Organ donors’ funeral costs should be paid, report says

BMJ 2011; 343 doi: (Published 11 October 2011) Cite this as: BMJ 2011;343:d6557
  1. Nigel Hawkes
  1. 1London

Organ donation rates might be boosted if donors’ funeral costs were to be paid by the NHS, the Nuffield Council on Bioethics suggests in a new report.

A payment would be triggered only if donors had signed the organ donor register and died in circumstances making their organs available for donation. The report draws a parallel with existing arrangements for people who donate their bodies to medicals schools, which then undertake to arrange their final disposal by cremation or burial.

The working party responsible for the suggestion said that it is a way of offering a financial inducement with little risk of turning organ donation into a financial transaction. The donor would not gain personally so would be unlikely to sign the organ donor register simply to get a free funeral, especially as only a tiny fraction of those who do sign the register are potential donors at their time of death. And even if potential donors had it in mind to spare their estate or next of kin the cost of a funeral, that judgment would involve altruistic as well as financial motives.

The working party, chaired by the Cambridge University anthropologist Marilyn Strathern, believes that altruistic motives trump financial ones. But unfortunately altruism is not producing enough organs for transplantation. Three people a day die while waiting for an organ, Dame Marilyn told a London press conference.

So the working party juggled with a range of possible financial motivators, trying to find one that did not overstep the mark but nevertheless had some prospect of increasing rates of donation. Offering a free funeral to relatives at the point of the donor’s death was rejected, because it would imply that the body was simply being used as a means for others’ ends. But if the offer had been set in train long before by the donor signing the register, that would render the transaction acceptable, they concluded.

Nobody knows, of course, whether it would actually increase donation rates. The report suggests that NHS Blood and Transplant should consider establishing a pilot scheme to test the public response. But even if that response were positive, it could be decades before names added to the register as a result actually resulted in more transplants being available.

“Paying for the funerals of organ donors would be ethically justified: no harm can come to the donor, and it would be a form of recognition from society,” said Dame Marilyn. The working party baulked at offering any inducement to living donors, however. At present they get reimbursement of their costs and a lapel pin. Paying more than this might undermine the motive of helping others in need, she said.

As to egg and sperm donations, the report distinguishes between those made for fertility procedures and those for research. At present there is a £250 (€290; $390) cap on the expenses payable for gametes given for fertility. This cap should be removed to ensure that donors are not left out of pocket. But for research the report sees no objection to offering actual payments, just as volunteers in “first in human” clinical trials are paid.

The working party doubts that changing the organ donation system from an opt-in scheme to an opt-out one would make a great difference to donation rates. Wales is planning such a system, and the report calls for it to be so designed that it can be the subject of robust research to determine its effects. The report is critical of the move to compel applicants for driving licences to indicate their wishes concerning organ donation, because the form that was introduced in August does not give them a chance to say no.

“We think it is very important for people’s wishes to be known in advance, but a compulsory choice system is only ethical if it includes an option to say, ‘No, I don’t want my organs to be donated,’” Dame Marilyn said.

Some experts were sceptical of the idea to reward donation by payment of funeral costs. Kevin Gunning, a consultant at Addenbrooke’s Hospital in Cambridge and a member of the Intensive Care Society, told the BBC: “It’s not going to change a great deal about the way people think about organ donation. I’m not sure that if I was signing up to the organ donor register as a 25 year old the fact that my funeral expenses were going to be paid would make a great deal of difference to whether I signed up or not.”

Tony Calland, chairman of the BMA’s medical ethics committee, said that it was an interesting idea. “While the association has generally opposed incentives for organ donation, we have not specifically considered the offer to pay for the funeral expenses for individuals who donate their organs.

“The BMA still believes that one of the best ways to increase organ donation is to move to an opt-out system with safeguards, and we will continue to lobby for this.”


Cite this as: BMJ 2011;343:d6557


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