Monthly Archives: June 2014

Incentives and Organ Donation

I’ve written here about incentives and organ donation on a number of occasions (see, for example, here and here). I spent Monday and Tuesday of this week at a joint workshop of the American Society of Transplant Surgeons and the American Society of Transplantation, discussing the ethics, legality, and feasibility of providing incentives for organ donation. An opinion piece stemming from the workshop will be published in the American Journal of Transplantation, which will outline the types of incentives that would be acceptable, the barriers that would need to be overcome, and define a reasonable path forward.

This was an interesting experience for me. The meeting was small and the breakout groups even smaller. My breakout group on incentives for living organ donation, for example, had only about eight participants. So it was a nice opportunity to meet some transplant surgeons and other transplant professionals from these societies that I had not previously worked with and to learn more about their thinking on these issues.

Al Roth, a featured speaker and participant at the workshop, posted the following excerpt on his website from a post last year by Dan Salomon, the president of the American Society of Transplantation, on his presidential blog.

Encouraging organ donation: Removal of Disincentives and Consideration of Incentives:

The Declaration [of Instanbul] outlined an international position on the ethics of paid organ donation intended to send a clear message that exploitive, paid living donation practices that were sometimes even criminal in nature, were not acceptable. The AST signed a letter supporting the Declaration. In the intervening 5 years, the Declaration had a significant impact on reducing and marginalizing these exploitive practices.

However, even at the time, concerns were raised here that opposing those specific practices as documented then in developing countries was not equivalent to banning any future consideration of examining financial incentives for living organ donation in the United States. I now think the time has come for a joint AST/ASTS effort to review the current status of living organ donation in the US. I think this effort should consider the problem from the perspective of disincentives that can be removed and from incentives, including but not limited to financial ones that could be acceptable. The effort should harmonize with the ethical principles embodied in the Declaration of Istanbul, but should reflect the real situation of clinical practice and ethics in the US today. The effort should be inclusive of all the major stakeholders in transplantation, not just the AST and ASTS. It is way beyond me to advocate for any particular outcome at this point, but I will be actively exploring the principle of organizing the effort next.

I could be wrong, but my sense from the meeting is that the current willingness to explore at least some types of incentives is a big departure from the societies’ prior positions on this issue.

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