Offering money isn't only way to increase organ donation

Posted: January 11, 2002

Last month, the American Medical Association entertained changes to the way we understand organ donation. Whereas organ donation has always been viewed as a gift, the AMA suggested that we investigate offering financial incentives to encourage organ donation.

The proposal was inspired in part by a questionable statistic: that only about a third of all eligible donors agree to donate their organs. In fact, donation rates are most reliably assessed at a regional level, and in some regions considerable majorities consent to donation.

Those outside of the transplant community often fail to realize how remarkable, even shocking, such high rates of donation really are. Consider:

Organ donation often involves accepting that a person can be dead despite the fact that he or she is still on a ventilator and still pink and warm. This sometimes requires a change in how we view death.

Organ donation normally involves making requests of families at a vulnerable time. The discussion requires courage of families. It requires the ability to think of others at a time of tragedy.

Organ procurement involves major surgery in which the body is cut and major organs removed from the deceased. This sometimes requires a change in the way we believe a corpse should be treated.

In some forms of organ donation (so-called non-heart-beating donation), medications may be given to the donor that are not for his or her benefit. Organ donation increasingly requires a change in how we view the practice of medicine.

Ordinarily, we would consider it cruel to make such demands on patients or their families, especially during a time of crisis and loss. We do so because it lets us prolong the lives of many people who would die without an organ transplant.

But we are comfortable doing so because we proceed with organ donation only when it appears to be the free wish of the organ donor. When patients have not signed their donor cards, family members may still say things like, "Yes, John always said he would want to donate his organs" or "Jane was such a giving person, she would want to do this."

Knowing that lives can be saved through this generous act often helps families find meaning in what may otherwise seem meaningless tragedy.

The AMA has not recommended that we stop viewing organ donation as a generous act. It has merely suggested that we consider offering financial incentives to increase consent rates. It suggests that the first step is to determine whether such a policy would in fact increase such rates. Some firmly believe it will. They also believe that even a small increase in the donation rate could save thousands of lives and would justify the policy.

Others believe it could backfire and offend donor families. Still others believe that regardless of its impact on donation rates, the policy is morally offensive.

Research has consistently shown that most transplant personnel resist the idea of offering financial incentives to increase donation. Perhaps some fear that incentives could backfire and lower donation rates. Perhaps some fear that even modest incentives could be coercive to the poor and interfere with truly free, informed consent. But perhaps some simply prefer to think that when they have their hands in someone's abdomen, they are enabling a gift, not trading commodities.

Fortunately, transplant personnel know that offering financial incentives is not the only way to increase organ donation rates. Studies have shown that consent rates are affected by advertising campaigns, by who makes the request, by the timing of the request, and by a willingness to answer questions and address unspoken fears.

Of course, no change in practice or policy will ever produce a 100 percent donation rate as long as we seek the free and informed consent of patients. We need to accept this hard fact. And we need to continue our commitment to balancing care for patients in need of donated organs with care for donors and their families. In the process, we need to listen to those who have agreed to organ donation.

We need to give them as many meaningful motivations as possible to donate. Foremost among them always should be their ability to give the gift of life.

James M. DuBois is an associate professor at Saint Louis University's Center for Health Care Ethics. He wrote this for the Providence Journal.

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