The transplant waiting list in the United States continues to grow longer over time, which has led to a debate on strategies to incentivize living donations. Transplant professionals are trying new methods to eliminate financial disincentives without crossing the line to paying for organs. Leaders of the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) discussed about the possible solutions to address the US transplant organ shortages at a recent workshop. The highlights of which is published in the American Journal of Transplantation.
Due to organ shortages, thousands of Americans are on transplant waiting lists for 5 or more years as their health deteriorates, and more than 1,000 of them die each year. The AST and ASTS leaders have conceived an "arc of change" that starts with immediate work to remove all financial disincentives to organ donation for both living and deceased donors. They also believe that solving the organ shortage will require more action than simply removing disincentives.
"As we follow the arc of change from removing disincentives like loss of wages and travel costs, we must move to considering incentives for donation like health insurance post-donation to ensure the long-term safety of donors," said lead author Daniel Salomon, MD, of The Scripps Research Institute, in La Jolla. "However, when speaking in terms of removing disincentives and considering incentives, there is little agreement on exactly where the line exists separating the two." Dr. Salomon, who helped organize the workshop with Alan Langnas, DO, of the University of Nebraska, noted that it is important to involve a wide range of stakeholders - including physicians and surgeons, government officials, patients and families, ethicists, and legal scholars—in discussions on how to define that line.
An accompanying viewpoint article provides an ethical justification for conducting a pilot study of a federally regulated approach to providing financial incentives to living kidney donors, with the goal of assessing donors' perceptions. A second accompanying viewpoint, however, states that if human organs become commodities they will most certainly be obtained from the most financially vulnerable in society. Therefore, instead of introducing payments or incentives, the authors believe that the number of organs available for transplantation should be increased only by removing all financial disincentives for organ donation.