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ASTS ethics committee endorses pilot program to test a financial incentive to increase organ donation.

The ever-increasing shortage of donor organs has finally convinced transplant professionals it is time to bite-the-bullet and explore offering Americans a financial incentive to donate.

More than 10 years after a year-long public attitude survey revealed that almost half of Americans support some kind of incentive for organ donation, the American Society of Transplant Surgeons' ethics committee has endorsed a pilot program to see if offering a small financial incentive to donor families in the form of a funeral benefit might increase their willingness to donate.

"The pilot program must offer a small incentive that is considered an expression of gratitude, not a bribe," Francis Delmonico, MD, chair of the ASTS ethics committee, told attendees at the American Transplant Congress in Washington, DC. "We must be careful to honor the deceased and not damage the dignity of the donor."

Delmonico stressed repeatedly that the incentive not be perceived as a "payment" but rather an expression of society's appreciation for the donor and donor families altruistic gift of donating an organ. Delmonico is director of the kidney transplant program at Massachusetts General Hospital and professor of surgery at Harvard Medical School in Boston.

The tentative step to support a pilot program acknowledges the glaring need for dramatic action as more than 79,000 Americans are now on the waiting list for organs and refusal rates to donate are continuing at between 40% and 60%, Delmonico told meeting participants.

The timidity shown by transplant professionals to even consider a pilot program of donor incentives in the past has been fueled by a US law that prohibits buying and selling organs and fear that offering incentives might actually reduce the number of donors.

According to one of the most comprehensive public attitude studies ever undertaken on organ donation, the public does not share the professionals' feelings on the issue.

The headline in the December 17, 1992 issue of Transplant News read: "Nearly half of Americans support some kind of incentive for donation." That finding and many more were contained in a national telephone survey of 1,200 Americans conducted jointly by the United Network for Organ Sharing (UNOS) and National Kidney Foundation.

Perhaps the most important finding revealed that in the 18- to 24-year-old age group, more than 65% supported some form of financial or non-financial incentives to increase the number of donors. Overall about 48% of respondents indicated they favor some kind of financial or non-financial incentives.

Addressing the ethical considerations of offering incentives, University of Minnesota bioethicist Jeff Kahn said the question revolves around what makes a gift. "We pay for blood, eggs and sperm," Kahn said, pointing out that the US system is inconsistent at best.

Women who donate their eggs in vitro for fertilization are paid as much as $75,000 in some areas of the country, Kahn noted. "That's what the world (of organ donation) would look like if we took the lid off restrictions on the market," he said.

Kahn said he supports a trial offering a funeral expense reimbursement providing the key participants include physician, patient advocates, the National Kidney Foundation and policymakers in Washington. "The trial must have adequate oversight and be implemented slowly to be sure the appropriate policy is developed," he added.

Delmonico cautioned that no study can proceed without congressional or federal approval.

The American Medical Association (AMA) narrowly defeated a similar recommendation to conduct a similar trial on financial incentives last December during its winter meetings. (Transplant News, December 15, 2002). However, buoyed by the slim margin of defeat, proponents plan to raise the issue again in a couple of weeks at the AMA's June 2002 meeting in Chicago.

Given the ASTS support, 2001 statistics released by the federal government in April showing living donors outnumbered cadaveric donors for the first time in recent memory, and the AMA's probable endorsement of a study, congress and/or the government may be asked for its approval before the year ends.
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Comment:ASTS ethics committee endorses pilot program to test a financial incentive to increase organ donation.
Author:Warren, Jim
Publication:Transplant News
Geographic Code:1USA
Date:May 28, 2002
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