May 3, 1999
Web posted at: 2:17 p.m. EDT (1817 GMT)

In a first-of-its-kind pilot program in Pennsylvania, organ donors may get $300 from the state toward their funeral expenses. Proposals to pay for organs are not new, but federal law prohibits the sale or trade of organs. Do incentives such as funeral credits violate at least the spirit of the ban on organ sales? Will they provide reasonable incentives to motivate families who need an enticement, or exploit the families of patients who wouldn't donate organs except that they need the money? Do incentive schemes merely reflect the dire shortage of lifesaving organs? Or do they turn what should be altruistic donations into cheap transactions for body parts?

What's your opinion?

A legal ban on payment for organs is driven by three concerns -- it could exploit people who need money and wouldn't donate except for payment; it could motivate families to decide to withdraw treatment; it could give rich people the chance to get available organs first. Does payment toward funeral expenses support any of these concerns?

Since this plan would affect only the supply and not the distribution of organs, it wouldn't change access by recipients except by making more organs available. And in that case, all would benefit equally.

Because payment would be for funeral costs and wouldn't enrich relatives, there would be little or no financial incentive to undertreat.

But if the concern is that organ donations be totally voluntary, what may appear as innocent incentives to some will look like irresistible offers to others.

Three hundred dollars is not much money to many people, but to some it may be the difference between a funeral and none at all. And as the price goes up, more of us will be enticed. We can all envision a dollar figure that will cause us to overlook better judgment, inhibition, or even firmly held convictions and do something we otherwise wouldn't -- whether it's participating in a drug trial, donating blood plasma, giving a kidney or donating our loved one's organs. The only difference is how much money it will take.

So one question is how likely $300 is to meet many people's price. And can we prevent it from being the only reason to decide to donate? The bottom line is that a decision to donate must remain voluntary and altruistic, rather than forced and mercenary.

For some, any compensation for donating organs takes away the altruism in the act, and they should be free to refuse any payment. But in offering incentives, the risk we run is that society comes to share the view that organ donation is no longer about altruism but about less virtuous motives.

Offering to defray funeral costs does not create incentives for families to hasten the death of a loved one. And so long as recipients are not bidding up the price to entice donors or their families, fair access to donated organs can continue without regard to ability to pay. But a policy for any kind of payment for organs walks a fine line between useful incentive and turning organs and their donors into commodities. We need more organ donors, but incentives that are too high for too many people turn donors into sellers, so that instead of making a gift, they end up making a score -- a situation we can't afford.