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Being paid for organ donation...

Fossa9

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    I am not quite sure which board this topic should be in but I believe that med students would have the most relevant ethical ideas on the topic. Since this may be something that you will have to deal with in the very near future.

    As you all probably know it is being discussed by lawmakers and could be coming in the near future. I really can't decide if this is a good idea. Then again, I am very hesitant to say that this is a bad idea. Being a fully registered donor, -eyes, skin, bone etc.-I believe that organ donation is a wonderful gift that everyone should give.

    The reason for this is obvious though, to increase the availability of organs for patients in need. But, I believe that this could ultimately prevent underprivileged individuals from obtaining organs. (I.e. if you don't have the money to pay for an organ, would you then die unless a free one comes up?)

    So my question is this: That do you think about paying the family's of deceased individuals for their gift of an organ/organs?
     

    Kirk

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      If we have the ability to ?donate? our organs, doesn?t this imply that we own them? I think we should pay for people to donate their organs. This would obviously increase the amount of organs available, and help many families (in financial ways).

      There would have to be laws enacted to assure fairness, and amounts would need to be set for what each organ would be worth. I don?t think this would be overly difficult though.
       
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      Jamier2

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        Originally posted by Kirk:
        •If we have the ability to "donate" our organs, doesn't this imply that we own them? I think we should pay for people to donate their organs. This would obviously increase the amount of organs available, and help many families (in financial ways).•••

        I'd argue that the families don't own the organs, the donors do (or did). With exceptions of a kidney or maybe a liver lobe, most donations require that the original "owner" is finished using them. You can't exactly sell your heart, if you did, you wouldn't be able to spend the profits. :)

        Because the family doesn't own the organ, they shouldn't be compensated for them. As far as pre-agreements, this would be impractical because most organ donors are relatively young and relatively healthy, and usually not quite expecting to donate when they do.
         

        mcwmark

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          I'd argue that paying people for organs wouldn't be such a bad thing, albeit the payment isn't so large that there would be incentive to "sell" the organ. For example, offering a stipend for funeral expenses and such would benefit both parties, donor and recipient.

          The question arises with live organ donation, such as with kidneys, I'd guess you'd have to be more careful with payment. Of course, under-the-table financial arrangements are not uncommon for non-related kidney donors which allow both the donor to get "paid", and the recipient to bypass the entire waiting list. As it is now, so many organs go unharvested that could save the many lives of people that die each year while waiting...a small donation, to help increase the donor pool, wouldn't be such a bad idea.
           

          Bertelman

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            The general consensus of the organ donation community is that payment for organs is a bad idea.

            1) Paying the donor family for organ donation may encourage the historian to hide certain facts such as incarceration, sexual history, drug use, etc. that may rule out the ability to donate. If someone was waving $10k over your head, do you think you might "forget" about that hepatitis your aunt said she thought she used to have?

            2) As mentioned above, how does payment to the donor FAMILY help the donor?

            3) Seriously, isn't enough of our world powered by greed and monetary compensation? I can think of few things left that are done out of pure feelings than organ donation. These families make a sincere sacrifice to help others. Let's keep it that way.

            I know this is going to sound callous, but a significant number of organ transplants are performed for preventable indications. Renal failure from uncontrolled DM. Cirrhosis from EtOH. Let's concentrate on reducing the numbers that need transplantation. I'm all for a health care system that rewards for good behavior. Pay less insurance premiums for following a healthy diet and staying compliant with care regimens. Get more Medicare benefits. You get the idea. Let's punish the folks who cost us the millions in heathcare, and reward those making the right decisions. (and no, I still do not think monetary compensation should be a reward for organ donation).
             

            beetlerum

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              The general consensus of the organ donation community is that payment for organs is a bad idea.

              1) Paying the donor family for organ donation may encourage the historian to hide certain facts such as incarceration, sexual history, drug use, etc. that may rule out the ability to donate. If someone was waving $10k over your head, do you think you might "forget" about that hepatitis your aunt said she thought she used to have?

              2) As mentioned above, how does payment to the donor FAMILY help the donor?

              3) Seriously, isn't enough of our world powered by greed and monetary compensation? I can think of few things left that are done out of pure feelings than organ donation. These families make a sincere sacrifice to help others. Let's keep it that way.

              I know this is going to sound callous, but a significant number of organ transplants are performed for preventable indications. Renal failure from uncontrolled DM. Cirrhosis from EtOH. Let's concentrate on reducing the numbers that need transplantation. I'm all for a health care system that rewards for good behavior. Pay less insurance premiums for following a healthy diet and staying compliant with care regimens. Get more Medicare benefits. You get the idea. Let's punish the folks who cost us the millions in heathcare, and reward those making the right decisions. (and no, I still do not think monetary compensation should be a reward for organ donation).


              You don't think those arguments are outweighed by a possible increase in the supply? If you were about to die unless you got an organ, I doubt you would think preserving life was outweighed by some kind of idea of increasing the culture of greed.

