Organ donation is broadly defined as a gift of a body organ such as a kidney to help someone who requires an organ transplant. This definition raises the immediate question of whether organ donors should be compensated because a gift refers to something that a person gives to another person without expecting any form of monetary payment. The current approach that people use to acquire body organs for transplantation relies on altruism from deceased donor families and voluntarism from live donors. Organ donation is one of the issues that are practiced under relevant legal authorities. For instance, section 301 in the U.S. NOTA (National Organ Transplant Act) affirms that it is against the law for any person to transfer, receive, or obtain any transplant organ for valuable agreement. The valuable deal is in this case considered as a transfer of monetary or valuable property between the organ recipient, donor, and organ brokers in a purchase transaction. However, the population of people waiting for an organ transplant is increasing at a significant rate in many countries. This growing number indicates there should be an accelerating number of donors too. For instance, the demand for transplant organs in the U.S. has grown from 30,000 people in 1992 to more than 101,000 today (Van Dijk and Hilhorst 45). As the shortage of organs increases, there arises a fundamental question on how the number of organ donations can be increased to meet this growing demand. Many stakeholders on this issue think that this supply-demand mismatch could have a financial solution “providing compensation to organ donors.
Of course, it is against the law in many countries to sell an organ. The NOTA Act in the U.S. illegalizes the exchange of body organs for monetary or valuable consideration. But for many years, leaders in the transplant department have been debating over the issue of offering incentives to those who volunteer to donate their organs such as direct payments or tax credits. However, some officials argue against this proposal fearing that this type of compensation could result in an unregulated market for organ donation and the benefits are not worth the consequences of these unregulated markets. The debate over this issue has divided the members of the transplant community into two groups, and there does not exist a clear consensus.
To begin with, one of the reasons why the government should legalize compensation for organ donors is the increase of the unmet demand for organs. Perhaps, the most significant part of the debate on compensation for organ donors surrounds kidney donation. This organ not only has the greatest needapproximately 90,000 people are candidates waiting for a kidney transplant in the UNOS list- but it is among the few organs that come from live donors (although people are born with two kidneys, one kidney can function normally) (DeJong et al. 463). Since kidney donation by deceased families alone has been unable to meet this accelerating demand for organs, there is need of the governments to focus their attention on alternative ways that could increase the population of living donors, and the most effective way is legalizing their compensation. For instance, last year the United States has approximately 9,000 deceased donors, who contributed to only 16,000 kidneys, which benefited only 20% of the people who were in the waitlist for kidney transplantation (DeJong et al. 470).
Another reason why compensation for organ should be legalized is to take away disincentives. One reason why people fear donating their organs is that donors end up losing massive amounts of money when they give an organ. One idea to increase the number of living donors is to remove all financial barriers that might hinder people from donating their organs (Van Dijk and Hilhorst 45). Favoring this type of compensation does not mean that living donors should financially benefit from their donations, but the government should also ensure that organ donation volunteers should not suffer monetary losses for their altruism. For example, there are rare cases where the donation procedure leaves donor with complications. In such cases, a donor will have to use his or her money to cater for medical treatment that might last for many years (Friedman 746). Others may use the money to cater for travels to and from health facilities, or they may lose a significant amount of money when they take off from work after the donation procedure.
The U.S. National Kidney Foundation is highly supporting the compensation for organ donors. For instance, the foundation is supporting the federal and state governments to legalize tax credits for organ donors that would serve as a compensation for the financial costs they incur during and after the donation procedure even if these will not increase the donations. The main reason why the foundation is supporting this type of reimbursement is that it perceives that it is the only right thing that the government can do to donors. But they also hope that compensating donors would influence more people to donate their organs. Providing compensation to outdo financial disincentives will alleviate living donation.
The last reason why organ donors should be compensated is that the government already compensates everyone involved in the organ donation process apart from the donor (Arnold et al. 1363). This refrain is a common assertion by many proponents of organ donation financial incentives. The government compensates all those who participate in the process of the organ transplant (apart from the donor or the next-of-kin in a deceased donation). For example, the government pays salary to the OPO coordinators for obtaining family consents; the OPO also benefits from an organ recovery acquisition fee, and the physicians and transplant surgeons and the facility where the transplant takes place charges for hospitalization. Considering this reality, it would be unfair if the donor, who apart from offering his or her body incurs the expenses mentioned above, is not compensated for the gift. However, the critical barrier to approval of this initiative is the NOTA's illegalization of the valuable consideration for organ donation (Arnold et al. 1370). For example, the 1994 Pennsylvania law that was supporting reimbursement for funeral costs to donor families was rejected merely because the government officials argued that the law was violating NOTA. Unless the government revises NOTA, legalizing compensation for organ donation would be impossible.
While compensation for organ donors has a potential solution to today's organ shortage, its ability to elevate the supply of organs is questionable. In a survey of people who refused to donate their organs for their family members who have died, more than 90% of the participants said that compensation would not have influenced them to donate (Friedman 746). Many people refuse to donate their organs, not because of lack of compensation but because they don't trust the health care system. For instance, people distrust system of U.S. health care because they think that the potential donor's healthcare might be compromised in case their donor statuses are known. Legalizing compensation for organ donation is not likely going to change these views, and may indeed, worsen the mistrust. This situation is true even with the proposed initiatives to help deceased families with funds to cater for funeral home expenses. This strategy would increase the price for funeral home services without benefiting the family of the deceased at all (Van Dijk and Hilhorst 56). Offering monetary incentives for organ donation deaths would create tension between people who have the option of donating their organs to their loved ones.
Another fear with the introduction of organ donation compensation is that it may create an organ market and situation whereby the rich people could misuse the poor for their organs. Once the government inserts monetary compensation for the organ donation equation, it will create a market. Once there is a market, there is no way the government will control and regulate the market. These new markets will be different from the current organ trafficking taking place in countries such as Pakistan and India. In these uncontrolled and unregulated markets, the middlemen who will be purchasing the organ s for the recipients might not care for the health of both the recipient and the donor (Friedman 748). The key argument here is that there is a need to make changes to the proposed compensation initiatives to ensure transparency about the health status of the donor and the risks associated with the donation surgeons.
Despite the discussed counterarguments, organ donations should be compensated, but the government should follow the necessary steps before its legalization. The main reasons behind their compensation are because it will; increase of the unmet demand for organs, remove take away disincentives, and ensure that the donor is treated fairly. While many people have been proposing that the government should find a way of removing the donor's disincentives, there has been a great debate on whether the government should legalize organ donation compensation or not, with people being passionate on the two sides.
If the government would ever legalize compensation for organ donation, it would most likely need to carry out pilot studies to test different forms of compensation. The government could have to carry out the pilot study to a few regions conducting them like studies with follow-ups (Arnold et al. 1376). Meanwhile, the problem of unmet organ demand remains. As officials are continuing with the debates about legalizing organ donation compensation, both the waiting list and the waiting time for organ recipients are getting longer. There is a need for the government to take urgent action to solve this elevating problem.
In conclusion, efforts to find a way of increasing the number of transplantation organs will persist as the challenge of supply and demand mismatch elevates. Perhaps the government needs to come up with consequent legislation and appropriate guidance to effectively manage the compensation of organ through a certified authoritarian body. This should be the next program for transplant organizations and government worldwide. There is no way people will experience organ donors suffer from the incurred disincentives and expect them to be altruist donors without any form of financial compensation.
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