Where "goodness of the heart" can't keep up with demand, is it time to start offering more tangible incentives for organ donation?


PROBLEM: Even in the face of a chronic shortage of kidneys, we tend to feel morally icky about people offering to donate their organs -- while still living but also after their deaths -- for any reasons other than altruism. That's not to mention, of course, the real possibility of exploitation among people who are in need of money as much as those they'd be donating to are in need of kidneys. But a stagnant donation rate led researchers at the University of Calgary to feel out the Canadian public's willingness to consider such a radical solution.

METHODOLOGY: An online survey was conducted of over 2,000 members of the Canadian public, along with 339 health professionals and 268 people who have or are affected by kidney disease. They were asked if they found varying amounts of financial incentives to be acceptable, and the general public was additionally asked how incentives might affect their willingness to donate.

RESULTS: Seventy percent of respondents were okay with financial incentives for kidney donations from deceased donors, and 40 percent also felt this way about living donors. However, only 14 percent of health professionals felt that paying living donors would be a good idea.

Proposed incentives that the respondents found most acceptable were a tax break, for living donors, or reimbursement of funeral expenses, for deceased donors. Few supported monetary payment to a deceased donor's estate.

The most commonly cited reason for being against any sort of payment for donors was that "a kidney should be donated from the goodness of one's heart." But in some cases, money appeared to be a much stronger incentive than altruism: more than half of those who said they wouldn't be a living donor to a relative were down with the idea once $10,000 were attached to the deal.

So far as a survey can indicate whether exploitation would become a factor were monetary incentives to be offered, people with lower incomes did not appear to be more likely to donate.  Still, 89 percent of the people who didn't want to register as donors didn't think that a monetary payment would not change their minds.

CONCLUSION: The overall consensus of those surveyed was that some degree of regulated financial incentives for living and deceased kidney donations might be acceptable to the public. The authors conclude that people might be more willing to be living donors if they could profit from it.

IMPLICATIONS: The survey doesn't tell us if implementing a financial incentive program would actually lead to more kidney donations, but it suggests that our enlightened neighbors to the north, at least, might not respond to the idea with complete moral outrage. This is good to know: before politicians can even propose such a controversial -- and currently illegal -- strategy, they're going to want to be sure people are generally on board.

Interestingly, people with kidney disease were less likely to support the idea of paying donors than the general public. It's worth considering that, like the health professionals, people who are more intimately familiar with the disease's realities might have thought through the potential consequences of the issue more thoroughly than people for whom it was merely an interesting hypothetical. 

Other studies conducted in the U.S. also suggest that Americans would be more likely to donate if they could expect a monetary reward. Which is no surprise, considering how we reacted to the Cash4Gold craze. All it would take for the idea to take hold here is coming up with a catchy name. I suggest "Kash4Kidneys", but "Dollarz For Donorz" is also on the table.

The full study, "Attitudes Toward Strategies to Increase Organ Donation: Views of the General Public and Health Professionals," is published in the Clinical Journal of the American Society of Nephrology.