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Should We Pay For Human Organs?

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DEDE SMITH/THE GAINSVILLE SUN/AP

A doctor prepares a donor heart for implantation

Here are some grim, preventable statistics: Last year, 5,700 Americans died waiting for organ transplants, and right now more than 80,000 people are praying for word that a life-saving donor has been located. Itís not that there arenít enough organs out there to go around — itís simply that available organs are not being earmarked for donation. Theyíre being buried or cremated instead.

The U.S. medical establishment has been trying for years to change that pattern, trying to find ways to encourage donation, debating the ethical quandaries inherent in such a delicate, and personal, choice. Monday, a committee appointed by the department of Health and Human Services began compiling a list of possible solutions to the organ availability dilemma. Each of the suggestions has circulated in ethicistsí circles for years; the most controversial of the proposals would provide a small monetary compensation to the survivors of organ donors. The consensus could be there, at least in the medical community: In a statement made a few weeks ago, the American Medical Association reversed itself and announced the payments could be ethical as long as the amount is "small enough to be considered a thank-you rather than a bribe."

Are we ready to start paying a bounty for human organs? Is there a better way? Itís a sticky policy debate — made even more complicated by the introduction of cold, hard cash in exchange for human tissue, a practice some medical ethicists consider the ultimate taboo. Cases in Asia, where prisoners and poverty-stricken parents have given up organs (or had them stolen) for much-needed cash, highlight the disastrous potential of such a plan taken to extremes.

Here in the U.S., where such nightmare black market scenarios thankfully remain in the realm of fiction, the money issue does have the potential to underscore the already painful divide between the countryís haves and have-nots. "The danger some people see in compensating survivors is the concern that it would have much more of a negative impact on a poor family than on a wealthy family," says Dr. Howard Brody, professor of family practice at the Center for Ethics and Humanities at Michigan State University. "People worry that weíll end up taking organs from the poor to give to the rich, who are by and large the people who make it onto the transplant waiting lists in the first place."

Organ donation can be a squeamish topic even for doctors, says Dr. Brody. Current law actually allows the harvesting of organs from people carrying donor cards, even over familial objections. Itís just that very few doctors have the stomach to override the wishes of a grieving family. (The HHS committee also suggested allowing organs to be harvested unless families actively prohibit it.)

This is a critical public health issue, and yet interest among the American public remains perfunctory at best. The number of patients dying while waiting for organs has been on the rise for years, primarily due to modern medicineís ability to keep people with debilitating illnesses alive for months, even years, while waiting for replacement organs. An increasing number of deaths, while tragic, may at least help raise public awareness about organ donations.

Some academics feel itís high time the public got involved in this ivory tower debate. "Ethicists have been debating all these possibilities for years now, but weíre not the ones who will be the ultimate arbiters on this issue," says Dr. Brody,. "The question is what the public wants to do, and eventually, what is decided in legislatures or in the courts." The key, says Dr. Brody, is balancing the powerful potential for good with the potential for abuse, and eventually deciding which we are more willing to live with. "If we do certain things to increase donations," he says, "we may err on the side of having a few people donating who didnít want to donate. And if we donít take action, weíll continue to see life-saving organs being buried over the express wishes of the deceased."

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