Should Canada pay organ donors?
According to the Canadian Institute for Health Information, in 2011, more than 4,500 Canadians waited for a life-saving organ donation, and nearly 250 died while waiting. Among industrialized nations, Canada's record for organ donors is strictly middle-of-the-pack. A survey published in late September explores the possibility of using financial incentives to boost organ donation. Too bad we already have evidence...
According to the Canadian Institute for Health Information, in 2011, more than 4,500 Canadians waited for a life-saving organ donation, and nearly 250 died while waiting. Among industrialized nations, Canada's record for organ donors is strictly middle-of-the-pack. A survey published in late September explores the possibility of using financial incentives to boost organ donation. Too bad we already have evidence the practice doesn't work.
Canada has a mediocre record of organ donation; not the worst, but certainly not as high as other countries. Right now, we depend on the altruism of Canadians to get them to step up as living donors and to sign organ donor cards without any expectation of a reward. The idea being floated in a survey by researchers at the University of Calgary is that authorities offer financial incentives to encourage organ donation. That means offering money to living donors willing to donate say a kidney, assuming of course they match to a potential transplant recipient. The proposal also calls for financial incentives that would be paid to survivors of deceased donors, who make up a large percentage of organ donors in Canada. You can read a good summary of the published survey here.
Financial incentives that have been proposed include offering living donors tax breaks - for instance a tax credit - or being able to claim Employment Insurance (EI) benefits while recovering from donor surgery. The Kidney Foundation of Canada supports the principle that live organ donors should not personally bear any costs associated with donation. For deceased donors, the incentive being talked about is to reimburse survivors for funeral expenses paid on behalf of the donor.
Researchers from the University of Calgary surveyed Canadians with and without kidney disease as well as health professionals. The results were published last month in the Clinical Journal of the American Society of Nephrology. Overall, 70 percent of those surveyed found financial incentives to be acceptable for deceased donors. But the approval rate drops to 40 percent when it comes to financial incentives for living donors. To me, that suggests that Canadians place extra emphasis on the potential risk of living donation since (by definition) the donor has to live with the consequences of his or her decision.
The next result is even more interesting. Forty-five percent of the Canadians support offering monetary payment as a financial incentive for living donors. However, the approval figure drops to just 27percent of those with or affected by kidney disease. In other words, the people most likely to gain from giving financial incentives to living organ donation are the least likely to want to see those incentives implemented. I suspect the reason is that organ recipients and their families do not want to bear the guilt of knowing that fellow Canadians may donate organs for the wrong reasons.
The kinds of financial incentives most acceptable to Canadians are reimbursement of funeral expenses for deceased donors and a tax break for living donors.
The authors of the survey are calling for research here on the impact of financial incentives on donor rates. But the record in the U.S. isn't all that promising, where since 2004, 16 states have offered tax breaks to living donors - for instance, allowing living donors to deduct up to $10,000 from their taxable income.
In submitting their survey, the authors could not have known that another paper was being submitted to the American Journal of Transplantation. That paper, which was published in August, found that states with tax breaks have an organ donation rate of 2.64 donors per hundred thousand population. States with no tax breaks have a donor rate just a hair less - 2.47 per hundred thousand - a statistically insignificant difference. Now, it could that the incentives offered were so stingy they didn't change anyone's mind. A doctor quoted in an article by Kevin O'Reilly in the American Medical News suggested that bigger tax breaks might have a bigger impact.
There are lots of other ways to boost organ donation. Canada could boost deceased organ donation dramatically by following the lead of countries in the European Union. They have led the way in switching from opting into organ donation (signing your donor card) to an 'opt out' system. In that kind of system, everyone is presumed to be donor unless they state explicitly that they don't want to.
According to a chart published earlier this year in The Economist, Spain is at the top of the list of deceased donors - at more than twice the deceased donor rate of Canada - and presumed donor consent is undoubtedly a big factor. Organ donation after cardiac death - which means waiting only for the heart to stop instead requiring a formal and more time-consuming declaration of brain death -- may be another way to increase donor rates. Canada is doing more organ transplants after cardiac death. One country - Israel - recently came up with new kind of incentive: signing your organ donor card means you move higher up the transplant waiting list if you ever need one. For that to work, you'd have to put safeguards in place to make certain someone didn't sign their organ donor card simply because they knew they needed one themselves.
