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Commentary

A Living Donor Let Me Live On
Sally Satel, MD, American Enterprise Institute, 10-25-06

Satel, the recipient of an organ donation, thinks that the time has come to establish pilot programs offering market incentives that may encourage more people to become organ donors. The current ban on compensation for organ donations, she explains, is not producing anywhere near enough organs for all of the people who need them.

Unfortunately, many of the more than 68,000 people waiting on the national list will not be as lucky as I was. According to the non–profit United Network for Organ Sharing (UNOS), which maintains the list under contract with the federal government, only 16,477 people received kidney transplants last year. This left tens of thousands to languish on dialysis. In big cities, where the ratio of available organs to needy patients is worst, the wait is up to eight years.

Public education about donation after death has gone only so far. In polls, 30%–40% of Americans say they have designated themselves as donors on their driver's licenses or on state–run donor registries. As for the remainder, the decision to donate will fall to their families, who are as likely as not to deny the hospital's request when they do not know their loved one's wishes. Most important, though, only a small number of the recently deceased—perhaps 13,000 a year—possess organs healthy enough for transplanting.

Without question, the chasm between the numbers of people needing a kidney and those willing and able to donate one will only worsen. This is largely due to a misplaced faith in the power of altruism. The current system expects people—living donors and the loved ones of the deceased—to give a body part and receive nothing in return. In fact, it is against the law to receive money or anything of value in exchange for an organ, a principle set down in 1984 by the National Organ Transplantation Act. It is time to change the law and permit imaginative pilot projects to increase the number of organs from donors—living and deceased. One of the most promising ideas focuses on the large potential pool of living donors. They could receive cash, tax breaks, guaranteed health insurance, college scholarships for their children, deposits in their retirement accounts, a contribution to their favorite charity and so on.



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