Tax credits aren't enough to relieve burden of organ donation

Maryland House Speaker Michael Busch talks about his liver transplant and the blessing that his sister Laurie Bernhardt, sitting next to him, was able and willing to donate part of her liver to him. (Karl Merton Ferron, Baltimore Sun video)

When I was 4 years old, my grandfather was diagnosed with an aggressive form of hepatic cancer after contracting hepatitis C. He would have benefited from a partial liver transplant but was unable to find a donor match in time to save his life.

In 2017, Maryland House Speaker Michael E. Busch received a partial liver transplant from his sister in order to combat nonalcoholic steatohepatitis. After his recovery, Mr. Busch proposed a bill that grants up to a $7,500 state tax credit to living kidney, liver, intestine, pancreas, lung or bone marrow donors. The Maryland General Assembly unanimously passed the bill in March of this year, and it went into effect in July.


The new law attempts to address the dire shortage of transplantable organs in the United States. According to the U.S. Department of Health and Human Services, there are currently over 114,000 people waiting to receive an organ transplant. Moreover, while 95 percent of U.S. adults support organ donation in theory, only 54 percent are registered donors.

Senate gives final approval to bill sponsored by House Speaker Michael E. Busch extending a tax break to living transplant donors.

Similar laws have been enacted in at least 18 other states including Arkansas, Connecticut, Ohio, Pennsylvania and Virginia. However, such tax breaks are not enough to increase the organ transplant supply.


In the United States, organ donation is a wholly altruistic act. The National Organ Transplant Act (NOTA) outlaws the sale of organs to prevent the creation of an unregulated organ market and to protect economically challenged people from exploitation.

However, organ donation is not costless to the donor. While insurance covers evaluations to determine donor candidacy, the entire surgical procedure and post-operative care, recent studies have found that organ donors, on average, pay $5,000 out-of-pocket for all other expenses. Some pay as much as $20,000.

Maryland’s tax credit only provides partial reimbursement for “qualified expenses,” which include travel costs, lodging expenditures and lost wages. The prospect of a slightly lower tax bill thereby does little to incentivize people to donate and to reward donors for their altruism. This is supported by a 2012 study that reported no significant change in living organ donation rates in 15 states after tax credit policies were implemented.

NOTA should be overturned, as donors should be monetarily compensated to both encourage and reward donation.

Everyone — from the nephrologists, hepatologists and transplant surgeons to the insurers and the hospital at large — gets paid. The recipient acquires a functional organ and an improved quality of life. Organ donors deserve to receive some tangible reimbursement, or at the very least, should not suffer economically for their altruism, as this disincentivizes them from donating.

Donors take considerable risks when donating, and surgical complications may extend hospital stay. Moreover, while recipients tend to feel better almost immediately after a transplant, recovery for donors is comparatively prolonged. Donors are thus left to face costs from lost salaries and in the worst cases, the possibility of losing their jobs.

Incentivizing and rewarding donations will not commercialize the human body any more than it already has been commercialized. Current laws permit donors to buy and sell plasma, sperm and egg cells, and hair. The public accepts that individuals retain the right to use these body parts in accordance with their personal autonomy; this same rationale can be extended to include kidneys, livers and other organs.

A system that directly compensates living organ donors should nevertheless be strictly regulated. No one should view this change in legislation as purely a means to gain financial profit and proceed to donate every organ physically possible.

Under this new policy, potential donors should still undergo the same physical and psychological tests to determine candidacy. They should be fully educated about the risks of donation and their rights as donors to ensure transparency throughout the entire procedure. Furthermore, the United Network for Organ Sharing (UNOS) should still monitor the organ allocation process.

UNOS currently manages organ donation and transplantation using an automated transplant waiting list to match donors with recipients. UNOS is efficient and operates within standard medical criteria; moreover, it does not consider socioeconomic status when prioritizing recipients.

Altogether, this new system will operate under the same conditions as living donation does now, with the added reimbursement to incentivize and reward donors. Such a new policy will be best implemented in stages, one state at a time.

Maryland should consider setting this precedent so that one day, no little girl will watch her grandfather be denied a liver transplant and a second chance at life.


Julia Angkeow (j.angkeow@columbia.edu) is a registered organ donor in Maryland and a first-year student at Columbia University.

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