "Our board agreed in June of last year that we would support studying the impact of incentives on organ donation," said UNOS spokeswoman Annie Moore. "We will support any studies that are conducted on incentives for organ donation, whether they be financial or general incentives."

In a July 22 "Dear colleague" letter seeking co-sponsors, Greenwood quoted AMA policy concerning the study of financial incentives and noted that there are 82,000 patients on the organ transplant waiting list.

"There are simply not enough usable organs to meet the demand," Greenwood's letter stated. "Through the use of incentives, we may increase the number of donors to alleviate the considerable shortage of organs, potentially saving thousands of lives."

Greenwood introduced the bill July 24, and by the next day it had four co-sponsors: Martin Frost (D, Texas), Rush Holt (D, N.J.), Donald Payne, (D, N.J.) and the Virgin Islands delegate, Donna Christian-Christiansen.


"I find it very encouraging, but we have to get something similar in the Senate for [studies] to go forward," said University of Pittsburgh neuroscientist Harold Kyriazi, PhD, who helped organize a group called the Ad Hoc Committee for Solving the Intractable Organ Shortage.

Dr. Kyriazi said his group might help with designing some studies as well as organizing a group of people on the organ transplant waiting list to help lobby for the bill.

"One thing opponents of financial incentives seem to worry about is, if we allow money for cadaveric donation, how can we still philosophically oppose money for living donations?" Dr. Kyriazi said. "But if we're able to increase the supply of organs through cadaveric donations, there'd be less need for living donations."

While testifying at Greenwood's June 3 hearing on organ donations, Dr. Sade noted that opponents also think financial incentives might deter altruistic individuals from donating a family member's organs and might fuel a trend toward viewing the human body as a source of profit.


"For its part, the AMA notes that there is a dearth of scientific data supporting these concerns," Dr. Sade said. "Nearly all the arguments against financial incentives are based on assumptions that can be proven or disproved by objective empirical studies."

The AMA has not endorsed specific incentives, but others have suggested tax credits up to $10,000 for deceased donors' estates, reimbursement for funeral expenses, charitable donations, direct payment and medals of honor.


ADDITIONAL INFORMATION:

U.S. House Energy and Commerce Committee hearing on organ donation, June 3

(energycommerce.house.gov/108/Hearings/06032003hearing946/hearing.htm)

Thomas, the federal legislative information service, for summary, status and full text of the bill authorizing the secretary of Health and Human Services to carry out demonstration projects to increase the supply of organs donated for human transplantation (HR 2856) (thomas.loc.gov)

AMA information on organ and tissue donation (www.ama-assn.org/go/organdonation)

AMA ethical opinion E-2.151, "Cadaveric Organ Donation: Encouraging the Study of Motivation" (www.ama-assn.org/apps/pf_online/pf_online?f_n=browse&doc=policyfiles/CEJA/E-2.151.HTM)

Ad Hoc Committee for Solving the Intractable Organ Shortage (www.pitt.edu/~htk/organgiving/proposal.htm)

Back to Top

Boston Globe

Fiscal incentive weighed to boost US organ supply

By Carey Goldberg, Globe Staff, 10/8/2003

With more than 6,000 Americans dying each year while they wait for organ
transplants, medical and political leaders are considering a desperate
experiment long viewed as taboo: rewarding the families of brain-dead
donors with thousands of dollars in hope of increasing the organ supply.

The American Medical Association, which represents nearly 300,000
doctors nationwide, and the United Network for Organ Sharing, the nation
al group that oversees the organ supply, have endorsed the idea of a test on
whether offering financial incentives will lead to a rise in donations.

Earlier this year, a group of academics, doctors, clerics, and others created
The Ad Hoc Committee for Solving the Intractable Organ Shortage, the first
group organized expressly to lobby for the idea of payment to encourage
organ donations.

Now, a bill in Congress proposes overturning a section of the current law
that bars payment for organs. Some advocates say its chances appear better
than similar attempts in the past. ''The number of deaths is so much more
glaring, that people who were once against the idea now recognize that
it might have merit,'' said Dr. Thomas Peters, director of the Jacksonville
Transplant Center in Florida and a member of the ad-hoc committee.

Peters, who has been following the issue in Congress, said he believes that
the bill, sponsored by Representative James C. Greenwood, a Pennsylvania
Republican, is the first to have a real chance of attracting broad support.

