Guarantee follow-up care, costs-covering for donors
It is encouraging to note data from the United Network for Organ Sharing that shows more than 30,000 organ transplants were performed in the United States last year, reaching the highest total in the country’s history. Nevertheless, the supply of organs donated by living and deceased donors will fall short of the number of patients added last year to the transplant waiting lists.
With the persistent shortage, there are those who would seek to increase the organs available for transplantation by providing financial incentives as a motivation for organ donation. These financial incentives would represent a monetary gain — or “valuable consideration” — and are currently prohibited by the National Organ Transplant Act (NOTA) of 1984 to buy and sell organs.
The financial incentives proposed include a contribution to the donor’s retirement fund, an income tax credit, a tuition voucher or global health insurance. Even though cash would not be exchanged, these incentives have a monetary value and target individuals who otherwise would not have the resources to secure their retirement or health insurance through the Affordable Care Act.
For those who are enticed by such incentives, they would simply be trading the commodity they have, such as a kidney, for a commodity they need, like a mortgage payment or health insurance. One in seven people in the United States live below the poverty line. The target group of donors and vendors becomes inescapable; it becomes the economically distressed to supply organs for transplantation.
Every other country in the world has wrestled with the dilemma of targeting the poor to be the source of organs by such incentives, and other than Iran — whose professionals now regret such a policy — every country will not permit such financial incentives.
The World Health Organization (WHO) rejects a system that would foster a social stratification in obtaining organs for transplantation. The WHO Guiding Principles of Organ Donation and Transplantation states clearly that “cells, tissues and organs should only be donated freely, without any monetary payment or other reward of monetary value. Purchasing, or offering to purchase, cells, tissues or organs for transplantation, or their sale by living persons or by the next of kin for deceased persons, should be banned.”
However, this WHO Principle emphasizes that “the prohibition on sale or purchase of cells, tissues and organs does not preclude reimbursing reasonable and verifiable expenses incurred by the donor, including loss of income, or paying the costs of recovering, processing, preserving and supplying human cells, tissues or organs for transplantation.”
Making reimbursement available for the actual costs or losses incurred — regardless of donors’ financial resources — would not enrich donors but merely make donating a kidney a financially neutral act. Since covering expenses results in neither a better nor worse financial situation for the donor, there would be no need to modify NOTA’s prohibition on paying for organs to assure coverage of donor costs.
Despite the Affordable Care Act, approximately 10 percent of Americans do not have health insurance. The financial neutrality components would include coverage of the cost for the follow-up visits for the kidney donor to include: blood pressure, physical examination, renal function assessment, urinalysis and assessment for diabetes.
If a donor’s medical insurance does not provide lifelong medical follow-up and treatment of any conditions related to the nephrectomy — or if the donor’s health insurance leaves the donor responsible to pay for a portion such care — those costs should be covered. Donors should also be provided with life insurance to cover death as a result of being a living donor.
Thus far, the government has not supported the provision of financial incentives as a motivation for organ donation, presumably because it does not want to be responsible for placing anyone at risk of kidney failure in their lifetime as a result of being a donor.
But we can all agree that a program of financial neutrality that provides care for the donor is an ethically proper approach for those who wish to be a donor. Otherwise the stale arguments that have been a point and counterpoint in the debate of financial incentives are going nowhere for the help of donors and the needs of the patients that would benefit from organ transplants.