Wednesday, July 4, 2018

Compensation for kidney donors debated in WSJ

Familiar positions, clearly stated, pro and con compensation for donors.
There are other reasons put forward for not rewarding organ donation, but the one espoused here (preserving "the ability for one to aspire to virtue") is perhaps the one I have the least sympathy with, as it seems to value the hope of heaven more than saving earthly lives...

How to Provide Better Incentives to Organ Donors
Three experts discuss strategies to address the shortage of organs available for people who need transplants

"We talked about options for increasing organ donation with Sally Satel, a doctor and fellow at the American Enterprise Institute and the beneficiary of two kidney donations; Alexandra Glazier, chief executive of New England Donor Services, which coordinates organ and tissue donation in six New England states and Bermuda; and Andrew Flescher, a professor of public health and English at the State University of New York at Stony Brook, and author of “The Organ Shortage Crisis in America.”
"WSJ: The gap between the number of people who need organs and the number of organs available continues to grow. Why is our current model failing to bridge that gap?
DR. SATEL: Having studied the issue for 12 years, since my first kidney transplant, I am convinced that the only solution—before technology makes donation from people obsolete, and it will—is to compensate potential organ donors.
PROF. FLESCHER: The way forward is living donation. Roughly 100,000 out of 120,000 folks who need an organ need a kidney, which can be procured from a living donor, as most of us are born with two kidneys. We need a way of getting everyone to care about the plight of folks on dialysis, not through any coercive measure, of course, but through simple exposure.
MS. GLAZIER: There is no question that need outpaces the supply significantly. That said, it’s important to recognize that the number of deceased organ donors in the U.S. has increased 26% in the past five years (2012-2017) and the number of organs transplanted has increased 28% over the same period. In the New England region, the increase was more than double this rate over the same time period.
"PROF. FLESCHER: I certainly do not think paying living donors is the way to go.
DR. SATEL: But what is left? I suppose the real question is what is so aversive about enrichment of some kind? Surely, we do it with plasma, egg, sperm, body, as in donations in medical schools, maternal surrogacy, breast milk, hair. We already pay for body products. And, of course, my colleagues and I do not recommend lump-sum cash, because we do not want to attract desperate, impulsive people who may regret acting. Instead, rewards could include things like tax credits, lifetime health insurance, a contribution to a 401(k) account or a tuition voucher.

PROF. FLESCHER: The introduction of money for a precious good comes at the cost of the ability for one to aspire to virtue, if not as hero, than as a civic-minded, socially conscious neighbor, free to act, and to be perceived as acting, out of the motive to offer help to one in need.
"WSJ: Sally, can you please sum up the central tenets of how compensation for living donors would work?

DR. SATEL: The principles of a system of compensation are these: 1. Informed consent. 2. Ensuring health protection, before and after. 3. An ample reward—something trivial amounts to exploitation. 4. Respect for autonomy of people who know what is in their best interest. 5. Expression of gratitude for the lifesaving act they performed.
I suggest a waiting period of six to 12 months to ensure that the would-be donor is sure he or she wants to proceed. And a noncash reward, because a cash reward will appeal to impulsive decision makers, and we need to avoid that.

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