Give an organ, get an organ

Stephen Giles proposes to bump up potential organ donors on the transplant list if they ever need organs

By Kimberly Roots

July 25, 2005

Should those with organ donor cards get organs first? (Illustration: Steve Lefkowitz)

Give and ye shall receive, possibly sooner than those who don;t offer to give at all.

If a Canadian social worker has his way, people who volunteer to be organ donors will receive priority if they are ever in need of an organ.

"People do not see the benefit for themselves in consenting to be a cadaveric donor," Stephen Giles wrote in the March 31 issue of the British Journal of Medical Ethics. "That is, they receive nothing, at least not enough, out of such an act."

Giles, who works with kidney disease patients at Toronto General Hospital, told Science & Theology News that his idea would shore up some of the inequities now associated with the transplant process.

"My idea is that altruism has failed, essentially, in this category," said Giles, who said he did not speak on behalf of the hospital. "The willingness to give, basically, is a self interest. People might be willing to pursue donation if they can clearly get something out of it."

Transplants come in two varieties: cadaveric, in which organs are harvested from someone recently deceased, and living, in which someone agrees to part with an organ he or she can live without. In Canada and the United States, patients needing transplants are placed on a national registry and must wait until a matching organ can be found.

Last year, the Canadian Institute for Health Information released a report showing that the number of cadaveric donors had remained virtually the same -- between 400 and 500 each year -- since 1994. The United States, in comparison, saw an increase of more than 2,000 cadaveric donors in that time span. At the end of 2004, the institute reported, 4,086 Canadians were on the waiting list for organs.

Some patients circumnavigate the waiting lists by having their family members and friends tested to see whether their organs may provide a match, and then arranging a private organ transfer.

In the United States and Canada, cadaveric donation is paid for by Medicare or private insurance. In Canada, those arranging for ograns from live donors must pay out of pocket for medical bills related to the procedure.

Giles said the system in Canada is unfair because patients who depend on public assistance programs for health care usually are unable to afford living donations, and there aren't enough cadaveric organs to go around. "It's not solving the problem," he said. "It's just kind of shifting the practice from one population to another. And basically that focus means that some of the most vulnerable people in society, which are the isolated and lower-income people, are at risk of not getting a living donation."

Giles said his proposal would increase the pool of potential cadaveric donors by relying on simple self-interest. But some critics say even selfishness won't be enough to make current nondonors register.

"I happen to think the people who resist doing this are not going to be moved by finding out that they're going to get a slight reward," said Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics. Those who choose not to sign up as donors do so for several reasons, including religious and aesthetic ones, he said. "You're not going to overcome that with a reward system. I don't even think you'd overcome that with money."

The idea of offering incentives isn't new. In 2002, the U.S. Organ Procurement and Transplantation Network and United Network for Organ Sharing joint board of directors agreed to support legislation to fund studies about rewards and incentives for donors.

"Given the growing organ shortage and the potential for incentives to help address it, we believe it is important to study their use now in a sensitive manner," Dr. Jeremiah Turcotte, OPTN/UNOS president, said in a statement released at the time.

Ideas for possible incentives include a medal of honor for donors and reimbursement for funeral expenses. Mark Fox, chair of the UNOS ethics committee, acknowledged that a rewards system makes some sense but said Giles' idea may not be practical.

"The people who are willing to make their organs available have already bought into the system," he said. "That ought to account for something when we have a limited resource and we have to make decisions. And yet, that's not the whole story."

The U.S. Department of Health and Human Services contracts UNOS to maintain a list of transplant centers and patients. The network assigns point values to various criteria that determine who will receive an up-for-grabs organ. These include blood type, immune status and length of time on the waiting list. Patients who have been living donors get four additional waiting-time points.

The previous-donor status is not an absolute guarantee a patient will receive an organ, Fox said.

"In the UNOS policy, it's people who have actually become donors and have put themselves at risk in doing so, rather than this conceptual thing -- "Yeah, I'm wiling to be a donor" -- getting them priority," Fox said.

Giles recently presented his ideas to the American National Kidney Foundation. He said he'd like to survey Canadians to find out if they would support a donation system like the one he has proposed.

"There's something about the sentiment that is right. It's something we want to encourage people to think about," Fox said.

Kimberly Roots is associate editor of Science & Theology News.

Copyright © 2005 Science & Technology News.

This article posted August 13, 2005.