I have a friend who donated a kidney to his brother. For him, it was never about the money but about helping a loved one. More power to him. That said, my friend was in and out of hospital in the months following his altruistic donation. It took a long time for him to get back to work. I see no reason why we can't give tax breaks and provide EI benefits to those who pay a huge price for giving the gift of life.
Canada has a mediocre record of organ donation; not the worst, but certainly not as high as other countries. Right now, we depend on the altruism of Canadians to get them to step up as living donors and to sign organ donor cards without any expectation of a reward. The idea being floated in a survey by researchers at the University of Calgary is that authorities offer financial incentives to encourage organ donation. That means offering money to living donors willing to donate say a kidney, assuming of course they match to a potential transplant recipient. The proposal also calls for financial incentives that would be paid to survivors of deceased donors, who make up a large percentage of organ donors in Canada. You can read a good summary of the published survey here.
Financial incentives that have been proposed include offering living donors tax breaks - for instance a tax credit - or being able to claim Employment Insurance (EI) benefits while recovering from donor surgery. The Kidney Foundation of Canada supports the principle that live organ donors should not personally bear any costs associated with donation. For deceased donors, the incentive being talked about is to reimburse survivors for funeral expenses paid on behalf of the donor.
Researchers from the University of Calgary surveyed Canadians with and without kidney disease as well as health professionals. The results were published last month in the Clinical Journal of the American Society of Nephrology. Overall, 70 percent of those surveyed found financial incentives to be acceptable for deceased donors. But the approval rate drops to 40 percent when it comes to financial incentives for living donors. To me, that suggests that Canadians place extra emphasis on the potential risk of living donation since (by definition) the donor has to live with the consequences of his or her decision.
The next result is even more interesting. Forty-five percent of the Canadians support offering monetary payment as a financial incentive for living donors. However, the approval figure drops to just 27percent of those with or affected by kidney disease. In other words, the people most likely to gain from giving financial incentives to living organ donation are the least likely to want to see those incentives implemented. I suspect the reason is that organ recipients and their families do not want to bear the guilt of knowing that fellow Canadians may donate organs for the wrong reasons.
The kinds of financial incentives most acceptable to Canadians are reimbursement of funeral expenses for deceased donors and a tax break for living donors.
The authors of the survey are calling for research here on the impact of financial incentives on donor rates. But the record in the U.S. isn't all that promising, where since 2004, 16 states have offered tax breaks to living donors - for instance, allowing living donors to deduct up to $10,000 from their taxable income.
In submitting their survey, the authors could not have known that another paper was being submitted to the American Journal of Transplantation. That paper, which was published in August, found that states with tax breaks have an organ donation rate of 2.64 donors per hundred thousand population. States with no tax breaks have a donor rate just a hair less - 2.47 per hundred thousand - a statistically insignificant difference. Now, it could that the incentives offered were so stingy they didn't change anyone's mind. A doctor quoted in an article by Kevin O'Reilly in the American Medical News suggested that bigger tax breaks might have a bigger impact.
There are lots of other ways to boost organ donation. Canada could boost deceased organ donation dramatically by following the lead of countries in the European Union. They have led the way in switching from opting into organ donation (signing your donor card) to an 'opt out' system. In that kind of system, everyone is presumed to be donor unless they state explicitly that they don't want to.
According to a chart published earlier this year in The Economist, Spain is at the top of the list of deceased donors - at more than twice the deceased donor rate of Canada - and presumed donor consent is undoubtedly a big factor. Organ donation after cardiac death - which means waiting only for the heart to stop instead requiring a formal and more time-consuming declaration of brain death -- may be another way to increase donor rates. Canada is doing more organ transplants after cardiac death. One country - Israel - recently came up with new kind of incentive: signing your organ donor card means you move higher up the transplant waiting list if you ever need one. For that to work, you'd have to put safeguards in place to make certain someone didn't sign their organ donor card simply because they knew they needed one themselves.
I have a friend who donated a kidney to his brother. For him, it was never about the money but about helping a loved one. More power to him. That said, my friend was in and out of hospital in the months following his altruistic donation. It took a long time for him to get back to work. I see no reason why we can't give tax breaks and provide EI benefits to those who pay a huge price for giving the gift of life.