We have an organ donation crisis, so pay people to give

A commentary by John Harris, appearing in The Times, 31 January 2012

‘Typically, each day three people who are waiting for a donor organ die … each potential organ donor overlooked by the system represents a personal tragedy,’ The Times reported yesterday. The British response to what amounts to a pandemic of lives lost for want of donor organs is shamefully inadequate.

Given our failure to solve this problem, we must think much more radically. We know that live donations are much more successful than transplants from the dead, but how do we increase the supply of healthy adults willing to donate a kidney? The obvious solution is to give donors an incentive — we should pay them.

There is a lot of hypocrisy about the ethics of buying and selling organs. We all believe in altruism — but that is a luxury when relying on self-sacrifice costs lives. And what altruism usually means is that everyone is paid but the donor; the surgeons and medical team are paid for their work, and the recipient receives an important benefit in kind. Only the heroic donor is supposed to put up with the insult of no reward.

Here is how a strictly regulated and ethical market in live donor organs and tissue might work. It would be confined to the UK; only citizens resident here could sell into the system and only citizens would be eligible to receive organs. This would stop any exploitation of desperate people from poor countries. There would be only one purchaser, such as the NHS, that would buy all live donated organs and distribute them according to medical priority. Direct sales or purchases of organs would remain banned.

Those who sold a kidney, for example, would benefit in three ways. They would know that they saved a life or liberated someone from dialysis and the fear of death; they would benefit themselves and others by helping to remove, or substantially reduce, the risk of death from organ failure; and they would be rewarded financially.

Prices would have to be high enough to attract sellers into the market, but dialysis and other alternative care do not come cheap. There is no doubt that a price could be fixed that would save both lives and the NHS money.

Of course, by bringing cash into the equation, people might be doing something that they might not do if it weren’t for the money. But that is not coercion — and almost all of us who work for a living do that every day.

Giving up an organ is a big thing to do, but good people often wish to do big things for others. The choice must be free, but those who did choose to sell an organ would be doing something truly wonderful.

By, John Harris, Professor of Bioethics and Director of the Institute for Science, Ethics and Innovation at The University of Manchester

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One thought on “We have an organ donation crisis, so pay people to give

  1. This is a really interesting standpoint, but you must acknowledge the moral dilemma it would introduce in society. I’m not sure we could leave life in the hands of an economic supply and demand model, and in addition, what’s to say it wouldn’t evolve to a point where private exchanges would happen because the idea of selling organs has suddenly become more acceptable? In addition, there may be “donors” that are only in it for financial gain, and not fully aware of the consequences which may eventually affect their own health. Even among UK citizens there must be a poor, recently immigrated,non-English speaking minority that are unable to understand the full set of circumstances.

    I completely agree with your cause, but I don’t think it can ever be so black and white. In addition you will find that the majority of medical practitioners are very against the idea of financial gain for organ transplantation. (Source: http://www.calgaryherald.com/health/Cash+organs+could+boost+donation+rate+Calgary+study+suggests/7311262/story.html#ixzz28r2zTPgP ) I believe many more factors must be considered, and if this method were ever to become acceptable, a huge amount of guidelines would need to be put in place, not all foolproof or achievable.

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