Families' self-interest and the cadaver's organs: what price consent?

Article Abstract:

A response is presented to an article by Thomas G. Peters in the March 13, 1991 issue of The Journal of the American Medical Association, in which it is proposed that a death benefit of $1,000 be given to families of potential organ donors who agree to the donation of needed organs. The current article states that this proposal is ''logically, ethically, and practically flawed''. Peters argues against altruism as the only motive for organ donation; however, altruism has not been correctly interpreted, according to the current author. This is a quality intrinsic to good societies and good persons, and physicians do not have the right to exclude it from patients' decision-making processes. It is feared that the freedom to make gifts to strangers will be eroded by creating a conflict between altruism and self-interest; such policies have had deleterious effects on blood donation. Moreover, families do not have absolute rights to make decisions about patients' bodies; rather, organ donation should only take place if it is in accordance with the wishes of the deceased. A death benefit implies that such rights belong to the family, and could even interfere with treatment, tempting physicians or family members to treat less aggressively. Donors could seek to receive the death benefit themselves, and what would prevent further commercialization of these scarce resources? It would be difficult to decide who the broker for such a program would be; all involved - doctor, hospital, organ transplant agency - could be suspected of having conflicts of interest. Since an experimental trial of such a program could not solve these complex ethical issues, there is no need for such a trial. While the severe lack of donated organs is a sign of the lack of altruism in society, eliminating altruism by offering death benefits is not the solution. Altruism remains the optimal motive for organ donation. Several other articles on organ transplantation appear in the same Journal issue. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Life or death: the issue of payment in cadaveric organ donation

Article Abstract:

The rate of organ donation remains low, in spite of public awareness and educational programs concerning the short supply of these organs. A proposal is made that a death benefit payment of $1,000 be offered to the families of potential organ donors. This would not affect existing laws that prohibit organ brokerage and that assure fair organ distribution, and could affect poorer people the most favorably. The historical background of organ donation is reviewed. Almost 6 percent of the 18,946 new patients in 1989 who waited for organ transplants died by early 1990, primarily as a result of the short supply of organs. The number of organ donors has held steady during the last three years. Altruism remains the main motive for organ donors, and many potential donor families turn away the procurement personnel who ask for donations. It is possible that a death benefit would increase the number of people who accept organ donation. Such a proposal deserves at least to be tested; if effective, a nationwide campaign could be mounted. The most important argument in favor of such an approach is the desperate need for organs. Altruism need not be the only reason families consent to the use of a dying patient's organs, and the medical profession should realize that people may be motivated by a variety of factors, including a desire for a tangible, monetary reward for their act. A relatively small death benefit ($1,000) would not be large enough to constitute coercion. Fears that such a policy would constitute organ brokerage, would be illegal, or could facilitate the donation of diseased organs are disputed. The social risk of a death-benefit program is slight, and the potential gains in terms of saved lives are great. Several other articles concerning organ transplantation appear in the March 13, 1991 issue of The Journal of the American Medical Association. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Factors affecting the waiting time of cadaveric kidney transplant candidates in the United States

Article Abstract:

A review of data from 1987 to 1990 on candidates for kidney transplantation kept by the United Network of Organ Sharing (UNOS) showed patients wait longer if they have antibodies to HLA antigens, have had a previous transplant, have type O or B blood, or have rare HLA antigens. Patients older than 15, those listed at only one transplant center, and blacks also waited longer. Since more whites donate organs than blacks, differences in HLA antigens between the races could be a factor. This could be solved by recruiting more blacks as donors. Being registered at more than one center may discriminate against economically disadvantaged groups. UNOS has formed a committee to study these findings.

Planning, Kidneys, Kidney transplantation, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation

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