Na An, MJLST Article Editor
In the United States, the number of patients on the waitlist for receiving organ donations is much greater than the limited number of supplies. One person is added to the list every 10 minutes, while only 3 in 1,000 people die in a way that allows for organ donation. As deceased individuals constitute about two thirds of organ donors, 22 patients die waiting for a transplant every day. The organ shortage also devastates the qualify of life for more than 100,000 people, and costs national economy tens of billions of dollars every year. It incentivizes international organized black markets and human trafficking. The organ shortage has multiple reasons, chief among which is people’s unwillingness to register as donors. Study has shown that 95% of U.S. adults support organ donation; yet, only 48% of them actually signed up as donors. Additionally, hospital procedures and customs often allow a family’s objection to undermine the wish of an intended donor.
Currently, the organ donation system is regulated by state law, federal law, government agencies, and hospital procedures. Each state maintains its own donor registry, mostly linked to the driver’s licensing process, and state laws vary in their donation education program. The National Organ Transplant Act (Act) instituted the Organ Procurement and Transplantation Network (OPTN) to match donated organs with recipients on the waitlist. The Act also prohibits the sale of organs. While the legislatures and courts remain silent, hospital procedures dictate. For example, hospitals will almost never retrieve organs without the family consent even when doing so would be against the wish of the deceased. Complicating the issue further is the inherent human rights of the donor, his/her family, and the recipient.
Confronting these issues, Stephanie Zwerner, in her article “A Small Price to Pay: Incentivizing Cadaveric Organ Donation with Posthumous Payments,” proposed a national donor registry and incentivization system. First, a national donor registry will replace state registries, and eliminate the interstate discrepancies and inefficiencies. The national registry can be consolidated with OPTN for effective administration. To improve the validity of donor intent documentation, the article proposed donor registration through health insurance application, registration to vote, or income tax reporting. Unlike “check-the-box” in driver licensing, everyone will be given a chance to fully consider their decisions. Families and hospitals would be more willing to respect the wishes of intended donors.
To further incentivize registration, the article proposed a single lump sum payment to the donor’s estate financed by the recipient’s health insurance provider upon the event of an executed cadaveric organ donation. Monetary compensation for organ donation has been a controversial topic. Not only it is illegal under federal statute, it has also been considered as the “commodification of human body parts” and an intrinsic evil. It decreases respect for life and human body, and can lead to exploitation of people in dire economic circumstances. Acknowledging these negative consequences, the author presented several benefits: increasing donations while decreasing familial objections, saving lives, relieving people on the waitlist for many years of suffering, reducing black markets and the economic burden on national economy. Considering that one donor could potential save eight lives, the article argues that the benefits outweigh the negative implications.