Organ Rifts

Nearly 25,000 Americans are on waiting lists for organ transplants. Each day, reports the National Kidney Foundation, five or six die. Though the foundation wants to increase the supply of organs, it can only use educational campaigns: Federal law prohibits the sale of human organs.

But the Kidney Foundation is exploring some controversial proposals to address the organ shortage. Earlier this year, it held four "town meetings" to discuss them. The most sensitive discussions involved financial incentives. India allows direct payment to living organ donors. (See "Spare Parts," Aug./Sept. 1990.) Pittsburgh attorney A. Bruce Bowden, the foundation's vice president, notes that not only are such practices illegal in most countries, most people consider it "anathema" even to talk about them.

But others suggest financially assisting organ donors or their survivors. Some propose letting recipient families pay a donor's funeral costs. Others imagine an optional survivor death benefit as a payroll deduction administered by Social Security. Financial consultants have contemplated a "futures" market for transplantable organs.

Financial incentives present a challenge: encouraging donors who might not otherwise come forward while sustaining the charitable impulses of people who donate voluntarily. Living donors and donor survivors often bristle at discussions of financial compensation. Bowden says any payment could lead to a backlash from altruistic donors.

The Kidney Foundation and the United Network for Organ Sharing plan to survey public attitudes toward incentives and other controversies surrounding organ donations. Widespread support for some form of compensation to donors could encourage congressional action to set up a few pilot programs. "We don't endorse any proposal," Bowden says. The foundation simply "is interested in locating a donor organ for everyone who needs one."