Would Allowing Donors to Sell Organs Ease Transplant Wait Lists?

Should would-be donors be allowed to sell their organs for money as a way to ease growing waiting lists for transplants?

Some experts think so, and the idea is causing some controversy as policy makers struggle to find ways to cut the number of Americans now dying on transplant waiting lists.

U.S.law forbids any money from changing hands in exchange for an organ donation. The law, on the books since 1984, was seen as an important protection against the development of a market in human body parts.

But since then, the waiting list for organs has grown by leaps and bounds. More than 92,000 Americans are currently awaiting a donated kidney, liver, pancreas, or other organ, while in 2005, just more than 30,000 organs were transplanted nationwide, according to the United Network for Organ Sharing.

The disparity has some experts calling for new -- and sometimes radical -- ways of encouraging organ donation beyond the traditional altruism that legally must motivate all donations now.

“The current system is failing to meet the human needs of Americans, and you can tell it’s failing to meet them because people are dying,” says Newt Gingrich, a former Republican Speaker of the House and possible 2008 presidential candidate.

A regulated market in organs “is at least worth exploring,” says Gingrich, who is now a senior fellow at the American Enterprise Institute in Washington.

New Approaches

Experts have called for experimentation with a series of different incentives. Offers to cover funeral expenses could be used to entice people to sign up to donate organs when they die. The government could offer a tax deduction or a credit for those willing to donate. Or, most controversial, those in need of organs could be allowed to offer cash to potential donors.

In a report on organ donation issued last month the Institute of Medicine came down against even experimenting with a regulated market in organs.

Organ donation and distribution is currently controlled by the United Network for Organ Sharing, which strongly opposes financial payments or any other material incentives.

Network Opposed

Francis Delmonico, MD, a transplant surgeon and the group’s president, tells WebMD that the group supports efforts to encourage altruistic donations and supports expanding medical criteria governing who is currently eligible to donate.

“But I’m not ready for the solution that is just going to dismantle all of that,” he says of calls for financial payments.

Supporters argue that the promise of money could motivate many people who otherwise wouldn’t consider donation to offer their organs. Critics warn that such a system would favor the wealthy, who can afford to pay for organs, while putting undue pressure to donate on poorer people.

The federal government is currently leading a large review of the organ donation system, an attempt to find new ways to spur donations from living and dead donors and their families.

But American Enterprise Institute scholar Sally Satel, MD, warns that the public is no longer responding to traditional appeals for altruistic donation. Satel says she wishes she could just “write a check and get my organ” before she received a transplanted kidney donated by a friend in 2004.

“Increasing the number of organ donors means rethinking our reliance on altruism,” she says.

By Todd Zwillich, reviewed by Louise Chang, MD

SOURCES: Newt Gingrich, senior fellow, American Enterprise Institute. United Network for Organ Sharing. Francis Delmonico, MD, president, UNOS. Organ Donation Opportunities for Action, Institute of Medicine, May 2, 2006. Sally Satel, MD, resident scholar, American Enterprise Institute.