The idea of mixing money into heart-wrenching decisions about organ
donation is repugnant to many and prompts fears that sinister organ farms
could traffic body parts or that the bodies of the poor could be exploited to
supply the rich.

But proponents' central argument has gained strength with each passing
year: The waiting list for organs, now at about 82,000 people, keeps
growing, and nothing has succeeded in significantly increasing the number
of donations. Almost 60 percent of those on the list are expected to die
waiting.

Research indicates that the families of less than half of possible donors
agree to donate. The transplant community has tried various initiatives,
from public awareness campaigns to donor registries, that have helped
some. But the gap keeps growing.

Overall, the waiting list has been increasing by about 12 percent a year,
while the number of brain-dead donors has been rising by under 3 percent,
to about 6,000 a year.

A recent study estimated that the number of potential donors each year is
about 17,000.

Proponents of financial incentives emphasize that they are not proposing the
buying and selling of organs and that the incentives would not be offered to
''live donors,'' those who plan to go on living after they volunteer an organ.

Rather, members of the ad hoc committee and other advocates propose that
the federal government finance carefully controlled pilot studies to
determine whether donation rates rise when families of brain-dead donors
receive a standard sum, perhaps $5,000, as thanks for public service.

They say the payment is comparable to the money given to families of
soldiers who die in the line of duty. Another suggestion would give a
$10,000 tax credit to the donor's estate.

The AMA has not endorsed a specific figure, and the United Network for
Organ Sharing endorses legislation that could carefully study the effect of
incentives, whether financial or nonfinancial.

For more than a decade, advocates have been pushing for such financial
incentives, said Harold Kyriazi, a neuroscientist at the University of
Pittsburgh and the founder of the ad hoc committee. ''But it's always been
sort of a fringe voice,'' he said. ''Now, I'd call it a vocal minority.''

Opposition from groups including the American Society of Transplant
Surgeons remains broad and strong.

Dr. Francis L. Delmonico, a Massachusetts General Hospital transplant
surgeon who is active in the National Kidney Foundation, said financial
incentives inevitably raise many of the same ethical problems inherent in
the outright buying and selling of organs.''Any attempt to assign a monetary
value to the human body or its body parts, even in the hope of increasing
organ supply, diminishes human dignity and devaluates the very human life
we seek to save,'' he testified at a congressional hearing on increasing
organ donation in June. He also warned that payments could ''undermine the
integrity of the donor pool'' and would give relatives incentives to cover up
flaws in a potential donor's medical history to get the money.

Other opponents argue that some families who would have donated a
patient's organs out of altruism may be turned off by the money and that
donations could actually drop or that some families could pull the plug
more quickly on their relatives.

The AMA was closely divided over endorsing the incentive experiment,
initially shelving the proposal before the organization finally endorsed it
last year.

Ultimately, supporters say the only way to determine whether money works
as an incentive is to test the ideas -- whether they are gifts that go straight to
the family, cash to cover funeral expenses, or tax benefits for the estate of
the donor.

''The point is to say, `Look, let's set up a few demonstration projects,' '' said
Alan Eisenberg, an adviser to Greenwood.

Without knowing the effects that those financial incentives would have on
donations, proponents say, it is impossible to assess the balance between
harm and good.

If the proposal is approved, the United States would apparently be the first
country to try an official program using financial incentives, said Lloyd
Cohen, a member of the ad hoc committee and a George Mason University
School of Law professor who has written extensively on organ markets.

The economic principles involved in such incentives are elementary, he
said. ''If you pay for something, you're more likely to get it than if you
don't.''

Eisenberg said Greenwood has not yet been trying to sign up cosponsors
for the bill, which was introduced in July.

But the measure has been drawing support across party lines, he said, and,
in general, editorial boards and national groups such as the AMA ''are
starting to build up this swell of pressure to say, `Let's try to do this.' ''

He also said that Tommy G. Thompson, US secretary of health and human
services, would probably support trying the idea. Thompson's office did
not respond to a request for his position.

John M. Newmann, an economist and two-time kidney recipient, opposes
the sale of organs from live donors, but said he strongly supports careful
research to test financial incentives.

''Everyone seems to have a very strong opinion on one side or the other,'' he
said. But ''no one offers any objective data to support these opinions,
because there are none.''