              I don't think transplant needs reflect more preventable conditions than anything else in medicine, and it seems neither appropriate nor effective to try to send a message. I mean, we do offer people organs. You really think knowing they can't buy one, only get one from the list, is going to encourage people to have healthy diets? Encourage them when all other incentives, including the myriad health benefits, fail? That incentive is just too long-term, uncertain, and possibly not an incentive at all as they might get an organ.

              That said. it's not obvious that allowing payment will increase the supply. Oddly enough, allowing payment might decrease the supply of freely donated organs, offsetting the gain from people donating for profit.
               

              Bertelman

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                You don't think those arguments are outweighed by a possible increase in the supply? If you were about to die unless you got an organ, I doubt you would think preserving life was outweighed by some kind of idea of increasing the culture of greed.

                I don't think transplant needs reflect more preventable conditions than anything else in medicine, and it seems neither appropriate nor effective to try to send a message. I mean, we do offer people organs. You really think knowing they can't buy one, only get one from the list, is going to encourage people to have healthy diets? Encourage them when all other incentives, including the myriad health benefits, fail? That incentive is just too long-term, uncertain, and possibly not an incentive at all as they might get an organ.

                That said. it's not obvious that allowing payment will increase the supply. Oddly enough, allowing payment might decrease the supply of freely donated organs, offsetting the gain from people donating for profit.

                You're right, transplant indications are not out of line with other interventions in medicine. But the other interventions don't require the recovery of human organs from deceased parties. I also agree it is not appropriate to send a message- that your organs are worth a dollar amount. I don't think keeping this a donation will drive people to control their DM, etc. But I also don't think it is appropriate to change how we currently manage the system to allow more of these folks to receive transplants.

                I didn't mean to suggest that keeping the status quo will actually drive some folks to change their lifestyle. I meant to say that an overall effort should be presented to prevent these people from ever making it onto a transplant list. I think most folks either don't believe or don't buy into the myriad health benefits. As a country, we do a poor job of promoting the benefits. That's because our priorities are not in the right place. And I believe that offering money to your wife for your own organ donation fits into the same category- the wrong priority.

                I think a better, more equitable and sincere way to increase organ donation would be to create a nationwide registry of donors. Allow people to state, while alive, that they will donate their organs. I'm pretty sure that when polled, far larger numbers of people are willing to donate their organs than those that actually are donated when their families are presented the option. If I state that I will donate my organs, then my family's decisions are removed from the equation, and my organs will be donated. The primary reason living relatives are asked to decide the fate of the organs is because, as living human beings, they are still able to sue. The deceased cannot. Thus, the hospital and recovery team must defer to their wishes. I say we allow the individual to make the determination, make the family impotent and remove their ability to sue the hospital for the recovery.
                 
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                mdterps83

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                  This idea that somehow you can increase organ donation by methods such as a registry or making clear one's dying wishes is simply a hopeful fantasy.

                  Sure you might do it increase it marginally but the real reason people don't donate organs is because they don't get anything in return. The family's (donor's) situation is exactly the same whether they donate or not!You can see it as greedy or whatever sort of label you wish to place on it, but the fact is people don't do many things for free, let alone give away body parts. People respond to incentives. Of course, one must make sure that the donor's wishes are the ones respected and that the family isn't scheming in some inappropriate way.

                  I see it as almost a guarantee that organ supply will increase w/ donor payments. Yeah, maybe some organs will be seedy, but that becomes less of a problem with increased supply.

                  Besides, banning voluntary transactions between consenting adults is horribly draconian anyway.
                   

                  DropkickMurphy

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                    Does anyone make any money off of that blood

                    Yes, on the order of several hundred dollars according to one source I remember. The Red Cross allegedly destroyed a huge amoung of donated blood after 9/11 because they simply couldn't sell it fast enough (which is kind of counterintuitive given the fact that they are normally screaming that they need far, far more than they ever get). Rather than donating it to non-profit groups that might be able to put it to use, they destroyed it.
                     

                    DropkickMurphy

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                      This idea that somehow you can increase organ donation by methods such as a registry or making clear one's dying wishes is simply a hopeful fantasy.

                      Sure you might do it increase it marginally but the real reason people don't donate organs is because they don't get anything in return. The family's (donor's) situation is exactly the same whether they donate or not!You can see it as greedy or whatever sort of label you wish to place on it, but the fact is people don't do many things for free, let alone give away body parts. People respond to incentives. Of course, one must make sure that the donor's wishes are the ones respected and that the family isn't scheming in some inappropriate way.

                      I see it as almost a guarantee that organ supply will increase w/ donor payments. Yeah, maybe some organs will be seedy, but that becomes less of a problem with increased supply.

                      Besides, banning voluntary transactions between consenting adults is horribly draconian anyway.
                      I tend to agree....I think if I want to sell my kidney for $10K or something, I should have a right to do so.
                       

                      Bertelman

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                        This idea that somehow you can increase organ donation by methods such as a registry or making clear one's dying wishes is simply a hopeful fantasy.

