Cold Cash for Warm Transplant Organs


It seems that at least one loopy idea shows up every year around this time. In 1991, it's a call to pay families for making the organs of their deceased loved ones available for transplant.

In last week's Journal of the American Medical Association, an article by a transplant surgeon called for cash rebates to families who are willing to donate the organs of their dead relatives. And some think-tank types inside the Washington Beltway, full of the sap of spring, are unleashing studies and op-ed pieces that sing the glories of garnering more organs if we allow the incentive of cold, hard cash. Even Louis Sullivan, the Secretary of Health and Human Services, has declared himself "intrigued" by proposals to pay for parts.

It's difficult to think of a more boneheaded idea in the history of health-care policy. Yes, I know there are not enough organs to transplant for all who now wait for a heart, liver or kidney. I know that thousands of Americans will die this year because of the shortage. Our decades-long reliance on altruism is not meeting the escalating demand for cadaver organs and tissues.

But is the solution to put price tags on the dead? "Sentimentalist," sneer the advocates of a free market in cadaver parts. If transplant surgeons, procurement specialists, hospitals, transplant coordinators and insurance companies can make a pretty good buck taking parts from the dead and putting them into the living, why should the dead and their loved ones be the only ones expected to participate for free? Besides, if some people want to make a few dollars by selling off their organs upon their demise, why stand in their way? The family makes some dough, more transplants are done, more lives are saved, and everybody is happy -- except maybe a couple of oversensitive ethicists who think money is somehow evil.

I do not think money is evil. But there are some things we ought not allow to be bought or sold -- and body parts are in that category.

Allowing commerce in cadaver organs and tissues is likely to do more harm than good. For example, consider this scenario: Imagine that your 10-year-old daughter has just died as a result of a swimming-pool accident. A few hours ago, she was healthy and vibrant. Now, she is brain-dead.

The doctor approaches. "I would like to discuss something with you," she says. "Your daughter is dead, but, if you allow it, she can still help someone else. We can use her organs to save the lives of other children her age. We can use her corneas to help others to see. If you will give your permission, we can use a small amount of her skin to keep a burn patient from dying."

You hesitate, shocked, wondering why you even have to listen to this question, wondering vaguely if your daughter has not suffered enough already.

The doctor sees your hesitation. "If you consent, I can offer you a cash reward of $2,000. Or, perhaps you would rather take a rebate of $5,000 on your next tax return? Or, maybe you would find reimbursement for funeral expenses more attractive?"

You threaten to slug her, and she leaves. Money and death do not mix.

Altruism may not be working as the basis of organ and tissue procurement. But unless the charms of spring have addled your brain, you can easily see that it's the only public-policy option we've got. Our only real choice is to make it work.

Arthur Caplan is director of the Center for Biomedical Ethics at the University of Minnesota. He is a columnist for the St. Paul Pioneer Press.

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