Removing disincentives from kidney donation: pro and con in the American Journal of Kidney Diseases

 Two dueling papers in the American Journal of Kidney Diseases consider the effects of compensating kidney donors to remove disincentives from kidney donation.  The first (by McCormick et al.) suggests that including payments to compensate for risk would increase donation. The second paper (by Danovitch et al.) agrees, but says that this is what would make  compensation unethical, since it is unethical to pay for risk, as that might convince some to donate who otherwise would not.

Reducing the Shortage of Transplant Kidneys: A Lost Opportunity for the US Health Resources and Services Administration (HRSA)

Frank McCormick, Philip J. Held, Glenn M. Chertow, Thomas G. Peters, John P. Roberts   DOI:https://doi.org/10.1053/j.ajkd.2020.10.007 

"If the government removes all of these disincentives, it would not only be a major step toward economic fairness, but it would also significantly increase the number of living donors. "

The True Meaning of Financial Neutrality in Organ Donation

Gabriel M. Danovitch, Alexander M. Capron, Francis L. Delmonico, DOI:https://doi.org/10.1053/j.ajkd.2020.11.006

"Although McCormick et al discuss this principle  in the accompanying Policy Forum Editorial,4 it is our opinion that they distort the meaning of financial neutrality.5 The authors expand the legitimate costs of donation, including travel, lodging, lost work, and other verifiable expenses, to reach a $38,000 fixed payment to donors by including a dollar value for wholly subjective factors such as pain, fear, risk, and quality of life. For example, “risk” is assigned a value of $6,500. These factors are intrinsic to the process of organ donation, and it is disingenuous to include them under the rubric of financial neutrality.

...

"Critically, HRSA explicitly rejects the suggestion that payment be made for “undertaking a ‘risk,’ whether it be a long-term health risk or surgical risk.”

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I have to assume that people who reject payments for risk live in rural parts of America where we have volunteer fire departments, rather than in cities, where we pay fire fighters, partly for the risk they take.

In a different context, here's a recent post about a paper in the Journal of Medical Ethics that considers payments for risk in vaccine trials:

Thursday, October 29, 2020

Paying participants in challenge trials of Covid-19 vaccines, by Ambuehl, Ockenfels, and Roth

"we note that increasing hourly pay by a risk-compensation percentage ... provides compensation proportional to risk only if the risk increases proportionally with the number of hours worked. (Some risky tasks take little time; imagine challenge trials to test bulletproof vests.) To ensure that equal consequences are compensated with equal amounts across a wide variety of studies, we instead recommend a three-part contract consisting of: (1) salary for time involvement that is adjusted to account for the amount of discomfort experienced during participation, (2) insurance against ex post adverse outcomes and (3) ex ante compensation for risks that cannot be compensated ex post (such as death). Such a scheme also increases transparency about what is requested from participants and thus contributes to high-quality participation decisions."