Would you donate a kidney for cash?
In a new survey from Canada, 45 percent of people said that money is an acceptable incentive for organ donations from living donors, while 70 percent of survey respondents said that cash is an acceptable enticement for people to donate their organs after death.
"We do need to consider a system where we compensate people for their giving," said study researcher Dr. Braden Manns, professor of nephrology at the University of Calgary in Canada.
The idea of paying organ donors is not new. "We have more patients on dialysis, but we don't have more donors; so we're looking at other ways to motivate people to donate," Manns said.
However, while the survey found that many people's think cash incentives are acceptable, people's answers may be different than their opinions when faced with the grueling realities of donations.
"Surveys are quick measures of people's feelings that may be relatively uninformed," said Peter H. Schwartz, a faculty investigator at the Indiana University Center for Bioethics who had no role in the new study.
Cash for kidneys?
In North America, "opt-in" organ donation programs are common; people must actively to choose to donate. In Europe, it's more common for countries to have "opt-out" programs, in which people become organ donors unless they expressely state they wish otherwise.
"Every option raises at least some concerns," Schwartz said. In opt-in programs, relatives can still control whether a person's organs are actually donated after their death. "We need to do better at encouraging organ donations," he said.
While selling organs is illegal, financial incentives are common in Canada and the U.S; these typically take the form of reimbursements from foundations for funeral expenses for deceased donors, and tax breaks from the government on expenses incurred during recovery for living donors, according to policy researchers.
Manns and colleagues looked at whether people would find it acceptable for additional incentives, to compensate living donors for the time and inconvenience involved in having surgery.
They conducted their web-based survey in October 2011, and included 2,004 people in the general public — a nationally representative sample from Canada — along with 339 health professionals and 268 people affected by kidney disease.
Results showed that health care workers were least likely to support the idea of financial incentives for donors. Just 14 percent said it was a good idea, whereas 45 percent of the general public said so.
The kidney disease patients fell in the middle range, with 27 percent saying paying for organs should be allowed.
"Very often, the reason health professionals give for their opposition to financial incentives is that the public would find them to be objectionable, but as this study and others suggest, the greatest source of concern is the health professionals themselves," said Robert Truog, director of clinical ethics at Harvard Medical School.
Though health care professionals may find financial incentives unpalatable, a regulated system would work, Truog said.
What kind of system would work?
One problem with offering financial incentives is that the organ transplant communitiy is deeply committed to the view that organs are always "gifts," and never "commodities." This view has always been problematic, but has become increasingly so as the shortage of organs has become more pronounced, and in the face of compelling arguments for the ethical use of financial incentives," Truog said.
Public support for financial incentives does not mean that they would work to increase organ transplants, he said.
"It's the physicians who actually perform the transplants; if they're not behind (financial incentives), they're not going to take part in it," George Annas, a bioethicist at Boston University School of Public Health, told MyHealthNewsDaily.
"People need to stop looking at just the supply side, but look at the demand side," Annas said, including preventative and less invasive medical interventions along with figuring out the underlying causes of the diseases.
"People can't let go of the notion of this as a cash-and-carry type of business," he said.
The survey results are detailed today (Sept. 27) in the Clinical Journal of the American Society of Nephrology.
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