Carey Goldberg can be reached at goldberg@globe.com.

This story ran on page A1 of the Boston Globe on 10/8/2003.
Copyright 2003 Globe Newspaper Company.

Pittsburgh Tribune-Review editorial, Monday, October 13, 2003

The organ shortage: Financial incentives

Juries award money in wrongful death lawsuits, and transplant surgeons are paid handsomely; precision down to the penny defines the "value" of a human life.


Clearly, the idea that it's unethical to associate a monetary value with organ donation in particular is built on a silly, emotional indulgence.

The irrationality exacts its toll every year; more than 6,000 people die waiting for transplants.

Federal law prohibits payment for organs; lawmakers feared organ trafficking. But the American Medical Association and the United Network for Organ Sharing say carefully controlled financial incentives for organ donation should be studied.

U.S. Rep. James C. Greenwood, R-Bucks County, has introduced legislation for a federal pilot program.

A leader in the effort -- the Ad Hoc Committee for Solving the Intractable Organ Shortage, founded by Harold Kyriazi, a neuroscientist at Pitt -- says perhaps 50 to 75 percent of organs potentially available are not donated.

The committee suggests offering $5,000 to the estates of all brain-dead patients judged suitable donors, but before harvesting to preclude "unseemly haggling."

The intention is to impress the importance of donation, and to convey gratitude.

However, we believe the incentives should be privately funded.

The cost of this gift of life should not issue from an organ of the state.

USA Today editorial, Oct. 16, 2003

Consider incentives to boost ranks of organ donors

For two years, Melissa Alexander of South Waymouth, Mass., waited for a transplant to replace her lungs, which were diseased from cystic fibrosis. Finally, in a desperate attempt to save the 32-year-old woman's life, doctors performed partial transplants on Oct. 3. But her body was so weakened from the long wait that she died the next day.

Medical advances offer the potential to save growing numbers of lives such as Alexander's through transplants of livers, hearts, lungs and other organs. Yet 6,900 patients on waiting lists died last year because of a critical shortage of donors. Currently, more than 82,000 people in the USA are waiting for transplants. That contrasts with 7,500 living and deceased donors so far this year.

The donor shortage persists in spite of numerous education campaigns aimed at persuading healthy Americans to donate their organs after they die. Medical studies estimate that organs could be obtained from 10,500 to 26,000 brain-dead victims each year if more people consented to the donations. And polls conducted for organ-procurement groups show 75% say they would be donors. Yet fewer than 30% have formally consented. In nearly half the cases, relatives step in and veto the wishes of the deceased.

The resistance to donating organs raises doubts about the nation's ability to meet the need for replacement organs without a change in strategy. Even medical groups long opposed to modest payments to donors, including the American Medical Association, now endorse the idea of testing some reward programs. But progress is stymied by an outdated federal ban on financial incentives for organ donations.

The medical community's shifting mind-set and the growing need for organs suggest the timing is right to test whether sensible ways exist to encourage donations without creating a for-profit industry.

Some possibilities include:

Offering the families of brain-dead donors a "death benefit" of $5,000 or $10,000 for the use of healthy organs. A Pennsylvania plan to offer a $300 "funeral benefit" four years ago was blocked by the federal ban.
Giving a $10,000 tax credit to the estate of a donor.
Compensating living donors for travel, expenses or lost income.
Wisconsin is considering a $10,000 tax deduction.

Before such ideas can be tested, Congress would need to ease its 19-year ban on compensation for organs. Senate Majority Leader Bill Frist, R-Tenn., a transplant surgeon, backs a proposal moving in that direction. A more direct approach has been offered in the House.

Critics argue that financial incentives will lead to a black market of organs auctioned off to the highest bidder. They say offers of money are an affront to human dignity and donors who give for altruistic reasons.

To avoid a black market, incentive programs would need close monitoring. But physicians, scholars, clergy and civic leaders who worked together this year to consider solutions to the organ shortage concluded that carefully limited financial incentives would motivate those already inclined to be donors to carry through with their plans.

Melissa Alexander and the other thousands who die annually while waiting for organs provide tragic evidence of the need for a new national policy. Test runs of incentive programs are a good place to start.

Back to Top
Back to AHCSIOS Home Page