Sunday, December 16, 2007

Rewarding the Kindness of Strangers (or Friends or Family Members)

While we wrote about Ashwyn last week and whether or not he was unduly influenced to give up a kidney, Sally Satel, a psychiatrist at Yale writes today in the NY Times magazine about desperately seeking a kidney and how her hopes for finding a donor were raised several times only to be dashed at the last moment because the donor changed his/her mind.

As a result of her experience, Sally is urging wherever she can — "in articles, in lectures, from assorted rooftops — that society has a moral imperative to expand the idea of 'the gift'" and to reward the kindness of donors.

She writes, "Altruism is a beautiful virtue, but it has fallen painfully short of its goal. We must be bold and experiment with offering prospective donors other incentives for giving, not necessarily payment but material reward of some kind — perhaps something as simple as offering donors lifelong Medicare coverage. Or maybe Congress should grant waivers so that states can implement their own creative ways of giving something to donors: tax credits, tuition vouchers or a contribution to a giver’s retirement account.

In short, we should reward individuals who relinquish an organ to save a life because doing so would encourage others to do the same. . . But unless we stop thinking of transplantable kidneys solely as gifts, we will never have enough of them."

Seems like a very sensible solution, and something we in the bioethics field having been talking about since the 80's -- but can we convince Congress to do something about it?


J.E. Cochran said...

As I previously wrote, the whole issue of providing donor incentives comes down to informed consent. Is it feasible to expect a person to give a truly "informed" consent if they are being unduly affected by the incentives being offered?

Cristy at Living Donor 101 said...

Unfortunately, prospective living donors aren't receiving Informed Consent under the current system. Two brothers, one donor and one recipient, are currently suing UPMC for lack of informed consent after a living liver donor transplant resulted in major complications for both.

Statistically speaking, 1-2 living donors die each year in the US within 90 days of the procedure, yet transplant centers tell prospective living donors: "We've never lost a donor". I'm sure the programs where LDs died never "lost" one either - until they did.