                        I disagree. As I mentioned, public support for organ donation is much higher than the number of people whow, when presented with the option of donation, actually choose to do so. This has to do with a number of factors, not the least of which is the circumstances of the approach. Families are brought together, often within hours of learning their loved one has been pronounced brain dead. Oftentimes the family members present have not been in contact with the deceased or each other for some time. This emotionally charged venue isn't exactly the best opportunity to ask several family members if they would like to subject their now-deceased mother to the organ recovery process.

                        If I asked 10 medical students today if they would donate their organs, I would bet more than half would say yes. If I then approached their mother/father/brother/sister/spouse/stepmom (or all of the above) a few hours after learning they were in a fatal car accident, I would place a large wager that less than half would agree, within the necessary time frame. Combine this with the fact that, for most situations, all family members must agree. When was the last time all your family members agreed on a certain point?

                        And I certainly don't agree that people should be allowed to broker their own transactions. That would lead to price wars. Great. Then the poorer patients would be unable to get organs. And people in financial trouble would be able to sell a single kidney, then would become a further financial burden on the healthcare system because they would then develop complications.

                        "Some organs will be seedy." Ha. By seedy you mean infected HepB, HepC, HIV? That equals a quick death in a transplant patient. Several steps are in place to prevent the transplantation of such organs. Mney would quickly disintegrate that.
                         

                        Miami_med

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                          There is some price that will bring organ donation up to necessary levels. That number is probably much lower than the cost of a transplant. It really almost seems immoral not to let people pay for them. Even for the non-libertarian leaning ones among you, how can we really see any moral conflict when the person is already dead.
                           

                          beetlerum

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                            There is some price that will bring organ donation up to necessary levels. That number is probably much lower than the cost of a transplant. It really almost seems immoral not to let people pay for them. Even for the non-libertarian leaning ones among you, how can we really see any moral conflict when the person is already dead.

                            I generally agree. However, allowing payment may also act to decrease supply due to the crowding out of charitable donation. The result will be more organs for people who can pay a lot and possibly fewer organs for people who can't.
                             

                            dpmd

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                              What do people think about making it the default action to donate the organs of brain dead people? At the hospital where I trained we had a few brain dead people that we couldn't ID in time to try to get consent and their organs went to waste. I agree that the time a family finds out they have lost their loved one is not the best time to force them to make a decision about doing something additional to the body. If this was just the normal action it would remove the burden of this from families who would then be free to grieve. Those who are opposed to organ donation for whatever reason could specify so on their driver license or in an online registry (opposite of the donate life site). However, those who don't care one way or another (ie those who have not discussed this with family or specified their preference on their driver license) could now be donors without having to burden the family with another decision at such a difficult time.

                              As for payment, I think it would result in more sketchy organs, just like places that buy plasma end up with a lot of sketchy people (plus military folks, my buddies used to love going there then getting drunk afterward). However, sperm and eggs are allowed to be sold, so they have found a way to deal with the sketchiness (if that is even a word) issue. I guess my problem with payment for cadaver organs is that the person is dead, and I don't see why any particular person would be seen as owner of said dead person and therefore entitled to payment for use of parts of that dead person. And I wouldn't want to allow arrangements to be made in advance of death for fear of giving people a greater incentive to kill someone (well, I made this deal with joe snuffy that I can have his heart when he dies...aaaand I'm not doing so well, maybe I see if someone can help him have an "accident") or themselves (well I am broke and I want to help my family so I will get this millionaire to promise me a million bucks for my heart and then I will off myself).
                               

                              nocallaochicas

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                                For people interested, there is an article about paying living people for kidney donation in the most recent Economist. The "Leader" (Economist term for Op-ed) says we should offer money to people to donate kidneys like they do in Iran (currently illegal in the States). There is an article to accompany the Leader on page sixty with more info and less opinion.

                                See Nov 18 Economist.

                                Although the Economist articles are mostly discussing living kidney donations, they do mention something more germane to the discussion here: the system for cadaver donation in Spain. There, apparently, "citizens' consent to having their organs transplanted when they die" is presummed "unless they specify otherwise".

                                I will hold adding my opinons to all of these topics until later, but thought you all might find this stuff interesting.

                                yalla 22 - did you dust off this thread because you saw the recent Economist articles?

                                so happy to have functioning kidneys/not be on dialysis - I think I will go urinate in celebration! ncc
                                 

                                Miami_med

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                                  I generally agree. However, allowing payment may also act to decrease supply due to the crowding out of charitable donation. The result will be more organs for people who can pay a lot and possibly fewer organs for people who can't.

                                  Yes, except that charitable donation has left us with a woeful shortage. The transplant costs something around $250,000. Anyone who can come up with that is not going to not get a transplant because of an extra couple of thousand dollars. Plus, allowing organ donation to be a mechanism for a grieving family to pay for funeral and burial expenses will allow for there to be mutual benefit in the situation. That always produces better results than hoping for goodwill.
                                   
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