TOPIC GUIDE: Organ and Tissue Donation
"Financial incentives provide the best solution to the crisis of organ and tissue donation "
PUBLISHED: 31 Aug 2010
AUTHOR: Jennie Bristow
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In April 2010, the UK’s Nuffield Council on Bioethics launched a public consultation on Human bodies in medicine and research [Ref: Nuffield Council on Bioethics]. A key question addressed by the consultation is whether it is ethical to use financial incentives to increase donations of organs and tissue, which in most cases is currently illegal in the UK [Ref: Human Tissue Authority]. Other options explored in the consultation include priority for the donor if they require a transplant later in life, the payment of more generous expenses and the sending of certificates or ‘thank you’ letters to the donor or donor’s family [Ref: BBC News]. The Nuffield consultation takes place in the context of a worldwide discussion about the shortage of human tissues and organs, and the search for more effective ways of encouraging donation is taking place in countries across the globe, from the USA [Ref: Daily News], Canada [Ref: Global Edmonton] and New Zealand [Ref: stuff.co.nz] to Israel [Ref: BBC News], China [Ref: Xinhuanet] and Malaysia [Ref: BNET].
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Organ and Tissue Donation DEBATE IN CONTEXT
This section provides a summary of the key issues in the debate, set in the context of recent discussions and the competing positions that have been adopted.
The problem of donor shortages
In the UK, an estimated 1,000 people die per year while waiting for transplants: around 8,000 people are currently waiting for an organ, but there were only 3,500 transplant operations last year [Ref: BBC News]. The increase in fertility treatment means that there is demand for approximately 1,200 more egg donors and 500 more sperm donors. In response to this situation, the UK’s Human Fertility and Embryology Authority (HFEA) has recently announced a public consultation on whether to relax the cap on payments to egg and sperm donors[Ref: Daily Telegraph]. Scientists also need people to donate human tissue for research. It is estimated that of the 660,000 people in the world who require any form of transplant, 10% receive one each year: and of these, 10% receive their transplant through commercial ‘transplant tourism’ [Ref: National Center for Biotechnology Information]. The use of organs and tissue in the UK is regulated by the Human Tissues Act 2004 [Ref: Human Tissue Authority].
There are different aspects to this debate, depending on which organs and tissues are being talked about. For organs such as hearts and livers, the debate is focused on encouraging people to donate at the time of their death. The questions about kidneys and bone marrow involve ‘living donors’, who will undergo risky and painful procedures to donate. To what extent should people be encouraged to put themselves through such procedures for somebody else’s benefit (or encouraged to do so)? Egg donation is more invasive than sperm donation, but in both cases the issue is complicated by other regulations, for example the removal of donor anonymity in the UK [Ref: The Times]. However, all of these discussions share a common theme: should individuals donate their organs and tissue for altruistic reasons, or should they receive financial rewards for doing so?
Donating for the common good?
The current situation in the UK is one where individuals ‘opt in’ to the organ donor register if they wish to donate their organs after death. Payment or incentives for living donations of organs and tissue is prohibited. This is based upon the ideal that people should donate their organs and tissues for altruistic reasons [Ref: Human Tissue Authority]: a situation that prevents people from being pressurised, through financial or legal means, and which represents a broader public-spiritedness that would be irreparably damaged by the introduction of incentives [Ref: Daily Telegraph]. One possible alternative that has been discussed in the UK is moving towards a system of ‘presumed consent’, where people are assumed to agree to consent to their organs being donated after death, unless they actively ‘opt out’ during their lifetime or their families are strongly opposed [Ref: The Times]. This system is used in Spain [Ref: BBC News], which is known for its high donation rate, and many other European countries [Ref: BBC News]. A system of presumed consent has been strongly supported by medical organisations including the British Medical Association [Ref: Medical News Today] and the Royal College of Physicians [Ref: Daily Mail], and former prime minister Gordon Brown.
A review of presumed consent by a government-appointed taskforce rejected such a system in 2008, on the grounds that it would ‘undermine the concept of a donation being a gift’ [Ref: Guardian]. It has been argued that forcing people to donate their organs will be counter-productive and the goal would be better achieved through a dedicated campaign to persuade people of the morality of organ donation [Ref: spiked]: UK Transplant launched such a campaign in 2009 [Ref: UK Transplant]. However, presumed consent remains a popular idea in the UK and elsewhere, as a means to increasing donation rates without offering financial incentives [Ref: Daily News]. Another option is that introduced by Israel, where donor card carriers are given a legal right to priority treatment if they should require an organ transplant [Ref: BBC News].
