Not so fast

James DuBois, PhD, professor of health-care ethics at St. Louis University School of Medicine, is against any kind of direct payment for any living donation for several reasons. Dr. DuBois served on an Institute of Medicine committee that studied the dollars-for-donors idea and voted against any selling of organs. The committee issued a report in 2006.


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“When you start paying living donors you see significant decrease in deceased donation, which is a shame because deceased donation poses no risk to donors,” Dr. DuBois said. In Iran, where payments for living organ donation are legal and common, deceased donation of kidneys was less than 1% in 2002, he noted.


His other major concern is exploitation. In Iran and India, it is almost exclusively the poor and unemployed who donate. In China, as in the United States, a disproportionate number of living women donate organs, and men are far more likely to be organ recipients than women.


A study of kidney donors in Iran, which was published in 2001, found that of 100 donors interviewed, 84% lacked full-time work, 93% had no health insurance, and 83% did it just for the money. In addition, 85% of donors said they would not do it again. “These data reinforce my fear that payments for living donation would become exploitative,” Dr. DuBois said.


Rocco Venuto, MD, professor of medicine at SUNY Buffalo and medical director of transplantation at an affiliated hospital, agrees with Dr. DuBois. “When [organ donation] is driven by money and not altruism then there is a problem that it is never going to be fair for people with less money,” Dr. Venuto said. “The human cost of giving up an organ has no price. A certain number of donors are going to die.”


However, both Dr. Venuto and Dr. DuBois support the idea of compensating living donors for their costs. They say a better way of addressing this problem is not direct payment to donors, but instead eliminating barriers to donation. They advocate tax deductions and compensation for travel and lost work.


“Tax breaks are good. I don’t think the person should end up a nickel richer, but they should also not have to pay all the bills,” Dr. Venuto said. “The system is set up so that your insurance covers your sister’s testing, but there is no system to help her with lost wages or travel costs and lost time. Some people have lost their insurance after becoming kidney donors, so we have a series of practical issues that we need to address to enhance the system in connecting people who are motivated to donate out of altruism and not money.”