How Can We Get More Living Organ Donors?

Allowing people to sell organs is a fraught issue, but maybe they could be reimbursed for the costs of donation.

When it comes to organ donation, in some ways, society is a victim of its own success. The development of good immunosuppressant drugs has made organs less likely to be rejected, and “people who wouldn’t have been successes previously,” now are, said Amy Friedman, a transplant surgeon and chief medical officer of New York’s organ donor network, LiveOnNY, at Spotlight Health, a conference co-hosted by the Aspen Institute and The Atlantic. Very sick patients who might not have been put on the waiting list in the past, are now eligible for a transplant.

All this would be amazing—if there were enough organs to give these people. There aren’t. There are more than 120,000 people currently on the waiting list for an organ transplant, and from January to May of this year, only 6,357 donors, who added up to 13,550 transplants.

Deceased organ donors are not enough to close this gap—less than one percent of the deceased are medically eligible to be donors, and while 95 percent of Americans say they support organ donation, only 50 percent are registered to be donors. Increasing that second statistic is important, but “Unless we turn to living donation and figure this out, it’s not enough,” said Sander Florman, a transplant surgeon at the Mount Sinai Hospital.

This only applies to kidney, liver, and pancreas donations—for lungs and hearts, the donor pretty much always needs to be dead. (You can donate a lung lobe, but it won’t grow back.)

Living donation is obviously a huge sacrifice—even though you can live a healthy life with one kidney, it’s still a major surgery, with the attendant recovery time and financial burden. People are more likely to be motivated to donate when someone they love needs an organ (though they might not be a match), but how do you incentivize them to donate to help a stranger?

One idea: Pay them. Allowing people to buy and sell organs would make more available, and likely keep people from turning to the black market. But, “when you open up the market, the moral argument is impacted there,” said Monir Moniruzzaman, a medical anthropologist at Michigan State University. Fewer people might be motivated to donate out of the goodness of their hearts.

Buying and selling organs is a very fraught issue—perhaps a lower threshold solution would be to offset the costs of donating. Florman brought up the National Living Donor Assistance Center, which provides financial assistance for recipients of living donations whose income is 300 percent of the federal poverty level or lower.

“Let’s offer it to everybody,” Florman said. “Why don’t we pay for lost wages, or the time it takes to go to the appointments? We could incentivize [organ donation], or we could just remove disincentives.”