WANTED: ORGANS FROM
THE DEAD FOR THOSE
WHO ARE ALIVE. $300 REWARD.
Written by Evelyne Shuster
to The Philadelphia Inquirer,
January 3, 1999

Altruistic organ donation has failed to reduce the gap between demand and supply of transplantable organs. The State of Pennsylvania therefore proposes to offer a $300 reward towards funeral expense to those who “donate” the organs of newly dead family members for transplant. The hope is that this plan will redress the decades-long organ shortage. Can we blame Pennsylvanians for trying to use money to prevent useful organs from being buried along with the deceased?
Fifteen years ago, in 1984, Congress outlawed all sales of organs in the U.S. First, money undermines organ donation as a valued rewarding altruistic gift. Second, financial incentive could result in exploitation of the poor who would most likely “donate” their relatives’ organs in exchange for payment. Pennsylvania officials are now questioning these reasons.
Organ donation should, of course, be informed, understanding, and voluntary. If payment for donating organs were allowed, it would corrupt the decision to donate by making it less than voluntary, informed and understanding. Offering financial incentive for organs would transform the donation from a priceless gift to a business transaction of a commoditized product. It also suggests the idea that the poor deserve help from society only so long as they and their bodies benefit us. It is hypocritical for us to claim that the $300 offering is simply a way to say “thank you” by helping the disenfranchised pay for funeral costs. If we want to subsidize the funeral expenses of the poor we should simply do it with “no strings attached.”

Financial incentives are more likely to disgust potential organ donors than to gratify them. Thus, this plan could actually reduce the number of people willing to “donate” the organs of their deceased loved ones. But even if financial incentives succeed in increasing organ supply, this will not reduce the gap between supply and demand. This is because whenever we have increased organ supply in the past, the demand for organs also increased proportionally. The more organs we harvest, the great the demand will be as more and more people join the queue.

The Pennsylvania proposal is also in collision course with good public policy. This is because every potential organ donor must be a healthy, preferably young person who has met a premature, avoidable death, usually by gunshot, automobile or motorcycle accident. Preventing these deaths should be the real goal of public health, and is more in the public interest than promoting organ transplantation. Society as a whole would be better off if we apply public money to help reduce accidental deaths in the first place, through strict gun-control laws, safer neighborhoods, better and more comprehensive drinking and driving education than to try to increase salvageable organs from the prematurely dead. Overconcentration on organ transplantation and ways to increase the supply of organs thus distract us from take effective action to save lives.

— Evelyne Shuster, Ph. D.
—Director of Research and Medical Ethics —Program
—Veterans Affairs Medical Center

EDITOR'S NOTE:
Dr. Evelyne Shuster’s lettter was to in response to the Pennsylvania State representatives’ anticipated disclosure of their plan to offer $300 for burial expenses to those who are willing to donate the organs of their newly dead family members.