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   Jeff Jacoby
Jeff Jacoby is a columnist for The Boston Globe.

Copyright Boston Globe

October 12, 2003

For a classic illustration of the Law of Unintended Consequences, consider the National Organ Transplant Act.

Passed by Congress in 1984, the statute makes it illegal to pay any compensation to organ donors or their families. The lawmakers' intentions were good: They feared the influence of money on what are often deeply emotional decisions about organ donation. They were loath to allow the spectacle of human organs being bought and sold like mere commodities. And they wanted to prevent any chance that the poor would be exploited to supply body parts for the rich.

Those things have indeed been prevented. But by making it a crime to offer donors any "valuable consideration" for organs, Congress achieved something else, too: the unnecessary deaths of tens of thousands of Americans -- men, women, and children who could have been saved if only the organs they needed had been available for transplantation.

The problem with the system Congress created is that it relies on altruism alone to stimulate organ donations. That isn't enough, as the rising death toll makes agonizingly clear. Some 80,000 people are waiting for an organ transplant right now; another 3,000 patients are added to the waiting list each month. But last year, only 24,900 organs were available for transplantation, and more than 6,500 patients died while awaiting an organ -- generally a kidney, liver, heart, or lung -- that never came.

The number of organs being supplied by living donors -- usually kidneys being given to a relative -- has been growing, from fewer than 2,000 in 1989 to nearly 6,000 now. But most vital organs are obtained from donors who have just died, and the number of these cadaveric donations, as they are called, has hardly budged in recent years. Between 15,000 and 20,000 decedents annually meet the physical criteria for cadaveric donation, but only about 35 percent of the time do their families give permission for organs to be removed.

Would more families be willing to give that permission -- and would more Americans sign up to be organ donors -- if they were offered a financial incentive to do so? Stands to reason. The best way to end almost any shortage is to boost supply by raising the price. Donor families are currently offered nothing to make a dead relative's organs available. It isn't surprising that so many say no. Make them a better offer, and more will say yes.

Some advocates have been making this argument for years, urging an amendment to the 1984 law that would permit the families of cadaveric donors to be compensated. As Carey Goldberg reported last week in The Boston Globe, Pennsylvania congressman James Greenwood has introduced a bill to do just that. The American Medical Association used to oppose financial incentives for organ donation; now it says the "time has come" to give them a serious test. Its call has been endorsed by two key institutional players, the American Society of Transplant Surgeons and the United Network for Organ Sharing.

So what would an organ-donor incentive look like? Proposals vary. Three years ago, Pennsylvania's legislature voted to pay $300 toward the funeral expenses of families that donated a deceased loved one's organs. It was never implemented because of the conflict with the 1984 federal law, but writing in Time magazine at the time, essayist (and M.D.) Charles Krauthammer pronounced the bill "too timid." Instead of giving the money to funeral homes, he asked, why not pay the families directly? "And why not $3,000 instead of $300? . . . after all, $3,000 is real money, even for bankers and lawyers."

Richard Devos, a co-founder of the Amway Corp. and the recipient of a transplanted heart, goes further. He recommends that insurance companies be allowed to pay a $10,000 benefit to the designated beneficiary of anyone who agrees to donate his organs, should he become brain-dead through accident or illness. And why would insurance companies want such a plan? Because it costs far less to transplant an organ than to provide indefinite treatment for a patient on the waiting list. For example, insurance companies save as much as $400,000 every time a donated kidney frees a patient from having to endure years of dialysis.

At the other end of the financial scale is a proposal by Donald Boudreaux and Adam Pritchard, adjunct scholars with the Mackinac Center in Michigan. Their idea is to offer a very small payment, no more than $25, to anyone who agrees to become an organ donor at death. That small incentive, they predict, would induce thousands of healthy people to sign donor registries. The fee would be paid by not by the government but by a nonprofit organization like the Red Cross. In exchange, whenever a hospital or insurer used a donated organ, it would make a much larger reimbursement to the nonprofit.

Anything that smacks of "commercializing" human organs is sure to provoke criticism, of course. And rightly so, perhaps, if the issue were how to boost organ donations from live donors. But the old taboo against paying for organs even from the dead cannot be allowed to stand. Not when 6,500 people a year are losing their lives because of it. Congress made a lethal mistake in 1984. The sooner it rectifies it, the sooner the dying will stop.

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