Paying for Organs…A Modest
Luke Brewster, MD, PhD, MA
John J. Brems, MD, FACS
Transplantation is one of the great success stories of modern medicine
Emphasize high likelihood of benefit to recipient
Nonmaleficence to donors
Aggregate benefits and risks to the donor/recipient pair
Ethics Statement of the Vancouver Forum on the Live Lung, Liver,
Pancreas, and Intestine Donor. Transplantation, 2006;81:1386-7.
Transparent allocation and monitoring of organs to recipients
Historically “to pay for organs is against the principles of organ
transplantation”…and “…donors must not be viewed primarily as a
resource for transplants.”
Crippen JS. Treatment of Hepatocellular Carcinoma after Transplantation and
Human Rights. Hepatology, 2007;45:263-65.
American Society of Transplantation. Statement on Ethics. http://a-s-
A Kind of New Argument
The extraordinary has now become commonplace
Exacerbated the discrepancy between recipient
candidates and donor organs
Mandated Choice failed
Living donors are the most common donors
Simple solution has been proposed
Pay for donor organs
“For every complex problem there is a simple
solution. And it is always wrong.”
Mencken HL. Prejudices: second series. 1920 p. 158.
New York: Knopf
Chicago School of Economics
Unclear how the market would
impact organs as a commodity.
Will not meet demand and may
contribute to increasing the demand
by increased supply
Nonprofit status confines costs
Goodman C, et al. Transfusion,
Would require regulation which
throws instability into market forces
Can oversight substitute for
Repugnance to such an idea
Wisdom of Repugnance
Application of market economy to human
Sanal, A. “Robin Hood” of techno-Turkey or organ
trafficking in the state of ethical beings. Cult Med
Kevorkian J. Solve the Organ Shortage: let the
bidding begin! Am J Forensic Psychiatry,
“It is a concept that takes a while to sink
in. When you first hear about it, it doesn’t
sound right.” –Dr. Matas
Wall Street Journal, Nov. 13, 2007;A1.
Leon Kass. The Wisdom of Repugnance: why we
should ban the cloning of humans. New Repub
Keep the scars, lose the kidney,
spend the money
Goyal M, et al. Economic and health consequences of selling a kidney in India. JAMA,
Who will the donors be and who pays?
Need all donors be paid? Are they just “used cars”?
Rothman DJ. Ethical and social consequences of selling a kidney. JAMA 2002;288:1640-41.
Sells RA. The case again: buying organs and a futures market in transplants. Transplant Proc
“Autonomy doesn’t trump everything else….The upper class
preying on the lower class…. May work in an economic model, but
not in a justice model.”
Dr. Thistlethwaite, University of Chicago Magazine
Resources (organs) will move like wealth to the powerful
further stagnating vertical movement in society
Vulnerable are not covered medically in our society
Legal implications for all
Why don’t you take
the procurement fee Then I get the
and I’ll sue the institutions?
Protection of Living Donors
The complex interaction and analysis of data implicitly benefits
the recipient (risks/benefits)
75% want to donate, no matter costs
Will payment make complications more acceptable?
All organs are not equal, certain blood groups, ages, and types of
organs are more valuable
Kulkarni S, Cronin DC II. Ethical tensions in solid organ transplantation: the price of success. World J
Quality organs pushed out of the market because there is no good way
to establish that they really are worth more
Offshore donors and/or recipient
Futures market for donors and its conflict with autonomy
The Money Experiment
Pay more for certain types
Led people with higher risks to donate blood or blood
products for money
Richard M. Titmuss. The Gift Relationship: From
Human Blood to Social Policy. New York: Pantheon
Contamination of the blood bank pool
Transfus Sci, 1997;18:379-86.
The use of contaminated organs can cause great harm to
many people and is not easily defended
Where do we go from here?
Ethical application depends heavily on the success to the
recipient and safety to the donor over time.
Donors should be properly monitored postoperatively
with long term follow up.
Eliminate disincentives to organ donation
Lost income and direct costs
Canadian Medical Association Journal, 2006;174:797-8.
Regional organ exchanges?
When we work together we can achieve great things