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Making organ donation a better deal

Making organ donation a better deal

By Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota

(CNN) -- Efforts to increase organ donation were in the news again last week.

The American Medical Association called for a study of incentives to increase people's willingness to donate organs, and an article in the New England Journal of Medicine looked at the appropriateness of such incentives.

These discussions are being driven by the widening shortage between the need for organs and the number of organs available

How to increase donations?

The many campaigns and programs aimed at increasing donations have not been all that successful. And the overall rate of organ donation after death has remained relatively constant over the last few years.

The problem is that the need for organs continues to grow, meaning longer waiting times for transplants.

One proposed solution is so-called presumed consent, a practice in which organs are collected after death unless individuals or families object.

Such an approach has never been tried in the United States, a country where citizens expect their permission will be sought for anything invasive of their privacy, and certainly of their body.

If education programs offer limited promise, and presumed consent is likely to fail, we're left with incentives.

Incentives vs. payments

The question is what form such incentives take. Direct payment is unacceptable under federal law for two reasons.

First is the potential for exploitation of poor families who might be desperate for money.

Second, such a system would make for inequitable distribution of organs, since those with the most money would be the first to get them -- violating a sort of fair allocation we require for the distribution of other scarce public resources.

What we need to work toward is a way to foster the altruism that such donations entail. This might include donations to the charity of the family's choice or other incentives that are not direct financial payments to the family.

Whatever the incentives, recognition of families with awards, plaques and ceremonies would go a long way in making them feel both valued and appreciated.

What any program needs to avoid is the practice or perception of paying for organs, and in the process creating a policy that turns body parts into a commodity.

Increase or backlash?

So would be the impact of incentives for organ donation? Would they increase interest and willingness to donate? Or would it decrease public support for a system that seems destined to treat organs as part of a free market?

Studies such as the one proposed by the AMA can help answer these questions.

Whatever the research shows, the goals of an organ donation program must be to recognize families who donate organs simply out of a desire to help their fellow man.

In doing so, the sense that organ donation is truly gift of life will be preserved.

Visit the
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.

"Ethics Matters" is a biweekly feature from the
Center for Bioethics and CNN Interactive.




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