Rewarding people for their sacrifice?
There are many forms of financial incentive up for discussion. One is a system similar to that used in Iran, where a compensated and regulated living-unrelated donor renal transplant program was adopted in 1988: eleven years later, Iran had eliminated its waiting lists for kidney transplants [Ref: Clinical Journal of the American Society of Nephrology]. Suggested alternatives to cash payments include incentives such as help with paying for funeral costs, a system of grants to reimburse living donors [Ref: Vancouver Sun], or tax credits [Ref: Science Daily]. Some have raised concerns that payment for organs and tissue will exploit the poor and vulnerable; however, some studies suggest that payments motivate people to donate kidneys across income groups [Ref: American Medical News], and that payments do not deter people from donating altruistically [Ref: Penn Medicine News]. It is argued that the ban on financial incentives in the developed world leads to ‘transplant tourism’, where individuals buy organs from desperate members of less wealthy societies: or even on the black market in countries like the USA [Ref: PR Newswire]. It is also argued that living donors face financial barriers to donating, and that incentives should be thought of as reimbursement [Ref: Canadian Medical Journal]. Some argue that offering financial incentives could encourage people to lie about their medical history, and put recipients at risk [Ref: Business Wire]; but others counter that these problems could be overcome with medical screening and regulation [Ref: FindLaw]. It is widely argued that altruism alone does not work, and nor is it straightforward, forcing the recipient of an organ to carry an emotional debt [Ref: American].
It is crucial for debaters to have read the articles in this section, which provide essential information and arguments for and against the debate motion. Students will be expected to have additional evidence and examples derived from independent research, but they can expect to be criticised if they lack a basic familiarity with the issues raised in the essential reading.
Nuffield Council on Bioethics 2010
BBC News 20 April 2010
Sun 17 March 2010
Mick Hume spiked 16 January 2010
Organ Donation Taskforce 17 November 2008
BBC News 17 November 2008
Medical News Today 15 January 2008
Sally Satel The Times 11 June 2010
Sherry F. Colb FindLaw.com 9 November 2009
Jeff Stier Guardian 24 July 2009
Charles A Erin and John Harris Journal of Medical Ethics 2003
Max Pemberton Daily Telegraph 26 April 2010
Joan Smith Belfast Telegraph 23 April 2010
Peter Ritter Time 19 August 2008
National Kidney Foundation 1 February 2003
Michael F. Cannon Cato@Liberty 23 June 2010
EUbusiness 20 May 2010
Kevin B. O'Reilly American Medical News 22 March 2010
PRNewswire 12 January 2010
Claire Ellicott and Fiona Macrae Daily Mail 28 July 2009
Sally Satel American 30 January 2009
BBC News 17 November 2008
Branwen Jeffreys BBC News 13 January 2008
Ahad J. Ghods and Shekoufeh Savaj Clinical Journal of the American Society of Nephrology 2006
Scott Klarenbach, Amit X. Garg and Sorina Vlaicu Canadian Medical Association Journal 14 March 2006
Linda C. Fentiman Issues in Science and Technology 1994
Rupert WL Major McGill Journal of Medicine
Definitions of key concepts that are crucial for understanding the topic. Students should be familiar with these terms and the different ways in which they are used and interpreted and should be prepared to explain their significance.
Useful websites and materials that provide a good starting point for research.
Shlomo Brody Jerusalem Post 5 July 2010
Andy Jones The Times 25 June 2010
Peter Stanford Daily Telegraph 30 May 2010
Independent 21 April 2010
Adam Brimelow BBC News 17 December 2009
BBC News 17 November 2008
Links to organisations, campaign groups and official bodies who are referenced within the Topic Guide or which will be of use in providing additional research information.
IN THE NEWS
Relevant recent news stories from a variety of sources, which ensure students have an up to date awareness of the state of the debate.
Daily Telegraph 22 August 2010
Edmonton Journal 7 July 2010
ScienceDaily 3 June 2010
New Straits Times 6 May 2010
Daily News Los Angeles 27 April 2010
Sunday Sun 25 April 2010
Xinhuanet 21 April 2010
Oxford Mail 20 April 2010
The Times 20 April 2010
Daily Mail 20 April 2010
Associated Press London 19 April 2010
Dominion Post 8 April 2010
Sudbury Star April 2010
Business Wire 22 March 2010
MSNBC 14 March 2010
Daily Telegraph 22 January 2010
Nephrology Times Volume 2, Issue 12 December 2009
Daily Mail 2 November 2009
Guardian 18 November 2008
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