Bioethics in Practice: Ethical Considerations for Incentivizing Organ Donation in the US
Yeshiva University’s Medical Ethics Society is proud to present “Bioethics in Practice,” a regular column featuring moral, political and halakhic perspectives on contemporary medical ethics issues. We hope to inspire interesting and productive discussion around campus and invite the student body to join in on the dialogue.
In light of the wide disparity between the number of available organs and needful recipients, much debate has surrounded the issue of appropriate organ distribution within the U.S. The current organ allocation system in the U.S. has been developed by teams of doctors, ethicists and lawmakers. The United Network for Organ Sharing (UNOS) has created complex algorithms which use specific mathematical formulas that account for a variety of medical factors unique to each organ type, and differentiate between the needs of adults and children. This system is thought to be the most ethical option because it maintains a sense of objectivity by using a numerical scoring system, and seeks to ensure that the patient with the most urgent condition, coupled with the best odds for survival, receives priority for transplantation.
Yet, despite the widespread success of UNOS, an average of 20 people in America die each day while awaiting a lifesaving organ transplant. It is undeniable that America is facing an organ shortage, which has only been increasing. Therefore, in recent years, strong arguments have been made in favor of incentivizing organ donation in the U.S. to increase the national donor pool.
The most commonly advanced proposition in the realm of incentivizing organ donation is allowing the sale of organs. In 1984, Congress passed the National Organ Transplant Act, which prohibits the sale of organs, or the offering of any financial compensation for an organ. Iran, notably, has commercialized the organ market, and currently has no waitlist for kidney transplants — by far the most needed organ. Furthermore, critics of the American system point out that the only person who receives no benefit from transplantation is the donor. The doctors and nurses are paid for their skills, as are the people who clean up following the procedure. The recipient, of course, is “paid” with a new organ. It seems odd that the person offering the most important thing of all, his or her organ, is the only one left uncompensated.
Oppositionists to this new capitalist system would argue that it enables the wealthy elite to purchase “life,” while condemning everyone else. The current system gives all people a chance to receive an organ, irrespective of socioeconomic status. By opening the market to wealthy patients, the poor would be ousted from the organ trade. To prevent this issue, the U.S. would need to impose strict regulation and potentially incur much of the financial burden. Perhaps America should look to Iran as an example; Iran allows organ trade, but tightly regulates the market — both as a way to prevent exploitation of the poor, as well as to limit organ tourism. According to this system, the market is contained within the country; that is, foreigners are not allowed to buy the organs of Iranian citizens. Additionally, organs can only be transplanted between people of the same nationality — so, for example, an Iranian cannot purchase a kidney from a Syrian refugee.
Another such incentive would be to give priority status on the waitlist to those who are registered organ donors. In fact, America would not be the first country to consider such a system. In 2010, Israel implemented new legislation which guaranteed that between two patients in medically comparable conditions, priority status for transplantation would be given to the patient who is a registered donor or who has a family member who has donated in the past. This led to an increase in organ donor registration as well as familial consent for posthumous donation, resulting in increased organ transplantation since then, with a record-breaking high in 2017. Using Israel as a case study, it is almost certain that an analogous system in the U.S. would likewise increase organ donations and aid in procuring organs for many people who might otherwise die before transplantation could occur.
However, some have posited that this type of incentification almost certainly discriminates against those who would opt to not donate organs due to religious beliefs, and question the constitutionality of this policy. Yet, one could fairly argue that this law does not mandate organ donation and therefore does not require a person, by any means, to violate his or her religious beliefs. If the U.S. decided to implement new legislation, following Israel’s lead, it would have to address those concerns.
Ultimately, should the U.S. choose to update its policies to help facilitate an increase in national organ transplantation rates, it will have to seriously weigh the possible negative effects of any such policies against the benefit of countless lives saved. Needless to say, new legislation would demand intense government administrative involvement and funding.
As technology improves, with science getting progressively closer to producing synthetic organs — via stem cell generation and 3D printing — it is possible that in the foreseeable future, organ shortages will be a crisis of the past.
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